Poster presentations / International Journal of Gynecology & Obstetrics 119S3 (2012) S531–S867 S697 enucleation, complicated at laparoscopy. Adequate hemostasis included in this study. Data were collected retrospectively from the provide safety of forthcoming pregnancy and labor. admission charts. PTL was confirmed for every patient according This way allows us to perform a high-grade suture in the uterus in to ACOG criteria if the patient had 4 contractions in 20 minutes or patients who is planning to have future pregnancy with minimum 8 in 60 minutes plus progressive change in the cervix and cervical invasive technique. dilatation greater than 1 cm and cervical effacement of 80 percent or greater. The patients with documented PSUC without cervical M514 changes were considered to have threatened PTL. Gestational ages LOCAL CARBOXYTHERAPY: NEW TECHNOLOGY FOR less than 259 days the pregnancy was considered to be preterm. GYNECOLOGISTS AND OBSTETRICIANS TO ACCELERATE AND Methods: Simultaneous maternal risk factors such as; history IMPROVE THE CLOSURE OF DEHISCENT SURGICAL WOUNDS of previous PTB, abortion, infertility, infectious disease, uterine 1,2,4 1,2,4 3,2 4 J. Elias , A. Carbone , A. Gaspar , G. Blugerman , disease, endocrine or any organ system disease was evaluated. Data 4 2 2 1 1 D. Schavelzon , M. Pelosi II , M. Pelosi III , M. Galich . Sociedad about pregnancy complications such as; rupture of membranes de Obstetricia y Ginecologia de Buenos Aires (SOGIBA), Buenos Aires, (ROM), vaginal bleeding, poly or oligohydramnious, diabetes, 2 Argentina; Pelosi Medical Center, Bayonne-New Jersey, NJ, United hypertensive disorders were extracted from the hospital charts. The 3 4 States; Universidad de Mendoza, Mendoza, Argentina; Centros ByS, cases were followed up to delivery and the time interval between Ciudad de Buenos Aires, Argentina admission for PSUC and birth also their neonatal outcomes were Objectives: The problem originating in open surgical wounds in the evaluated. postoperative period is serious and not uncommon. Some forms of Results: There were 297 (90.82%) singleton, 27 (8.25%) twin and accelerating healing and the improvement of this process show a 3 (0.91%) triplet pregnancies. Only 12 women (3.6%) fulfilled the good resolution in terms of healing, but not in appearance. We ACOG criteria for PTL who delivered in a few hours and 315 cases present a methodology to achieve a faster resolution that is nearly (96.3%) were classified as threatened PTL and most of them were complete for aesthetics and function, with little or no formation of discharged undelivered from the hospital. 103 cases were missed scarring. and 224 mothers and their 247 neonates remained. 121 women Materials: CO2 was used in 10 patients with dehiscent wounds: from this cohort had preterm birth (PTB) and delivered before 6 abdominal surgeries, 2 vulvovaginal, 1 breast lumpectomy and 259 days (54%). We found that 121 women from this cohort finally 1 foot surgery wound. All involved Dermo Thera® equipment; had PTB before 259 days (54%). designed and intended for gynecologists, with hand pieces for the Pregnancy outcomes including; the time interval between vagina and/or cervix, neck treatments and cutaneous superficial admission for PSUC and delivery, the mean gestational ages at treatments. birth, birth weights, number and duration of NICU admissions were Sessions every 48 to 72 hours. We took a sample of the closed evaluated in each group. wound before its final apposition for an anatomical-pathological Conclusions: Regular uterine contractions even in the absence of study of the growth tissue, and compared it with samples of tissue cervical changes should be considered as a potent risk factor for PTB. corresponding to wounds not closed with CO2. The most frequently associated maternal risk factors were history Methods: Study prospective, observational and descriptive. of abortion, infertility and previous PTB, and the most frequently Results: We obtained a faster closure (according to the size of the associated complications were preterm ROM, vaginal bleeding and dehiscence) and aesthetically very acceptable in the ten patients febrile diseases. (100%), both factors were far superior to those achieved with the M516 current treatments. Histopathological studies clearly showed the PREVALENCE OF PREGNANCY GINGIVITIS AND ASSOCIATED best neo-vascularization, minimal or absent inflammatory infiltrate, RISK FACTORS AMONG LIBYAN WOMEN less significant fibrous reaction and an effective, ordered and faster F.A.A. Elrishi1, A.M. Elsalhi2. 1Obst. & Gynecology, Misurata Central collagenogenesis when comparing them to the standard/current Hospital, Misurata, Libya; 2Misurata Central Dental Clinic, Misurata, treatments. Libya Conclusions: Carboxytherapy has demonstrated the pathophys- iological effect for the success of this treatment compared to Objectives: to determine the prevalence of pregnancy gingivitis and treatment to the present. The Bohr effect caused by an increased the risk factors of the severity of the disease, also to highlight the pressure of the injected gas (CO2) causes rapid increase in magnitude the problem and increase attention about dental care arteriolar blood velocity, and the resulting higher flow rate causes during pregnancy in our locality. an immediate transfer of O2 at high pressure and immediate Materials: A cross sectional study was conducted among the all ’interstitial fluid cleaning’ of extracellular fluid by full reabsorption pregnant women attending Misurata central dental clinic at the of toxic free radicals and cellular debris. This phenomenon forms early morning, the sampling method was convenient sampling and the basis of the acceleration and improved circulation, improving a total of 122 subjects were examined. The subjects were assessed in skin healing and neovascularization, evidenced by more effective one single clinic visit by single examiner to ensure a standardization and sooner neocollagenogenesis and wound closure. In summary, of scoring. we believe this study demonstrates the enormous benefits of Methods: Patients were assessed in one single clinic visit. The Carboxytherapy for the quick physiological and aesthetic healing patient’s age was ranged between 17–46 years old. of surgical wounds. The data was documented in the questionnaire of the epidemiological examination according to WHO recommendation. M515 The partial recording system; where in six teeth were selected; MATERNAL RISK FACTORS AND NEONATAL OUTCOME OF THE were used in the clinical examination for assessment of (GI) and ADMITTED PATIENTS FOR PRETERM SPONTANEOUS UTERINE (PI). Stages of pregnancy, gingival index, plaque index, simplified CONTRACTIONS oral hygiene index, oral care, education level and obstetrical history 1 1 1 1 B. Namavar Jahromi , L. Salarian , Z. Shiravani . Shiraz University were recorded and analyzed by using SPSS 15.0 for windows. of Medical Sciences, Shiraz, Iran, Islamic Republic of Results: Of the 122 patients, 94 women (77%) had moderate to se- Objectives: To evaluate several maternal risk factors and outcome vere grade of gingival condition, 96 (78.6%) had moderate to heavy of pregnancies who were admitted for preterm spontaneous uterine grade of supragingival plaque and 93 (76.2%) had fair to poor grade contractions (PSUC). of oral hygiene scores. 100% these women showed signs of gingival Materials: All of the 327 pregnant women who were admitted for inflammation with a high mean gingival index (1.58±0.046) and PSUC in Hafez hospital from 23 Sep. 2007 to 28 Feb. 2009 were statistically significant increases as pregnancy advanced reported. Carboxytherapy new tool in cosmetic procedures box

CO2 rejuvenation provides advantages for addressing cellulite

Poster presentations M514 LOCAL CARBOXYTHERAPY: NEW TECHNOLOGY FOR GYNECOLOGISTS AND OBSTETRICIANS TO ACCELERATE AND IMPROVE THE CLOSURE OF DEHISCENT SURGICAL WOUNDS

J. Elias A. Carbone A. Gaspar G. Blugerman D. Schavelzon M. Pelosi II M. Pelosi III M. Galich First published: 22 October 2012 https://doi.org/10.1016/S0020-7292(12)61702-0

http://www.carboxytherapymiami.com/photogallery.html

FDA Approved https://www.youniquecosmeticsurgery.com/contents/non-surgical/skin-rejuvenation/carboxytherapy http://www.lindbergnutrition.com/ns/DisplayMonograph.asp?StoreID=1C7A08050B8F4419BFFBA945004C A5D1&DocID=bottomline-ungraded-carboxytherapy https://www.healthline.com/health/carboxytherapy#side-effects https://www.esiw.com/courses/kybella-training-fda-approved-treatment-of-the-double-chin/ https://www.self.com/story/people-are-injecting-carbon-dioxide-into-their-faces-to-fight-dark-undereye- circles Vaginal Rejuvenation through Carboxy therapy Page 1 of 1

Vaginal Rejuvenation through Carboxy therapy 69

By Dr Roome

What do I mean vaginal rejuvenation, how does it work and what can be expected. In my practice I started doing a protocol for vaginal rejuvenation about 6 months ago. It entails injections of Carbon Dioxide, at strategic points at a specific flow rate and volume.

