These concerns are real, they are common, and they are not something you have to accept as inevitable. The answers here are honest and complete. If your question isn't here, call or text us — 289-271-2444.
These concerns are among the most common we hear — and among the least frequently discussed with healthcare providers. That needs to change.
It is common — affecting the majority of women to some degree — but common is not the same as normal, and it is not something you have to accept. The decline in estrogen and testosterone that accompanies perimenopause and menopause directly affects genital tissue, clitoral sensitivity, vaginal lubrication, and sexual response. These are physiological changes, not psychological ones.
They are also treatable. The approaches we offer — O-Shot® PRP, Clitoxin™ neuromodulator, GAINSwave for Her® shockwave, and hormone optimization — address different parts of this picture. Shannon will assess your full situation and tell you which combination is most appropriate for you.
Both situations — primary anorgasmia (never) and secondary anorgasmia (lost over time) — are conditions we work with. Secondary anorgasmia is more amenable to the treatments we offer because the capacity for orgasm existed and the question is what changed. Hormone shifts, reduced blood flow to genital tissue, reduced nerve sensitivity, and pelvic floor dysfunction can all contribute.
Primary anorgasmia has a more complex picture that may involve psychological, anatomical, and physiological factors. Shannon will be honest about what is and isn't within scope for us to address and will refer you appropriately if needed.
Yes. Painful intercourse (dyspareunia) in women has several common causes — vaginal atrophy from estrogen decline, reduced lubrication, vulvodynia, vestibulodynia (pain at the vaginal opening), and lichen sclerosus. Several of these are within our scope to treat effectively.
The O-Shot® PRP improves tissue health and lubrication. GAINSwave for Her® increases blood flow and nerve sensitivity. Hormone optimization addresses the underlying estrogen decline driving atrophy. For lichen sclerosus specifically, the O-Shot® has shown meaningful results. Shannon will identify the likely cause at your assessment and tell you which treatment is most appropriate.
Yes. Childbirth significantly affects the pelvic floor, vaginal tissue, and sexual function — often in ways that don't fully resolve on their own. EMSELLA® is highly effective for pelvic floor rehabilitation post-partum. The O-Shot® addresses tissue changes, sensitivity, and lubrication. GAINSwave for Her® supports blood flow restoration in genital tissue. Many women wait years before addressing these changes; most wish they had come sooner.
The O-Shot® (Orgasm Shot) is a trademarked procedure developed by Dr. Charles Runels. It uses platelet-rich plasma (PRP) derived from your own blood, injected into the clitoral tissue and anterior vaginal wall. The growth factors in PRP stimulate tissue regeneration, new blood vessel growth, and nerve repair in the treated areas.
The result is improved sensitivity, improved arousal response, improved lubrication, and in many cases improved orgasm quality and ease of achievement. It also has a meaningful effect on urinary stress incontinence because the anterior vaginal wall supports the bladder neck. Shannon is a Canadian Clinical Instructor for this procedure — one of a small number in Canada trained to teach it to other providers.
The honest answer: it is far more comfortable than most women expect. A topical anaesthetic cream (BLT 20/8/8 compounded) is applied to the clitoral and vulvar area for a full 25 minutes before any injection. An injectable lidocaine block is added at the frenulum of the clitoris for additional comfort. By the time Shannon injects the PRP, the area is well anaesthetized.
Most women are genuinely surprised by how tolerable the procedure is. If you have specific concerns, tell us when you book — we can address them in detail.
Approximately 60–75 minutes, including the blood draw, PRP processing in our centrifuge, numbing time, injection, and aftercare review. You leave immediately after and resume your normal activities. There is no downtime.
Initial changes — improved sensitivity, lubrication, or reduced leaking — are often noticed within 2–4 weeks. Full results develop over 8–12 weeks as the PRP growth factors work and new tissue matures. Results typically last 12–18 months before a maintenance treatment may be appropriate.
Results vary between individuals. Shannon will give you a realistic expectation based on your specific situation at your assessment.
