Eliza Dolecka, Health Guide: The professor agreed to talk about pussy health. It's pretty bold, not just in terms of language.

Prof. Marzena Dębska: The Polish language indeed offers limited vocabulary when it comes to describing sexual organs and intimate areas. From childhood, we are often told that having a penis is a matter of pride, but having a vulva is something to be ashamed of. It's high time to change this. Personally, I prefer the term 'pussy' over, for example, 'vulva.' While we do have the term 'vagina,' which refers to the internal canal, there isn't a better term for the vulva, which encompasses the external genital organs.

- A full professor, an outstanding expert who treats fetuses in the womb, implementing innovative methods to repair tiny hearts and bladders, talking about pussies? The topic seems rather trivial."

- Unjustly! Indeed, women are not used to the idea that someone might recognize their needs and roles beyond pregnancy and childbirth. When I see there's a problem, I try to gently, so as not to offend the woman, bring up the topic of the vulva and sometimes also aesthetic gynecology. Above all, I am a doctor for women, not just their children.

- Aesthetic medicine seems to be quite a slippery topic, especially lately, with doctors and celebrities being almost persecuted for promoting it. *

- I have nothing against aesthetic medicine, but aesthetic gynecology is something else entirely. Most procedures that fall under this category have proven health benefits, and some are even performed in hospitals under the NFZ insurance. The official term 'plastic and reconstructive gynecology' has even been introduced. There are several scientific societies that deal with this. Discomfort caused by congenital defects of the labia, postpartum damage, or so-called urogenital atrophy is subjective, but I notice that trivializing these issues and disregarding a woman's right to feel better in her body is often not a matter of medical assessment, but rather the prevailing mentality.

- Either way, aesthetic gynecology seems to be far from your professional interests, doesn't it?

“If you mean fetal therapy, that is indeed the case. But on a daily basis, as a gynecologist, I have to be much more versatile. In addition to working in the hospital, I take in various patients, in whom I encounter problems other than fetal defects much more often. With women with whom not so long ago we talked about pregnancy planning, childbirth, contraception, today I also talk more and more often about Menopause. It's a natural turn of things. At every stage, I try to be with the patient and help her in accordance with the current state of the art medical knowledge. I observe how much worry and pain women experience from the most various abnormalities of intimate zones, even at a young age. It doesn't have to be that way.

- What are the younger patients coming to you for?

- For example, for an enlargement of the labia minora, which are unfortunately only "smaller" in name. The labia can be so large that they stick out of underwear, cause discomfort while walking, and become a nuisance when riding a bike. Chafing occurs on the labia, and even deep, slow-healing wounds can develop. Young girls sometimes come in with their mothers and ask for help. Women who have given birth often suffer from vaginal stretching, perineal injuries, poorly healed wounds, scars, and urinary incontinence. Many of them do not tell their doctors because they think that this is just how it has to be.

- And do you bring it up with them?

- It’s not that simple. I wouldn’t want to offend anyone. I always examine, and I try to ask how the woman feels about her body—after giving birth, during sex, or as menopause approaches. I often hear from my patients that there is a problem; their personal life is falling apart, their husbands are loving, but they have grown distant because the woman refuses to have sex. These are often very serious issues.

- Does that lead to surgery?

- Problems and their solutions are very diverse, but generally, surgical interventions are less common. In the case of vaginal looseness after childbirth, many different actions can help. These are usually painless and minimally invasive, such as ultrasonic vaginal tightening (HIFU) using radiofrequency or laser. Importantly, many of these procedures also reduce the intensity of urinary incontinence, improve the condition of the mucous membranes, increase moisture, and thus reduce the risk of intimate infections.

- And in the case of enlarged labia minora?

- If they are indeed too large and cause problems, they can be reduced very simply by performing a labioplasty. These procedures can be done with parental consent even in teenagers. Lately, they are increasingly being performed under local anesthesia, without the need for general anesthesia. I recently had a patient come in with her mother. The mother hoped I would talk the girl out of her "whims." In this case, I could not agree with the mother; the procedure was very necessary. After it, the girl regained her zest for life. The mother was also pleased, seeing the changes in her daughter.

- Are enlarged labia minora mostly a congenital problem?

- No, women in their later years often come in with the same problem. Usually, it is caused by a secondary loss of fatty tissue around the labia majora. Similar changes occur, for example, on the face. The loss of subcutaneous fat causes so-called "cheeks." In the case of the vulva, the labia minora start to protrude—but here, labioplasty is not necessary. On the contrary—restoring the natural shape and firmness of the labia usually only requires filling them with a small amount of hyaluronic acid and firming the skin covering the labia, for example with a laser or radio waves. This makes the vulva elastic again, firmer, and the skin regains its former color. An additional advantage of this procedure is that filled labia close the entrance to the vagina again, preventing dryness and reducing susceptibility to infections.

- What else happens with mature women?

- In their case, the condition known as urogenital atrophy dominates, which usually causes not only a change in appearance but also a loss of function of the sexual organs. Atrophy, or the progressive degeneration of sexual organs, is a very serious medical problem. Vaginal mucous membranes, the skin of the vulva, become thin, dry, prone to injury and infection. This can make sexual intercourse difficult or even impossible. Not to mention the lack of pleasure from sex. There is often persistent burning, itching, and frequently symptoms from the urinary system—frequent urination, urgency, urinary incontinence. All of this can be really bothersome. Women suffering from this condition avoid sexual contact, isolate themselves, but rarely seek medical help. This is a problem for many women because although it mainly affects postmenopausal women, it can affect women as early as in their forties, still menstruating regularly.

- Do they also explain their discomfort by their age?

Exactly. Meanwhile, the vagina, vulva, or simply the vulva area, should be cared for just like the face and other body parts: effectively regenerate it, eliminate unfavorable changes if they appear, and prevent the consequences of aging. This can be achieved not only through aesthetic gynecology procedures but also with a range of hormonal medications and vaginal preparations.

- Can you really change a lot for the better?

- A common sight in the gynecologist's office is a woman, beautifully dressed, well-groomed, with a "done" face, lying on the gynecological chair, only to find that her vulva is dry, discolored, and her labia are wrinkled. We can easily "rejuvenate" such a vulva—firm it, moisturize it, restore its elasticity. Many patients after such a procedure have admitted that they felt fantastic and finally dared to confidently show their partner. Moreover, it positively impacted their relationship and libido. Personally, I believe that for a woman's attractiveness, a nice vulva is more important than plumped lips.

- So women decide on such procedures mainly for their partners?

- I wouldn’t say so. It’s different for everyone. Sometimes they do aesthetic gynecology procedures primarily for health reasons, with additional benefits, such as better appearance and improved sexual function, being a bonus. Many women do these procedures for themselves, for their well-being, to improve self-acceptance, even when theoretically there is no one to show the results to.

- Theoretically?

- I remember a patient, probably 56 years old. When she came to me, she was completely devastated. Her husband had left her for a younger woman. They weren’t doing well in their intimate life or in general. After two births, she lost the pleasure of sex. Her husband supposedly loved her, said he accepted her and thought she was the most beautiful, but after some time, she found him in bed with his lover. The woman felt defeated, unattractive, and thought she had no chance of finding happiness again. Her vulva indeed looked bad, and she knew it. A few minor procedures were enough to restore her sense of sexual attractiveness. That was just the beginning. When the same patient came back to me a few months later, she was a completely different person. She was radiant and happy. It all started with her vulva, but then she took care of the rest—improved her mental health, enhanced her appearance, strengthened her hair, treated her teeth, and even tattooed beautiful freckles on her face. She now attracts many men and only regrets not fighting for herself earlier.