Many of the patients had watched 90210 on TV and the surgical option of vaginal rejuvenation. It had appealed to them to make them feel more confident and regain some youth. The problem was that after the surgery, while the tissues were tighter, which was a better sensation for their partner, they felt that sex had become more painful, and that other facets like vaginal dryness, and poor libido or loss of sensation could not be treated surgically.

We now do treatments on about women daily, and the results have been reasonably consistent - improved sensation, much improved lubrication - to the point that even postmenopausal women do not need KY or other external lubricant, the most remarkable effect has been an improvement in libido in the women. This was an unexpected though very welcome side effect. Many of the women that have come in, even as young as early 30's have stated that after the birth of their babies, their libido or sexual drive just disappeared.

There are many factors that can cause this - the sleep deprivation and the production of a hormone called Prolactin affects sexual drive, but for many of these women their sex drive never recovered and they are left with guilt and embarrassment and eventually failed relationships with no real help available to remedy the problem. Testosterone supplements can help but have their own set of side effects which are unacceptable.

So when I speak of Vaginal Rejuvenation, I'm speaking of regaining function as well as a cosmetic improvement. Function includes intensity of sensation, lubrication, response and climax time, as well as improvement in libido.

How does it work : Carbon dioxide injection lowers the oxygen pressure in the tissues, this has to be enough though to reach a therapeutic effect. If sufficient amounts are infused, then a growth factor is released that causes new capillaries to grow into the area and be regenerated - around the nerves, improving sensation and response, around the glands improving lubrication, and in the muscle and soft tissues, improving tissue density and thickness.

What can I expect : The treatment entails the injection of carbon dioxide at specific points, it takes around 10 minutes to do. The tissues feel slightly tender or puffed out for at best 30 minutes or at worst a day, almost like period pains, but this is not severe, and thus far no clients have stopped treatment due to discomfort levels. The needle is really tiny and the procedure is very simple.

By the 4th treatment we usually ask for feedback - we usually do the first 4 on a trial basis, and then the client does maintenance treatments once a month. The feedback has included the following and more :

z improved sensation

z better orgasm and reached much faster

z improved bladder control

z cosmetic plumping of tissues

z improved sex drive and libido

z quicker bodily response when the partner initiates sexual contact

z much improved lubrication

z dyspareunia (painful intercourse) - pain on intercourse stopped by the fourth treatment

z better sense of well-being

z lifted mood and sense of confidence

z feeling like a woman again, and feeling desirable

Women on this trial initially have stated that this procedure has changed their lives. In many that have now been done, only 2 have said they don't know if it's helped them, which is a huge success rate thus far but I am still seeking more candidates - any woman at this stage over the age of 35. Email lieslroome@gmail for any further information.

http://hubpages.com/hub/Vaginal-Rejuvenation-through-carboxy-therapy 31/03/2010

PRELIMINARY STUDY OF THE EFFECT OF INJECTIONS OF MEDICAL CARBON DIOXIDE ON

FEMALE SEXUAL DYSFUNCTION DUE TO VAGINAL VASCULAR INSUFFICIENCY SYNDROME

By: Dr Liesl Roome – Clinic Reju – Umhlanga – South Africa Hendrik Bester – B-Med Clinic – Cape Town – South Africa AIM

The aim of the study was to investigate whether injections of medical carbon dioxide into various sites along the female external and internal genitalia would assist with pre-menopausal, menopausal and postmenopausal female sexual dysfunction as a result of vascular insufficiency syndrome. It is important to note that women can expect to live at least one third of their lives in the postmenopausal years.

ABSTRACT

Vasculogenic factors

The recently named clitoral and vaginal vascular insufficiency syndromes are directly related to diminished genital blood flow secondary to atherosclerosis of the iliohypogastric/pudendal arterial bed. Although other underlying conditions either psychological or physiological/organic may also manifest as decreased vaginal and clitoral engorgement, arterial insufficiency is one etiology that should be considered.

Diminished pelvic blood flow secondary to aortoiliac or atherosclerotic disease leads to vaginal wall and clitoral smooth muscle fibrosis. This can ultimately result in symptoms of vaginal dryness and dyspareunia.

Histomorphometric evaluation of clitoral erectile tissue from atherosclerotic animals demonstrates clitoral cavernosal artery wall thickening, loss of corporal smooth muscle and increase in collagen deposition. In human clitoral tissue, there is a similar loss of corporal smooth muscle with replacement by fibrous connective tissue in association with atherosclerosis of clitoral cavernosal arteries. While the precise mechanism is unknown, it is possible that the athersclerotic changes that occur in clitoral vascular and trabecular smooth muscle interfere with normal relaxation and dilation responses to sexual stimulation.

Aside from atherosclerotic disease, alterations in circulating estrogen levels associated with menopause contribute to the age- associated changes in clitoral and vaginal smooth muscle. In addition, any traumatic injury to the iliohypogastric/pudendal arterial bed from pelvic fractures, blunt trauma, surgical disruption, postnatal complications, diabetes or chronic perineal pressure from bicycle riding, for instance, can result in diminished vaginal and clitoral blood flow and complaints of sexual dysfunction.

Estrogen During the reproductive years, estrogen matures the vaginal tissue, making it thicker. During menopause and postmenopause, diminished estrogen results in thinning of the vaginal and vulvar tissue. The vulva and vagina become paler in colour, drier and more easily injured or irritated by sexual activity.

Approximately 30 percent of skin collagen is lost in the first five postmenopausal years. During the menopausal transition, estrogen levels gradually drop from 120 ng/L to about 18 ng/L. As a result of diminished estrogen, the vaginal canal shrinks in length and diameter and has fewer glycogen-rich vaginal cells to maintain moisture and suppleness.

The cells that line the vagina naturally shed and renew every three days. As such, over the counter vaginal creams are temporary and will maintain moisture for at the most three days. Vaginal pH

The base of the bladder also has estrogen sensitive tissue. Menopausal tissue changes in the bladder also result in thin, weakened bladder tissue. These vaginal and bladder changes are referred to as Uro-Genital Atrophy. Symptoms are usually mild during the menopause transition, and tend to become more progressive during the postmenopausal years.

Postmenopausal women have fewer glycogen-rich vaginal cells and therefore fewer lactobacilli present.

A healthy vaginal flora reduces the risk of urogenital infections. An important function of the vaginal and cervical epithelial cells is to regulate the pH of the lumen of the lower genital tract. During the pre-menopausal years vaginal luminal pH ranges between 4.5 and 6.0 with mild alkalinization to about 6.5 before ovulation.

Lack of estrogen, such as after menopause, is associated with alkalinization to about 6.5 - 7.0. Alkalinization above 6.5 is associated with increased risk of vaginal infections, whereas low (acidic) vaginal pH can inhibit the growth of serious pathogens. Alkalinization of the vaginal fluid can also cause dyspareunia.

The normal vagina of an adult woman is colonized by lactobacilli. These probiotic bacteria produce lactic acid, which maintains an acidic pH and hydrogen peroxide, which acts as an antiseptic agent. Lactobacilli protect the vagina from pathogenic infections and are considered important for vaginal health. Lactobacilli species help acidify vaginal luminal pH, which reduces the risk of urogenital infections.

The distance from the urethral opening to the vagina is reduced secondary to decreased collagen content and tissue atrophy. This, and changes in vaginal flora increase susceptibility to urinary tract infection.

Some results of above conditions

Symptoms of Atrophic Vaginitis can present as vaginal dryness, vulvovaginal pruritus, vaginal dyspareunia and postcoital spotting.

Symptoms of Atropic Urethritis and recurrent cystitis can present as dysuria, frequency and incontinence.

CONCLUSION

Vaginal engorgement and clitoral erection depend on increased blood inflow. It appears that with increased blood flow by means of the insufflations of carbon dioxide to the area, estrogen levels in the vaginal area are simulated. In this way many symptoms of vaginal vascular insufficiency syndrome are improved as is shown by the anecdotal results that follow below. References

Goldstein, I., Berman, J. “Vasculogenic female sexual dysfunction” Int J Impot Res 1998; 10:84.

Park K. et al. “Sildenafil inhibits phosphodiesterase type 5 in human clitoral corpus cavernosum smooth muscle” Biochem Biophys Res Commun 1998; 249: 612-617.