Yes — and this is one of its most significant and underappreciated benefits. The anterior vaginal wall injection in the O-Shot® protocol directly supports the bladder neck and urethral tissue, which is the area responsible for stress urinary incontinence (leaking when you cough, sneeze, laugh, jump). Many women experience meaningful improvement in urinary control following the procedure, particularly when combined with EMSELLA® pelvic floor rehabilitation.
Yes — and this is one of the most important applications of the O-Shot®. Women treated for breast cancer frequently cannot use estrogen, leaving vaginal atrophy, dryness, and painful intercourse unaddressed for years. The O-Shot® does not involve hormones. It uses your own growth factors to restore tissue health locally, without affecting systemic estrogen levels.
Two peer-reviewed studies have specifically documented PRP for genitourinary syndrome in breast cancer survivors: Hersant et al. (Menopause, 2018) and Chen et al. (Obstetrics & Gynecology, 2025). Both showed meaningful improvement in dryness, pain, and tissue quality with no serious adverse events, with results lasting 9–18 months. Shannon regards this population as one of the most important she treats and approaches these assessments with particular care given the oncology context.
Interstitial cystitis (IC) and bladder pain syndrome are conditions we are watching closely in the PRP literature. Multiple published studies have documented PRP reducing IC pain, primarily through direct bladder injection. Our O-Shot® protocol — which targets the anterior vaginal wall tissue adjacent to the bladder — may offer a less invasive pathway to similar benefit. Emerging research also shows synergistic effects when combining shockwave therapy (GAINSwave for Her®) with PRP for IC.
This is an area where the research is accumulating but not yet conclusive. Shannon will discuss your specific IC history at your assessment and give you an honest picture of whether our protocols are likely to help, before you commit to treatment.
Yes. The O-Shot® and Clitoxin™ can be performed in the same appointment and are frequently combined. Shannon typically performs the PRP injection first, then the Clitoxin™. A combined consent form covers both procedures. The comprehensive approach addresses both tissue regeneration (O-Shot®) and neuromuscular tension reduction (Clitoxin™) at the same time.
Clitoxin™ uses Xeomin® (incobotulinumtoxinA — a neuromodulator) injected superficially into the body of the clitoris. The mechanism is the reduction of involuntary smooth muscle tension that can inhibit the clitoral response cycle. When that tension is reduced, the tissue responds more freely and fully to stimulation, which many women describe as easier arousal, greater sensitivity, and more intense or consistent orgasm.
It is not a cosmetic procedure applied to the wrong location. The product, dosing, injection technique, and anatomical target are specific to this application and to the Dr. Charles Runels Clitoxin™ protocol. Xeomin® is the only product authorized for this use in our clinical framework.
Clitoxin™ is an off-label application of botulinum toxin type A. Off-label use of medications is common, legal, and well-established in medicine — many treatments that are now standard of care began as off-label use. Shannon will provide a full off-label disclosure as part of your consent process and will explain the current evidence base for this specific application honestly.
No. The dose and injection technique are calibrated specifically to reduce hypertonicity (excess tension) in the smooth muscle while preserving and enhancing sensory response. The goal is more sensation and easier response — not less. The injections are superficial (not deep pelvic floor injections) and the effect is localized to the clitoral tissue.
GAINSwave for Her® is low-intensity shockwave therapy applied externally to the clitoral and vaginal region using a handheld device. No needles, no numbing, no downtime. It works by stimulating blood vessel growth and nerve sensitivity in the treated tissue through acoustic energy.
The O-Shot® delivers PRP directly into the tissue via injection — a more targeted intervention with a stronger regenerative signal. GAINSwave for Her® achieves similar vascular and tissue benefits non-invasively, through repeated sessions. They work on the same problem through different mechanisms and are frequently combined for a comprehensive outcome.
Women with reduced genital sensitivity, difficulty with arousal, vaginal dryness, provoked vestibulodynia, or those wanting to enhance sexual response without injections are strong candidates. Women who prefer to start with a non-invasive approach before considering the O-Shot® often begin with GAINSwave for Her®. It is also appropriate for women who have had the O-Shot® and want to maintain or extend their results between treatments.