Gregor Reid: “Probotic agents to protect the urogenital tract against infection” American Journal of Clinical Nutrition, Vol. 73, No. 2, 437S-443s, February 2001

Gorodeski, G.I., Hopfer, U. “Estrogen acidifies vaginal pH by up- regulation of proton secretion via the apical membrane of vaginal- ectocervical epithelial cells” Endocrinology Vol, No. 2 816-824

Robinson, D., Cardozo, L. “The role of estrogens in female lower urinary tract dysfunction” Urology, 62 (4A Suppl.), 45-51 2003 EQUIPMENT USED: CDT Evolution by Carbossiterapia, Italy.

PROTOCOL: Flow rate: 50cc / min Program: 13 Volume per insertion: 40-50 cc Number of injections: 7 Description of insertions: · Two intra-dermal insertions, one on each side of the mons pubis · Two intra-dermal insertions (one on each side into the labia majora) between the vestibular bulb and the greater vestibular gland – do not insert the needle into the glands · Two insertions on either side of the lower vaginal opening 2cm below the insertion · One just above the clitoris (or inside the vagina at about 2 cm from the opening)

TREATMENT RESULTS

MEDICAL DOCTOR TESTIMONIAL

“I have now been doing this procedure for around 6 months with reasonably consistent results on which I would like to do an informal report. There are a number of categories in which there are results and I have divided them into:

Sexual Function Structural changes - patients feel that the tissues have 'plumped out' and that the vagina itself feels 'tighter' – this was re-iterated by a number of the male sexual partners - enhanced sexual sensation after 1st treatment and much improved by 4th treatment - appearance of labia improved - improved lubrication – between the 1st and 4th treatment at some point patients no longer need to use an external lubricant - less stimulation required to achieve climax - intensity of climax improved - visible changes in hair growth – where pubic hair was thinning or sparse, it starts to grow full again

Libido - a renewed interest in sexual activity after the 1st treatment, for some patients, this was quite intense - improved self esteem during sexual activity due to improved appearance of vaginal area

General Well-being - a number of the patients commented on feeling less 'moody' or agitated - an elevated sense of well-being

Bladder control - improved bladder function – better emptying of bladder and not requiring to urinate as frequently - Patients that had urgency when needing to empty the bladder can now complete what they were doing and then use the bathroom at home whereas prior to treatment, they used to have to interrupt their shopping to search for public facilities - Nocturia stopped in a number of the patients and they expressed gratitude for having uninterrupted sleep - 2 Patients commented that they can now jump on a trampoline without any leakage where this had not been the case since giving birth.

The changes have been surprising in some cases and for some life changing. I do believe this treatment has the potential to revolutionize women's health, as nothing on the market currently, offers these results, and without the risks associated with hormonal treatments or the famous 'vaginaplasty'. Neither of these current solutions really address lubrication issues fully or provide a comprehensive solution, not to mention the far reaching effects on psyche and relationships when it comes to libido restoration.”

Dr Liesl Roome Medical Director and Owner of Clinic Reju Umhlanga South Africa PATIENT TESTIMONIALS

“I am over the moon re the great results I have had from the carboxytherapy treatment and feel energized amongst other superb benefits.

I will list the immediate re-action and positive feel from the above: · The vaginal area looks very pleasant and attractive (over fifty and my vagina looks as good as a thirty year old) · Heightened sex drive – on average 3 times a week – compared to three times a month pre-carboxytherapy · Moist and sweet excretion – multiple orgasms · Bladder back to normal – compared to blocked lymphatic tissues · Regular bowel movements · Positive mood – no crazy, manic mood swings · No longer on HRT (hormone replacement therapy) · With G-spot injections, intenser orgasms

This is a relatively pain-free procedure that has changed my life.

Menopause - ????????

No such thing after carboxytherapy.”

HildaK (Patient of the B-Med Clinic) Age: 52 Cape Town South Africa (The above patient is healthy and post full hysterectomy) “I went for vaginal carboxytherapy to the clinic for six weekly treatments and experienced the following: · The labia majora became fuller and more prominent · Vaginal dryness diminished and I experienced more moisture in the area · My sex drive increased · I experienced more feeling during sexual intercourse · I normally experience hot flashes around 18h00, but since treatment, found that they subsided · My mood swings have improved – in the past, I have been prone to experience depression · I noticed different orgasms from clitoral stimulation to G-spot stimulation – those from the G-spot being much more intense post G-spot injection I will recommend this treatment to any woman struggling with menopausal symptoms.”

ZandraK (Patient of the B-Med Clinic) Age: 58 Cape Town South Africa (The above patient is healthy and postmenopausal)

“The treatment (vaginal carboxytherapy) was so effective, libido and moisture-wise, that it was embarrassing.”

AnnelieT (Patient of B-Med Clinic) Age: 41 Cape Town South Africa (The above patient is healthy and pre-menopausal) “After one carboxytherapy vaginal treatment, I was so sexually aroused and the vaginal area so moist, that it was almost too much to handle.”

DanielleV (Patient of the B-Med Clinic) Age: 39 Cape Town South Africa (The above patient is healthy and pre-menopausal)

“I noticed the following after three carboxytherapy vaginal rejuvs – · Vaginal area looks firmer and plumper · Sex partner commented on vaginal tightness and moistness · Less time to reach orgasm, even experienced multiple orgasms · Dramatic improvement in mood swings, less agitated · With G-spot carboxy insertion, orgasms were more intense and lasted longer.”

CindyW (Patient of B-Med Clinic) Age: 49 Cape Town South Africa (The patient is healthy and pre-menopausal)

“I think this is a fantastic treatment (vaginal carboxytherapy) and will not miss my bi-monthly treatments – ever! Vaginal area looks sexier Intenser orgasms, especially after G-spot injection Need to have intercourse every day Downside – am undergoing Brazilian bikini line laser hair removal and have noticed that the hair has started re-growing all over the vaginal area.”

JoanB (Patient of B-Med Clinic) Age: 54 Cape Town South Africa (The above patient is healthy, postmenopausal and has not undergone a hysterectomy)

“After having carboxytherapy to my vagina, I must tell you that I found no benefit.

I only had two treatments in that area – after the first, I experienced for about 5-6 days what felt like period pains. The second treatment involved a significantly reduced dosage when I experienced the same pain but less intense and for only 2 days.”

Marika V (Patient of the B-Med Clinic) Age: 62 Cape Town South Africa (The above patient is healthy, postmenopausal and has not undergone a hysterectomy) Ringiovanimento vaginale con Carbossiterapia.

Cosa si intende per ringiovanimento vaginale

Come funziona

Risultati

La chirurgia estetica genitale ed in particolare quella vaginale è utile in patologie o alterazioni estetiche o di recupero estetico ma non da’ risultati per quando riguarda la :

- Secchezza vaginale

- Riduzione libido

- Perdita della sensibilità vaginale

Questi fattori si possono modificare con il normale invecchiamento generale (diminuzione degli estrogeni) e locale ( Vasculopatie), ma in alcuni casi dopo interventi chirurgici dell’area pelvica o in alcuni casi dopo il parto spontaneo.

Fattori generali posso essere : Perdita di sonno, iperprolattinemia .

Molte donne che non hanno un recupero fisiologico del desiderio sessuale, vivono questo disturbo con il senso di colpa e/o imbarazzo che spesso porta alla fine del rapporto di coppia.

Quindi quando si parla di Ringiovanimento vaginale si parla sia della funzione che del recupero estetico.

La funzionalità comprende :

- Intensità della sensazione

- Lubrificazione

- Miglioramento della libido

- Risposta orgasmica al culmine

Meccanismo d’azione della terapia

Consiste in iniezioni di anidride carbonica in alcuni punti strategici dell’area genitale.

Ciò determina una riduzione della pressione parziale di ossigeno nei tessuti .

La somministrazione di adeguate quantità di CO2 determina il rilascio di fattori di crescita, con un aumento di nuovi capillari nelle zone interessate con un effetto rigenerativo sia attorno ai nervi, sia intorno alle ghiandole, che nei muscoli. Tutto ciò determina :

- Miglioramento della sensazione vaginale

- Risposta orgasmica

- Lubrificazione

La terapia dura circa 10 minuti

Nei tessuti si avverte un lieve bruciore e gonfiore che può durare da pochi minuti al massimo 1 giorno.

L’ago usato e piccolissimo e la procedura è molto semplice.

Dopo il quarto trattamento e il mantenimento di 1 seduta al mese i risultati sono:

- Miglioramento della sensazione

- Miglioramento dell’orgasmo e della capacità nel raggiungerlo

- Miglioramento del controllo vescicale

- Turgore – Idratazione – Volumizzazione con miglioramento dell’elasticità dei tessuti.

- Miglioramento della libido e del desiderio sessuale

- Reazione corporea più rapida quando il partner inizia il contatto sessuale

- Miglioramento della lubrificazione vaginale

- Miglioramento della dispareunia durante il rapporto a partire dalla 4° seduta

- Miglioramento del senso di benessere

- Aumento del tono dell’umore e senso di fiducia

- Sentirsi come una donna nuova e desiderabile .

Le donne che si sono sottoposte a questi trattamenti hanno dichiarato che questa terapia ha cambiato loro la vita sessuale in senso positivo; migliorando il rapporto con il partner o di coppia

LA CARBOSSITERAPIA NEL TRATTAMENTO DELLL’INVECCCHIAMENTO VULVO VAGINALE

Dott.ssa Alessandra Scilletta, Chirurgo Plastico La Dott.ssa Scilletta Alessandra ha conseguito la Laurea in Medicina e Chirurgia presso l’Università di Catania e un Diploma post-laurea in Chirurgia Plastica e Ricostruttiva presso l’Università di Catania. La Dott.ssa Scilletta è autrice di varie pubblicazioni scientifiche e ha tenuto vari corsi formativi sulla carbossiterapia all’estero . Ha inoltre lavorato in Spagna per 13 mesi presso il reparto di Chirurgia Plastica dell’Ospedale Reina Sofia a Cordoba . PREMESSA. Sebbene tutti i tessuti epiteliali siano sensibili alle modificazioni delle concentrazioni ormonali , nessuno possiede la sensibilità dell’epitelio vaginale, sia dal punto di vista della rapidità della risposta allo stimolo ormonale che alla quantità e qualità della risposta stessa. La menopausa spesso porta con sé atrofia o degradazione dei tessuti circostanti il perineo, una ridotta risposta agli stimoli , oltre ad una perdita di funzionalità e di turgore dei tessuti ed una ridotta sensibilità della zona. In tutti questi casi è possibile utilizzare i protocolli innovativi per migliorare la funzionalità dell’area genitale. Il trattamento viene utilizzato in sinergia con le terapie classiche (terapie ormonali, tecniche di bioristrutturazione, prp, etc) con l’obiettivo di rendere l’area più turgida ed idratata. Il ruolo di questa terapia è quello di ossigenare e riattivare i processi metabolici e di drenaggio che contribuiscono all’invecchiamento fisiologico, con le ben note conseguenze funzionali.

Il Percorso terapeutico

Il trattamento di carbossiterapia effettuato con CDT è una procedura rapida che permette al paziente di tornare alle proprie attività subito dopo il trattamento. Durante la fase iniettiva la paziente potrebbe avverte un leggero fastidio, la maggior parte delle pazienti descrive questa sensazione come un leggero calore e pizzicore nella zona trattata. Per effetto della CO2, subito dopo il trattamento la zona apparirà leggermente gonfia ma tornerà normale nel giro di una trentina di minuti. Nella mia esperienza clinica, occupandomi di carbossiterapia dal 2007, e avendo trattato nell’ultimo anno e mezzo più di 80 donne dai 37 ai 73 anni con applicazioni di Carbossiterapia per utilizzo vulvovaginale, ho sempre riscontrato un miglioramento della sintomatologia di volta in volta lamentata dalle pazienti. Non si sono registrati effetti collaterali. Sono escluse dal trattamento pazienti affette da enfisema , BPCO, insufficienza renale o in stato di gravidanza. Le pazienti oncologiche, vengono sottoposte a trattamento, solo in presenza di remissione completa di malattia e dopo lo starbene del collega oncologo. Nelle pazienti più sensibili è stata applicata una crema anestetica 30 minuti prima del trattamento

. Prima Dopo

Prima Dopo

Courtesy of MD Alessandra Scilletta – Catania (Italia)Ottobre 2012

CONCLUSIONI

Grazie all’utilizzo del gas è possibile migliorare i seguenti aspetti: - aspetto estetico della zona trattata, poiché i tessuti riacquistano turgore; - tono e funzionalità della vagina: il miglioramento della microcircolazione nella zona trattata determina una migliore lubrificazione; - sensibilità della zona, con possibile miglioramento della qualità dell’orgasmo. - nel periodo post-partum, la carbossiterapia è indicata per il trattamento della cicatrice dell’episiotomia, per migliorarne sia la qualità in termini di durezza nonché la sintomatologia algica. - Trattando la zona del perineo, si migliora la circolazione ed il quantitativo di Ossigeno, apportato ai muscoli, danneggiati dall’incisione chirurgica. - Incremento della sensibilità, dovuto ad una migliorata circolazione a livello clitorideo - Crescita di epitelio mucosale dopo 8 sedute, come dimostrato nell’articolo: Elias j., Carbone A., Gaspar A.,”Carboxytherapy local treatment of vaginal mucosa atrophy or hipotrophy of vaginal mucosa at menopause and postpartum.”. - International Journal of Ginecology & Obstetric 119(2012):S563- S564.

La carbossiterapia un promettente approcio non chirurgico al ringiovanimento Vulvo Vaginale

AMAC 2014 - 1° Congresso Asiatico Medicina Anti-Aging - Singapore Settembre 2014

Drssa Alessandra Scilletta

PREMESSA. La menopausa spesso porta con sé atrofia o degradazione dei tessuti attorno al perineo, una ridotta risposta agli stimoli, oltre a una perdita di funzionalità e di turgore dei tessuti, e una ridotta sensibilità della zona. In tutti questi casi è possibile utilizzare la carbossiterapia per un ringiovanimento non chirurgico della vagina. Il trattamento di carbossiterapia consiste in 5 o 6 microiniezioni di anidride carbonica da effettuarsi nell’area per stimolare la crescita di nuovi capillari nei tessuti Osservazioni cliniche Il trattamento è normalmente ben tollerato e dura 5-10 minuti. Durante la fase iniettiva la paziente potrebbe avvertire un leggero fastidio, la maggior parte delle pazienti descrive questa sensazione come un leggero calore e pizzicore nella zona trattata. Per effetto della CO2, subito dopo il trattamento la zona apparirà leggermente gonfia ma tornerà normale nel giro di una trentina di minuti. Grazie ai trattamenti di carbossiterapia è possibile migliorare le seguenti condizioni: - Aspetto estetico della zona trattata, poiché i tessuti riacquistano vigore - Tono e funzionalità della vagina: il miglioramento della microcircolazione nella zona trattata determina una migliore lubrificazione - Secchezza e irritazione quotidiane: questi sintomi possono essere ridotti grazie alla migliorata microcircolazione. - Sensibilità della zona, con possibile incremento dell’attività orgasmica. Si tratta di una procedura rapida ed il paziente può tornare alle proprie attività subito dopo il trattamento. Gli effetti dei trattamenti sono cumulativi. A seconda della gravità del problema possono essere necessari da 6 a 10 trattamenti settimanali e un trattamento al mese per il mantenimento.

Prima Dopo Prima Dopo Talk on V – Reju Liesl ROOME, M.D., Durban, South Africa Hendrix Bester Bmed Clinic Cape Town South Africa University of Cape Town Medical School

The purpose of this multi center investigation is to summarize the feedback from 72 women who underwent the V-Reju treatment. And the question I would like to leave with you is... Are we sitting on the next VIAGRA, but for women? And I would be so brave to say that from what I've seen in this group of women that this treatment could revolutionize women's quality of life as far as bladder control and function, as well as women's sexual health as we know it.

The women were aged between 34 and 68, with 2 in their 30's, 21 in their 40's, 36 in their 50's and 13 in their 60's.

I am going to discuss the three categories of feedback and with that, the possible scientific reason for the result, though some results will need much further study.

In the questionnaire given to these women there were direct questions about sensation, lubrication and cosmetic changes, and then there was space for the client to provide additional information.

• Cosmetic change : 36 of 30 said yes • Sensation improvement : 47 of 30 said yes • Lubrication improvement : 58 of 30 said yes.

The following information was volunteered – and please bare in mind: most South African women find it a taboo to discuss their sexuality and bladder function for that matter. In another culture there may be much more volunteered information. I have also adapted the questionnaire to include more specific sexual questions for the next group and I am also now making use of the King’s Quality of Life Questionnaire for urinary incontinence to take the study further.