Urinary incontinence affects approximately 1 in 3 women. Most never seek treatment because they think it's inevitable. It's not.
Stress urinary incontinence (SUI) is leaking triggered by physical activity or pressure — coughing, sneezing, laughing, jumping, lifting. It happens because the pelvic floor muscles and urethral support are insufficient to hold urine against sudden pressure changes. This is the most common type and is highly responsive to EMSELLA® pelvic floor rehabilitation and the O-Shot®.
Urge urinary incontinence (UUI) is characterized by a sudden, urgent, difficult-to-control need to urinate, often followed by leaking before you can reach a bathroom. The bladder muscle (detrusor) contracts involuntarily. This type responds to EMSELLA® and may also benefit from the O-Shot® and hormone optimization.
Mixed incontinence is a combination of both and is very common. Shannon will determine your type at assessment and recommend the appropriate treatment pathway.
Not significantly. EMSELLA®, the O-Shot®, and GAINSwave for Her® are all appropriate for women post-hysterectomy. The pelvic floor, vaginal tissue, clitoral tissue, and urethral support structures are not removed in a hysterectomy and remain responsive to treatment. Shannon will review your surgical history at your assessment.
Yes. Shannon holds the Certified Continence Advisor designation and is one of the few providers in the Niagara region with specific training in both urinary and fecal continence. EMSELLA® strengthens the entire pelvic floor, including the anal sphincter complex, and has been shown to improve fecal urgency and control in appropriate candidates.
If you are experiencing fecal incontinence or urgency, please mention it when you book — it is within our scope and it deserves the same attention as urinary incontinence. People just talk about it even less.
Several reasons. First, many women do Kegels incorrectly — contracting the wrong muscles, or doing surface contractions that don't recruit the deep pelvic floor. Second, voluntary Kegels cannot achieve the depth or intensity of contraction that EMSELLA® delivers. EMSELLA® produces supramaximal contractions — the type and depth that voluntary effort cannot reach — using High-Intensity Focused Electromagnetic (HIFEM) energy. Third, if your pelvic floor muscles are significantly weakened from childbirth, menopause, or other factors, voluntary exercise may simply be insufficient to produce meaningful change on its own.
EMSELLA® delivers thousands of deep pelvic floor contractions per session. After six sessions, the cumulative neuromuscular training effect is significantly greater than what Kegels alone can achieve for most patients.
You sit in a chair, fully clothed, for 28 minutes. The machine does the work.
You sit on the EMSELLA® chair, fully clothed. You do not need to undress, remove anything, or prepare in any way. The device delivers High-Intensity Focused Electromagnetic (HIFEM) energy through the seat of the chair into your pelvic floor, inducing thousands of deep muscle contractions over 28 minutes. You feel a strong buzzing, tingling, or pulling sensation in the pelvic floor — calibrated to your comfort level. Most patients read or rest during the session. You walk out immediately after with no restrictions.
The standard protocol is 6 sessions, delivered twice per week over three weeks. This is the protocol used in the clinical studies and the one Shannon follows. Results continue to develop for 4–6 weeks after completing the series as the pelvic floor muscles strengthen and neuromuscular coordination improves. Maintenance sessions — typically 1–2 per year — help sustain results long-term.
Yes. EMSELLA® is FDA-cleared for both urinary incontinence and improvement of sexual function through pelvic floor strengthening. A stronger, better-coordinated pelvic floor improves the vascular engorgement response during arousal, enhances sensation, and strengthens orgasmic contractions. Many women who come in specifically for incontinence report significant improvements in sexual satisfaction as a secondary benefit — and vice versa.
EMSELLA® is contraindicated for women with metal implants in the pelvic region (hip replacements, some IUDs), pacemakers or other electronic implants, copper IUDs, pregnancy, or active malignancy in the pelvic area. Body piercings between the waist and knees must be removed for treatment. Shannon reviews all of this at your assessment. If you're unsure whether something applies to you, mention it when you book.