The first section I would like to put a special emphasis on, as it profoundly changes women's quality of life, which is the effect of treatment on incontinence and bladder function. I will also include references to past studies that may explain why we see this effect:

10 women stated voluntarily that bladder function had improved and I would like to elaborate as this particular facet had a life changing impact on these women: − The bladder emptied properly and fully at voiding − Urgency improved (they could finish their shopping) − Decreased nocturia – to the point where the 68 year old now sleeps through the night again for the first time in decades − Stress incontinence decreased – they could run and jump, sneeze and cough without leakage and one stopped needing daily sanitary towels.

On the sexual function side the following information was volunteered:

21 enjoyed sex more and mentioned becoming multi-orgasmic for the first time

6 felt that it took less stimulation to get aroused or reach orgasm

11 reported improved vaginal tone

12 commented on improved libido

8 felt general wellbeing, less moody and irritable, calmer

7 said their partners commented on vaginal tightness and 'plumping of internal tissues, cosmetic improvement and lubrication.’ Some of these 7 women had not told their partners they were participating in this study.

Possible scientific explanations for the results achieved:

Physiological explanations for some of these effects are simple, and for others further investigation is needed. An article on Ovarian hormones and vaginal blood flow by Sarrel states that : "A decline in serum estrogen levels results in thinning of vaginal mucosal epithelium and atrophy of vaginal wall smooth muscle. Decreased estrogen levels also result in a less acidic environment in the vaginal canal. This can ultimately lead to vaginal infections, urinary tract infections, and incontinence as well as complaints of sexual dysfunction.(1)

In a paper by Dr Berman (2) on the Physiology of female sexual function and dysfunction he notes the severity of the problem in that 30-50% of women suffer from it. And he quotes another study saying "Recent studies evaluating the impact of age and estrogen status on the female sexual response demonstrated that older women and menopausal women not receiving hormone replacement therapy had decreased genital blood flow compared to controls.”(1)

It is also necessary to look at the connection between estrogen and blood flow and the tissue atrophy associated with estrogen's decline, and one of the connections has to do with Vascular Endothelial Growth Factor. (3)

In an abstract by Goldstein (4), he states that the "Specific physiologic impairments of vasculogenic female sexual dysfunction include vaginal engorgement and clitoral erectile insufficiency syndromes. These syndromes exist when during sexual stimulation abnormal arterial circulation into the vagina or clitoris, usually from atherosclerotic vascular disease, interferes with normal vascular physiologic processes. Clinical symptoms may include delayed vaginal engorgement, diminished vaginal lubrication, pain or discomfort with intercourse, diminished vaginal sensation, diminished vaginal orgasm, diminished clitoral sensation or diminished clitoral orgasm.”

Estrogen is proven to have an effect on genital bloodflow, and one of the modulators of this effect is VEGF. The other stimulant for VEGF is hypoxia, which is what we are inducing with Carboxy therapy. This is supported in a paper titled : 'Regulation of vascular endothelial growth factor (VEGF) gene transcription by estrogen receptors α and β by Dr Michael Mueller and others from the Center of Reproductive Sciences at the University of California's Obstetrics and Gynaecology Department, wherein he states that: 'Previous studies indicate that oxygen tension is a key regulator of VEGF gene expression, both in vitro and in vivo (5, 6).’

We know that Carboxytherapy results in improved tissue perfusion, and therefore also muscle function, reversal of tissue atrophy and improved nerve function. It will be of great value to investigate the effect of carboxytherapy on the neurogenic bladder, which is debilitating and up to now no hope has been offered in the form of treatment.

Wehbe and Whitmore, conclude that: “Sexual dysfunction is a common, underestimated, and untreated complaint in women with urological disorders. Identifying sexual complaints and treating the underlying etiologies can result in significant improvement in a woman's quality of life (7).”

In conclusion, the feedback after only 4 treatments per woman, has been surprising, and for many of these women life changing. I do believe this treatment needs in-depth study into the treatment of female sexual dysfunction, low libido, and vaginal dryness, and most importantly, stress incontinence and over-active bladder. The medical fraternity has until now failed to provide solutions for these problems, and to have a modality that is minimally invasive, low risk, treating not only the weak bladder, but sexual dysfunction comprehensively, I would be so brave once again to say that we have something that could revolutionize women’s health as we know it.

Equipment used : CDT Light by Carbossiterapia, Italy. Protocols: Flow rate : 50-80 cc'min Temperature : 40 Volume per insertion: 30-50 cc Number of injections: 4-8 Insertions: • two sub-cutaneous injections either side of mons pubis • two injections lateral to the vaginal opening • if required – one injection into the anterior vaginal wall, about 2 cm internally • if gas does not travel into the labia majora and plump the area out, then two insertions into the labia majora

References: (1) Sarrel PM. Ovarian hormones and vaginal blood flow: using laser Doppler velocimetry to measure effects in a clinical trial of post-menopausal women. Int J Impot Res 1998; 10(Suppl 2): S91–S93; discussion S98–S101. PubMed ISI (2) International Journal of Impotence Research (2005) 17, S44–S51. doi:10.1038/sj.ijir.3901428, JR Bermam (3) Cell Mol Biol Res. 1994;40(1): 35-9. Hypoxia regulatory elements of the human vascular endothelial gorwht factor gene. Minchenko A, Salceda X, Bauer T, Caro J (4) Goldstein, I, Berman, J. Vasculogenic femail sexual dysfunction. Int J Impot Res 1998; 10:84 (5) Cell Mol Biol Res. 1994;40(1):35-9. Hypoxia regulatory elements of the human vascular endothelial growth factor gene.Minchenko A, Salceda S, Bauer T, Caro J. (6) Cardiovasc Res. 1994 Aug;28(8):1176-9. Upregulation of vascular endothelial growth factor expression induced by myocardial ischaemia: implications for coronary angiogenesis.Banai S, Shweiki D, Pinson A, Chandra M, Lazarovici G, Keshet E. (7) J Sex Med. 2010 Apr 1. Urogenital Complaints and Female Sexual Dysfunction 4 ISSN 2518-1572 (Online) КЛІНІЧНА ФАРМАЦІЯ. – 2018. – Т. 22, № 2 ISSN 1562-725X (Print)

Recommended by Doctor of Biology, Professor L. M. Maloshtan UDC 616-08:616.6:615.017:546.264-31 https://doi.org/10.24959/cphj.18.1458 S. M. Drogovoz, H. Zelenkova*, A. L. Shtroblya**, N. Ya. Asadullayeva, V. A. Ulanova National University of Pharmacy DOST, Svidnik, Slovakia* Uzhhorod National University** The potential of carboxytherapy in diseases of the urogenital system organs

Recently carboxytherapy has been widely used for the treatment of many diseases, and it is associated with the high

medical practice and more than 50 years in aesthetic medicine. Aim.efficiency To substantiate and low cost. the Carboxytherapy use of carboxytherapy as the method as an innovative of treatment method has been of treatment used for for70 diseasesyears in theof the international urogenital system organs. Materials and methods the cervix, menopause, vulvovaginal atrophy, initial stages of the stress urinary incontinence, erectile dysfunction, and impotence was performed.. The analysis of scientific sources concerning the treatment of sexual dysfunction, erosion of Results. It has been determined that various variants of carboxytherapy can be used to obtain the antihypoxic, repara-

treatment. Patients with different pathologies of the urogenital system noted improvement in functioning of urogenital tive-regenerative, spasmolitic, anti-inflammatory, analgesic and antioxidant effects in clinical practice as a result of the- fore, the quality of life has been improved. organs, release of pain, decrease in inflammation, mood stability, and good mental and physical performance. There Conclusions. 2 can be considered as a unique medicinal product, and carboxytherapy as an alternative treat- ment for many diseases. Key words: carboxytherapy;Thus, СО carbon dioxide; hypoxia; oxygenation; diseases of the urogenital system

С. М. Дроговоз, Г. Зеленкова*, А. Л. Штробля**, Н. Я. Асадуллаєва, В. А. Уланова Національний фармацевтичний університет ДОСТ, м. Свидник, Словаччина* Ужгородський національний університет** Можливості карбокситерапії при захворюваннях органів сечостатевої системи