Perimenopause is the transition period — often 4–10 years — during which estrogen and progesterone levels fluctuate and decline. Symptoms during this phase can be significant: irregular periods, hot flashes, night sweats, brain fog, mood changes, sleep disruption, and sexual changes. Perimenopause typically begins in the mid-to-late 40s but can start earlier.
Menopause is defined as 12 consecutive months without a menstrual period. At this point estrogen production from the ovaries has effectively ceased. Most women are in their early to mid-50s at menopause, though surgical menopause (from oophorectomy) can occur at any age.
Both stages are treatable and we work with women throughout both. You do not have to wait until full menopause to seek help with symptoms.
The fear around HRT and breast cancer stems primarily from the 2002 Women's Health Initiative study, which has since been significantly reanalyzed and recontextualized. That study used synthetic hormones (conjugated equine estrogen and medroxyprogesterone acetate) and a population of older women — and even then, the absolute risk increase was small.
The current scientific consensus — including from major menopause societies in North America and Europe — is that for most women under 60 or within 10 years of menopause onset, the benefits of HRT outweigh the risks. Bioidentical hormones and transdermal delivery (patches, gels, creams) have different risk profiles than oral synthetic hormones.
Shannon will review your personal and family history and give you an honest, individualized assessment of whether hormone therapy is appropriate for you, what the actual evidence says, and what options exist. The goal is always an informed decision, not a prescription.
Yes — you must be physically located in Ontario at the time of your virtual appointment. Our Nurse Practitioner is licensed to prescribe in Ontario only. If you are a US patient wanting hormone care, you would need to attend in person in Niagara Falls, or be located in Ontario at the time of your appointment.
Lichen sclerosus is a chronic skin condition that primarily affects the vulvar and perianal tissue in women, causing white, thinned, or scarred patches of skin. It causes significant itching, discomfort, pain during sex, and can cause architectural changes to the vulva over time if untreated. It is not contagious and is not sexually transmitted.
It affects women of all ages but is most common in post-menopausal women and in girls before puberty. It also affects men — see our men's FAQ for that information. It is significantly underdiagnosed and many women live with it for years before receiving a correct diagnosis.
Yes — the O-Shot® is one of the most promising regenerative approaches for lichen sclerosus. PRP's growth factors promote tissue regeneration, reduce inflammation, and improve the health of affected tissue. Published case series and clinical reports have shown meaningful improvement in lichen sclerosus symptoms including itching, pain, and tissue quality following PRP injection.
This is not a cure — lichen sclerosus is a chronic condition that requires ongoing management — but PRP is increasingly recognized as an important part of the treatment picture, often used alongside topical corticosteroids rather than replacing them. Shannon will review your diagnosis and current management at your assessment and tell you honestly whether PRP is likely to benefit you.
A Discovery Conversation is a free 20–30 minute conversation with our Patient Coordinator — in person in Niagara Falls or by phone. No exam, no medical history review, no treatment of any kind. It is simply a conversation about your situation, what's available, and whether the next step makes sense for you.
It is free because we believe you should be able to understand your options without financial commitment. We take on 20 paid assessments with Shannon per month — the Discovery Conversation ensures both of us are confident that a paid assessment is the right next step before you invest.
Everything is completely confidential under PHIPA. Your name, visit, and treatment information are never disclosed to anyone without your written consent. We do not proactively contact your family physician. If you want us to communicate with your GP or specialist, we are happy to do so — but only with your explicit written permission.
OHIP does not cover these procedures. EMSELLA® sessions may be submitted to extended health benefits under physiotherapy when conducted through our supervised physiotherapy pathway — ask about this when you book. Clinical consultation fees may be partially reimbursable through some extended health plans. We can provide detailed receipts for everything you receive. Health spending accounts (HSAs) typically cover medical procedures and consultations.
Yes — and we actively encourage it when appropriate. Sexual function affects both partners, and aging affects partners differently and often at the same time. Many couples book their assessments together and find it helpful to understand each other's treatment plans and timelines. Shannon approaches couples without judgment and with the understanding that this is a shared concern, not an individual one. Couples programs are available at combined pricing.
A free Discovery Conversation takes 20 minutes and will answer everything else. No exam, no obligation, completely confidential.
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