- Останнім часом карбокситерапія широко застосовується для лікування багатьох захворювань, що пов’язано з Метависокоефективністю роботи. і дешевизною даного методу. Карбокситерапія як альтернативний метод лікування ви- користовується впродовж 70 років у світовій медичній практиці і більше 50 років в естетичній медицині. Матеріали та Обґрунтуванняметоди. застосування інноваційного методу лікування – карбокситерапії при захворю ваннях органів сечостатевої системи. - Аналіз літератури проводили шляхом опрацювання наукових статей щодо лікування Результатисексуальної дисфункції, ерозії шийки матки, клімаксу, вульвовагінальної атрофії, початкових стадій стресово- го нетримання сечі, еректильної дисфункції, імпотенції. . Встановлено, що в клінічній практиці використовуються різні варіанти карбокситерапії для отри- мання антигіпоксичного, репаративно-регенеративного, спазмолітичного, протизапального, аналгезуючого та- антиоксидантного ефектів. У результаті пацієнти з різними патологіями органів сечостатевої системи відзна Висновкичають поліпшення самопочуття, покращення функціонування цих органів, усунення болю, запалення, підви- щення настрою, розумової і фізичної працездатності,2 а в цілому і якості життя. Ключові слова:. Таким чином, можна вважати СО унікальним лікарським засобом, а карбокситерапію альтернатив ним методом лікування при багатьох захворюваннях. С. М. Дроговоз, карбокситерапія; Г. Зеленкова*, А.вуглекислий Л. Штробля**, газ; гіпоксія; Н. Я. Асадуллаева, оксигенація; захворювання В. А. Уланова сечостатевої системи Национальный фармацевтический университет ДОСТ, г. Свидник, Словакия* Ужгородский национальный университет** Возможности карбокситерапии при заболеваниях органов мочеполовой системы

В последнее время карбокситерапия широко применяется для лечения многих заболеваний, что связано с Цельвысокоэффективностью работы. и дешевизной данного метода. Карбокситерапия как метод лечения используется на- протяжении 70 лет в мировой медицинской практике и более 50 лет в эстетической медицине. Обоснование применения инновационного метода лечения – карбокситерапии при заболева ниях органов мочеполовой системы. ISSN 1562-725X (Print) KLÌNÌČNA FARMACÌÂ. – 2018. – Vol. 22, No. 2 ISSN 2518-1572 (Online) 5

Материалы и методы. -

Анализ литературы проводили путем обработки научных статей относительно лече Результаты.ния сексуальной дисфункции, эрозии шейки матки, климакса, вульвовагинальной атрофии, начальных стадий стрессового недержания мочи, эректильной дисфункции, импотенции. - Установлено, что в клинической практике используются различные варианты карбокситерапии- для получения антигипоксического, репаративно-регенеративного, спазмолитического, противовоспалитель ного, анальгезирующего и антиоксидантного эффектов. В результате лечения пациенты с различными пато- логиями органов мочеполовой системы отмечали улучшение самочувствия, улучшение функционирования Выводы.этих органов, устранение боли, воспаления, повышение настроения, умственной и физической работоспособ- ности, а следовательно и качества жизни. 2 Ключевые Таким слова: образом, можно считать; СО уникальным; лекарственным; ;средством, а карбокситерапию аль тернативным методом лечения при многих заболеваниях. ne of the main карбокситерапия etiological factors углекислый in deve газ гипоксия­ rapy оксигенация stimulating заболевания the endothelial мочеполовой vascular системы growth Olopment of the pelvic organ pathology is a factor, endothelial proliferation, angiogenesis, va- decrease in the blood circulation of these organs sodilation, oxygenation eliminates vaginal dryness leading to hypoxia. Hypoxia precedes development in 80 % of women, improves libido and sexual sen- of sexual, gynecological, andrological and nephro- sitivity in 75 % of patients [9, 10]. Carboxytherapy logical dysfunction of pelvic organs. can help to renew the blood supply of the pelvic The oxygen transport function of the body is im- possible without carbon dioxide since hemoglobin minates the symptoms of the vaginal mucosa dry- gives oxygen to tissues, instead it receives carbon organs;ness [11]. it also normalizes the vaginal flora, and eli- dioxide [1, 2]. Carbon dioxide is the most important Vulvovaginal atrophy is a problem, which 50 % product of cellular respiration; therefore, there are of women face during the menopause. It can be ac- many sensors in the body that regulate the concen- companied with such symptoms as itching, vaginal tration of this gas. The shift of the CO2 level from bleeding during sexual activities, leucorrhoea, etc. the physiological values triggers numerous adap- [12, 13]. Several alternative therapies are used for tation reactions. For instance, if the partial pres- this disease, including carboxytherapy. The frac- sure of CO2 decreases in the alveolar air, hypocap- tional CO2 laser with pulsed radiation has been de- nia develops, and the respiratory center activity decreases; moreover, in some cases it can lead to of the vagina (SmartXide2V2LR laser system DEKA apnea. The CO2 concentration increase automati- signedMELA, Italy).specifically CO2 affects to treat the the vaginal mucous mucosa membrane micro- cally serves as a signal for increasing the intensity circulation and improves the tissue trophism due of breathing and the blood circulation; due to tis- to stimulation of the collagen synthesis and acti- sues oxygenation the muscle tension and spasms -

vationgical changes of fibroblasts. after the The treatment clinical studywith CO conducted2 by a la- decrease;factors increases it provides [3, 4].the analgesic and anti-inflam on 40 patients showed significant positive histolo-- matoryOne effect,of the andinnovative the body’s methods resistance for treating to harmful pel- toms of vaginal atrophy [12]. The effectiveness of vic organs is carboxytherapy, which causes dilata- sertreatment and a significant with these positivemethods effect is accompanied on the symp by tion of blood vessels. It also has the antihypoxic, an- - lagenesis, restoration of the acid pH and proper chological condition of patients [5, 6]. Elimination of formationmoistening. of On elastic the whole, fibers, carboxytherapy stimulation of improves neocol ti-inflammatory,hypoxia reduces formation analgesic ofeffects, underoxidized improves products the psy- the condition of a patient with climacteric vaginal (the antioxidant effect of carboxytherapy) [3, 7]. atrophy symptoms [12, 14, 15]. Carboxytherapy is an alternative method for Traditional methods of the climacteric vaginal treating diseases of the urogenital system. It can be atrophy treatment are limited only by the local ef- used in combination with other therapeutic methods fect on the vagina mucous membrane, and these ef- - fects are temporary and reversible. The treatment lytic and other positive effects. Carboxytherapy sig- with the fractional micro-ablative CO2 laser not only to enhance the analgesic, anti-inflammatory, spasmo induces molecular changes at the site of injury, but The main complaints in gynecological diseases also has a permanent long-term effect [14]. nificantlyare dysfunction reduces of the the dose menstrual of other cycle, drugs painused in[7, the 8]. Erection occurs as a result of changes in the lower abdomen, sexual dysfunction and infertility blood circulation in the penis due to reduction of [8]. The age-related sexual dysfunction occurs in the smooth muscle vessels under the action of sym- 30-50 % of women. The cause of it is a decrease pathetic nerves activities [16]. in the blood circulation due to the atherosclerotic Erectile dysfunction in men (persistent inability rosis, postmenopausal changes (decrease in the estro- for the sexual activity) is associated with micro- pathology when there is vaginal and muscular fib- toangiopathy, achieve and it occurs maintain in approximately erection, which 50 is % sufficient of men. gen level, change in the vaginal flora). Carboxythe- 6 ISSN 2518-1572 (Online) КЛІНІЧНА ФАРМАЦІЯ. – 2018. – Т. 22, № 2 ISSN 1562-725X (Print)

However, only 16 % of them visit a doctor since from the body through the lungs increases the tis- this problem has a psychological background [16]. sue oxygenation. One part of CO2 increases the con- Problems associated with erectile dysfunction are centration of oxygen in tissues more than 3 times. increasing with age. This is associated with emer- Consequently, when tissues are saturated with oxy- gence of risk factors: chronic diseases, obesity, dia- gen, its release from tissues decreases and it causes betes mellitus, microangiopathy, arterial hyperten- vasoconstriction with a decrease in the local blood sion, increased cholesterol level, atherosclerosis [17]. circulation. The excess of CO2 (hypercapnia) dilates Psychological disorders because of erectile dysfunc- blood vessels, increases delivery of oxygen and nu- tion can be more devastating than the pathological trients to tissues [7]. problems of a chronic medical condition. Erectile Being a powerful natural vasodilator CO2 redu- dysfunction and depression are interrelated: in ces the basal tone of the arterioles and promotes 50-90 % of patients with depression there is a de- the increased blood circulation. The body interprets creased interest in sex, and on the contrary, erec- - tile dysfunction leads to an increase of depression. ciency and reacts by increasing the blood circula- Impotence is much broader term that includes thetion procedureand VEGF (vascularof carboxytherapy endothelial as growth oxygen factor), defi not only the problems with erection, but also with which stimulates neoangiogenesis. Thus, in perspec- the sexual desire (libido), ejaculation or achieve- tive, carboxytherapy improves the blood circula- ment of orgasm (culmination) [18]. According to tion in the pelvic organs due to appearance of new the Massachusetts study of aging in men [19] 52 % of men between 40 and 70 years suffer from im- and other organs [10]. potence. The frequency of this disorder increases vesselsOther and modern the arterial mechanisms blood influxof the tocarboxythe- the penis with age. Risk factors for erectile dysfunction and rapy action for pelvic organs are also associated with impotence include arterial hypertension, hypercho- physiological properties of CO2. Invasive introduc- lesterolemia, diabetes mellitus and other peripheral tion of CO2 (carboxytherapy) causes imbalance of vascular diseases when hypoxia of the pelvic or- the physiological correlation between CO2 and O2 gans occurs. volumes in tissues. The increased content of CO2 Carboxytherapy is an innovative medical tech- in tissues causes stress in the body, and the body nology aimed at the non-invasive and painless treat- copes it with the help of the own reserves. Due to ment of erectile dysfunction. The goal of this therapy the action of CO2 in the body the main mechanisms is to increase the blood circulation and oxygenation of homeostasis adaptation start; they are a neuro- in the pelvic organs, improve the erection with the humoral reaction that involves the hypothalamic- pituitary system of the endogenous pain regulation,

Due to the pharmacological properties of CO2 optimization of the antinociceptive self-regulation reflexcarboxytherapy action (by is analogy able to affect with pathogenesisthe shock wave) of these [8]. (stimulation of the endogenous synthesis of en- pathologies, reducing symptoms and improving the dorphines that provide the analgesic effect). - Pomerants B. also stated that the analgesic effect rience covers 30 years of carboxytherapy in gyne- of carbon dioxide injections is associated with the patients’cology, andrology, quality of urology life [10]. and Today, nephrology, doctors’ inexpe the endorphine synthesis [10]. The placebo effect also treatment of diseases of the prostate and urinary has no small share: release of endorphines and the system. placebo effect are in close synergy when conduct- The mechanism of the carboxytherapy action ing carboxytherapy. in diseases of the urogenital system is associated Invasive carboxytherapy has been used for a long with an increase in tissue oxygenation due to the time as an auxiliary treatment for diseases of the

Bohr effect: it shows the effect of the CO2 concentra- urogenital system. It slows down the signs of sexu- tion and the pH value on the process of binding and al aging, treats cervical erosion, leukoplakia; poly- releasing of O2 from hemoglobin [9]. The process cystosis, endometriosis, menopause, vulvovaginal of CO2 and O2 gas exchange occurs both in lungs, atrophy, amenorrhea and oligomenorrhoea, the ini- kidneys, uterus, and in the prostate gland [10]. tial stages of the stress urinary incontinence; it is The effectiveness of binding hemoglobin to carbon also used in medical and diagnostic laparoscopy. dioxide (with formation of carbhemoglobin) is in- Vaginal rejuvenation with the help of carboxythera- versely related to binding to oxygen. In tissues the py occurs due to the increased blood supply to pel- part of the excessive CO2 binds to hemoglobin, and it promotes the release of oxygen and tissue oxy- It also eliminates the symptom of dryness of the genation. vicvaginal organs mucosa and normalization[9, 11]. Carboxytherapy of the vaginal acts on flora. the All cells of the body (neurons, hepatocytes, car- level of microcirculation of arterioles and precapil- diomyocytes, epitheliocytes, etc.), release CO2 as a lary sphincters by increasing the rate of the blood

chemical reactions. The process of CO2 elimination drainage. These mechanisms of the CO2 action are product of vital activity and the final product of bio- flow in tissues, as well as by improving lymphatic ISSN 1562-725X (Print) KLÌNÌČNA FARMACÌÂ. – 2018. – Vol. 22, No. 2 ISSN 2518-1572 (Online) 7

- examining of the fallopian tubes [9]. Thus, carbon tal system accompanied with hypoxia, edema [10, 20]. dioxide due to its antibacterial properties (for the widelyAt the used site in of inflammatory CO2 injection diseases the nerve of endings the urogeni sen- is an important component of diagnostic procedures contribute to the analgesic effect of CO2), the tissue aerobicfor diseases microflora) of the urogenital and the absence system. of side effects sitivitytrophism changes, and the muscle local protective fibers relax processes (these improve. changes The purpose of non-invasive carboxytherapy - ronmental factors increases due to the pronounced fenses, restore the balance of the nervous processes,

Inantioxidant addition, the effect body’s of CO resistance2 [7]. to unfavorable envi (carbonincrease dioxide the oxygen baths) content is to mobilize in the arterialthe body’s blood de- Invasive carboxytherapy in gynecology is used and improve all metabolic (carbohydrate, fatty, pro- for the treatment of pain in the lower abdomen tein) processes in the body [4]. Carbonic baths have (painful menstruation, conditions after operations the vasodilating, analgesic, bactericidal and spas-

2 at the injection molytic effects and also cause oxygenation appearing - from dilation of arteries and capillaries. Carbonic –tors, adhesions). while rapid The pH pressure change ofto COalkali (alkalosis) at mineral baths are used in pathologies of the uro- sitethe site causes of CO the2 injection flow of affects impulses chemoreceptors, from barorecep and genital, endocrine and immune systems as they im- it contributes to the analgesic and spasmolytic ef- prove the blood supply of the body and accelerate - removal of toxic substances from it, reduce pain due ers of the vessels is due to a decrease in the amount to their analgesic, reparative-regenerative, spasmolitic fectsof Ca 2+[7]. calcium In addition, ions (formation relaxation of of calcium the muscle bicarbo fib- nate during dissociation of carbonic acid), and it “Dry” CO2 baths help to reduce toxic symptoms leads to local vasodilation and acceleration of mi- andafter anti-inflammatory chemotherapy; increase properties the physical [4]. and sexu- crocirculation [10]. al activity of men and women, reduce menopausal In 1981, Dr. Kovarzhik developed and patented the method of CO2 medical commercial use called bladder and other organs of the small pelvis, as “Bioterik”. For this purpose special hygienic and symptoms;well as in the they treatment are used of infertilityin inflammation [1, 3, 4]. of the harmless polyethylene bags with CO2 are used. In balneology CO2 baths are recommended for Taking into account the peculiarities of this proce- the following diseases of the sexual system: impo- dure a patient does not inhale CO2 during carboxy- - therapy (the CO2 concentration in the bag is almost tal organs in remission (adnexitis, salpingoophori- 100 %). This procedure is used in women as an an- tence,tis, menopause), chronic inflammatory ovarian dysfunction diseases of [20]. female geni algesic therapy in painful menstruation and during Thus, in clinical practice various variants of carb- the menopause [4, 14]. oxytherapy are used to obtain the antihypoxic, re- Thus, carboxytherapy is an auxiliary and alter- - native therapy with a successful positive result for tory, analgesic and antioxidant effects. As a result, improving the circulation of the pelvic organs with parative-regenerative,patients with pathologies spasmolytic, of various anti-inflamma organs of the the gynecological, andrological and nephrologic dys- urogenital system note improvement in function- function. ing of urogenital organs, release of pain, decrease This innovative technology is designed to im- prove the local blood circulation which is achieved and physical performance. Therefore, the quality by subcutaneous administration of CO2 in pelvic or- inof lifeinflammation, has been improved. mood stability, and good mental gans. In order to improve blood circulation in this Contraindications of carboxytherapy are nephri- area the action similar to shock wave therapy is used. tis and nephrosis. In case of these diseases the treat- ment using this method should be withheld. vasodilating, angio-stimulating and antioxidant action. At present, carboxytherapy is widely used in all It has the anti-inflammatory, analgesic, anti-hypoxic,- areas of medical practice as it is a highly effective cur, and carboxytherapy provides faster recovery and safe method of treating many diseases. This me- Theof the fibroblast pH level activationand normalization and collagen of the synthesis vaginal mu oc- thod of treatment has been used for 70 years in the cosa [21, 22]. world medical practice and more than 50 years in Carbon dioxide is also used as an alternative con- aesthetic medicine. Thus, it is possible to consider trast substance for diagnosis in diseases of urogen- 2 to be a unique drug, and carboxytherapy to be an ital system. From economic point of view, the use alternative method in off-label therapy for many of CO2 СОdiseases. procedures in the peripheral angiography, diagnos- Conflict of interests: significantly reduces the cost of diagnostic of interests to declare. authors have no conflict ing bleeding in patients with renal insufficiency or 8 ISSN 2518-1572 (Online) КЛІНІЧНА ФАРМАЦІЯ. – 2018. – Т. 22, № 2 ISSN 1562-725X (Print)

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12. 2 fraccional microablativo. Rev Enfer Tract Gen Inf., 8, 13. Elias,Gonzalez, J., Carbone, P., Ruiz, A., A. Gaspar,I., Galindo, A. et L. al. (2014). (2012). Tratamiento Carboxytherapy de la atrofialocal treatment vaginal en of lavaginal menopausia mucosa con atrophy laser deor hypotrophyCO of vaginal mucosa at menopause and postpartum.36–40. International Journal of Gynecology & Obstetrics, 119, 14. Filippini, M., Del Duca, E., Negosanti, F., Bonciani, D., Negosanti, L., Sannino, M., Nisticò, S. P. (2017). Fractional CO2 Laser: From Photomedicine and Laser Surgery, 35 (3), S563–S564. 15. Brandi, C., Grimaldi, L., Nisi, G. et al. (2010). The role of carbon dioxide therapy in the treatment of chronic wounds. In Vivo, 24Skin (2), Rejuvenation to Vulvo–Vaginal Reshaping. 171–175. doi: 10.1089/pho.2016.4173 16. Erektilnaia disfunktciia: prichiny i sposoby lecheniia (2014). Lekarstvennyi spravochnik, 3 (15), 17. Randrup, 223–229. E., Baum, N., Feibus, A. (2015). Erectile dysfunction and cardiovascular disease. Postgrad Med, 127 (2), 18. Kurochka, D. (2011). Provizor, 7, 72–73. 19. The health of normally aging men: The Massachusetts Male Aging 166–72. Study Experimental Gerontology, 59–60. 39 (7), 10.1016/j.exger.2004.03.023 20. Drogovoz,O’Donnell, S.A. B.,., Kabachnyi,Araujo, A. B., V. McKinlay, I., Kabachna, J. B. I. (2004). V. (2016). Ukrainskyi visnyk psykhonevrolohii, 3 (88), 21. (1987–2004). 975–984. doi: Acta Med. Croatica, 67 (1), М 83–86. 22. Hinman,Sinozic, T., R. Kovacevis,S., McCrory, J. P.,(2013). Pirotta, Carboxytherapy M. et al. (2014). – Acupuncture supportive therapy for chronic in chronic knee pain wound a randomized treatment. clinical trial. JAMA, 312 (13), 137–141.

Information1313–1322. about authors / Відомості про авторів / Информация об авторах Drogovoz S. M., Doctor of Medicine (Dr. habil.), professor of the Pharmacology Department, National University of Pharmacy (https://orcid.org/0000-0002-9997-2197) Дроговоз С. М. (https://orcid.org/0000-0002-9997-2197) Дроговоз С. М., доктор медичних наук, професор кафедри фармакології, Національний фармацевтичний університет (https://orcid.org/0000-0002-9997-2197) Zelenkova Hana,, доктор Doctor медицинских of Medicine (Dr. наук, habil.) профессор, director кафедрыof the Private фармакологии, Clinic of Dermatovenerology, Национальный Svidnikфармацевтический, Slovakia университет (http://orcid.org/0000-0003-3995-8032) Зеленкова Гана (http://orcid.org/0000-0003-3995-8032) Зеленкова Гана, доктор медицини, завідувач приватної дерматовенерологічної клініки, м. Свідник, Словаччина (http://orcid.org/0000-0003-3995-8032) Shtroblya A. L., Candidate, доктор медицины,of Pharmacy заведующая (Ph. D.), associate частной professor дерматовенерологической of the Department of Pharmaceutical клиники, г. Свидник, Subjects, Словакия Uzhhorod National University (http://orcid.org/0000-0002-9499-4880) Штробля А. Л. http://orcid.org/0000-0002-9499-4880) Штробля А. Л., кандидат фармацевтичних наук, доцент кафедри фармацевтичних дисциплін, Ужгородський національний університет ( http://orcid.org/0000-0002-9499-4880) Asadullayeva N., кандидатYa., Candidate фармацевтических of Pharmacy (Ph. наук, D.), teaching доцент assistantкафедры of фармацевтических the Pharmacology Department, дисциплин, National Ужгородский University национальный of Pharmacy (http://orcid.org/0000-0002-2431-7315)университет ( Асадуллаєва Н. Я. (http://orcid.org/0000-0002-2431-7315) Асадуллаева Н. Я., кандидат фармацевтичних наук, асистент кафедри фармакології, Національний фармацевтичний університет http://orcid.org/0000-0002-2431-7315) Ulanova V. A., Candidate, кандидат of Pharmacy фармацевтических (Ph. D.), teaching наук, assistant ассистент of the кафедры Pharmacology фармакологии, Department, Национальный National University фармацевтический of Pharmacy (http://orcid.org/0000-0002-0654-4872)университет ( Уланова В. А. (http://orcid.org/0000-0002-0654-4872) Уланова В. А., кандидат фармацевтичних наук, асистент кафедри фармакології. Національний фармацевтичний університет (http://orcid.org/0000-0002-0654-4872) Mailing address, кандидат: 12, Kulikovska фармацевтических str., Kharkiv, 61002, наук, Ukraineассистент, Pharmacology кафедры фармакологии, Department, National Национальный University фармацевтический of Pharmacy. университет Tel. +38(057) 706 30 69. E-mail: [email protected] Адреса для листування: E-mail: [email protected] Адрес для переписки: 61002, м. Харків, вул. Куликівська, 12, кафедра фармакології НФаУ. Тел./факс +38(057)706-30-69. E-mail: [email protected] 61002, г. Харьков, ул. Куликовская, 12, кафедра фармакологии НФаУ. Тел. +38(057) 706 30 69.

Надійшла до редакції 06.04.2018 р. L’obiettivo di questo studio multicentrico è sintetizzare i riscontri avuti su 72 donne che si sono sottoposte al trattamento “V-Reju”.Ciò che è emerso potrebbe essere realmente qualcosa di rivoluzionario per la qualità sessuale della donna, potremmo parlare di Viagra al femminile. Le donne erano così suddivise: di età compresa tra i 34 e i 68 anni, 2 nella trentina, 21 nella quarantina, 36 nella cinquantina e 13 nella sessantina. Parlerò di tre diverse categorie di risultati, e con esse la possibile spiegazione scientifica che necessiterà di ulteriori studi ed approfondimenti.

Nel questionario fornito a queste donne vi erano domande riguardo le sensazioni, la lubrificazione e i miglioramenti estetici.

• Cambiamenti di carattere estetico (36 su 72 hanno risposto sì) • Miglioramento delle sensazioni (47 su 72 hanno risposto sì) • Miglioramento della lubrificazione (58 su 72 hanno risposto sì)

Ciò che è emerso è che, la maggior parte delle donne sudafricane ritiene che sia ancora un tabù discutere di tutto ciò che riguarda gli aspetti della sessualità. Ho adattato il questionario per includere più domande specifiche possibili è stato utilizzato anche il questionario “King’s Quality of Life” per le incontinenze urinarie.

Nella prima sezione vorrei dar risalto su quanto sia evidente la miglioria nella qualità della vita sessuale delle donne, che è l’effetto sul trattamento dell’incontinenza femminile. Vorrei anche includere della bibliografia su studi recenti che possono spiegare perché si ottiene questo effetto:

43 donne hanno dichiarato che le funzioni della vescica sono migliorate e voglio elaborare come questo fatto ha avuto un importante cambiamento nella qualità della vita di queste donne: • Lo svuotamento e il riempimento della vescica durante l’evacuazione. • Miglioramento dell’urgenza (possono terminare tranquillamente i loro acquisti). • Riduzione di perdite notturne, fino al punto che ora una donna di 68 anni dorme di notte per la prima volta nell’ultimo decennio. • Riduzione dello stress da incontinenza (possono correre e saltare, starnutire e tossire senza fuoriuscite e non c’è più l’esigenza giornaliera di ricorrere a salviette.

Dal punto di vista delle funzionalità sessuali si evincono le seguenti informazioni:

21 hanno avuto rapporti sessuali più soddisfacenti, diventando anche per la prima volta multi- orgasmiche. 6 hanno notato che servono minori stimoli per raggiungere il piacere o l’orgasmo. 11 hanno affermato di avere un tappeto vaginale più tonificato. 12 hanno avuto un aumento della libido. 8 hanno avvertito un benessere generale, sono più tranquille, meno irritabili e con meno sbalzi d’umore. 7 hanno affermato che il loro partner ha notato una maggiore strettezza vaginale e un tessuto più tonico, avuto dei miglioramenti di carattere estetico e nella lubrificazione vaginale. Alcune di queste sette donne non hanno raccontato al partner di essersi sottoposte a questi studi.