Advance Diploma Course  in Aesthetic Dermatology & Sexology

Advance Diploma Course  in Aesthetic Dermatology & Sexology

Course Duration        : 2  Days

Course Target            : Aesthetic Dermatology & Sexology

Faculty                         : Dr. Refazul Alam (refat) , Dr. Syeda Maria Adnin / Dr. Afnan H Tanna, Dr. Jinat Khan / Dr. Nizhum Ahmed & Dr. Masuma Munni

Open to All  MBBS Students undergoing Internship , MBBS & BDS.

CPD certificate in Advance Diploma Aesthetic Dermatology & Skincare will be awarded.

DAY 1:            5th July 2025 (Saturday)  Skin Anatomy of Genital & Intimate Areas, Hyperpigmentation, Laxity & Dermatoses – Diagnosis & Treatment.
09:15 – 09:30	Collection of Lecture Course Notes
09:30 – 11:30	Introduction to conclusion of Skin Anatomy of Genital & Intimate Areas.
11:30 – 11:45	Morning Tea Break
11:45 – 01:30	Hyperpigmentation, Laxity & Dermatoses – Diagnosis & Treatment
01:30 – 02.00	Multiple Choice Question Quiz on Skin Anatomy of Genital & Intimate Areas & Hyperpigmentation, Laxity & Dermatoses
02:00 – 02:30	Lunch Break
03:00 – 17:30	Clinical Case Discussion: Vulvar melanosis, Lichen sclerosus, Frictional pigmentation
DAY 2:          6th July 2025 (Sunday) Clinical Sexology for both Male & Female
09:15 – 09:30	Collection of Lecture Course Notes
09:30 – 10:15	Details in Clinical Sexology – Sexual Dysfunction & Male & Female Sexual Dysfunctions – ED, PE, Low Libido, Vaginal Dryness
10:15 – 10:30	Morning Tea Break
10:30 – 12:15	Advanced Therapy Session: Hormone Balancing, PRP, O-Shot, P-Shot Workshop: Role of Cosmeceuticals & Nutra-pharma in Sexual Wellness Live Roleplay/Case Management: Counseling + Rx + Aesthetic Protocol
12:15 – 12:30	Multiple Choice Question Quiz on above topic
12:30 – 13:30	Lunch Break
13:30 – 17:00	Live Demonstrations and Hands-On Training Workshops Emfemme & Shockwave

Advance Diploma Course in Aesthetic Dermatology & Sexology

Day 01

•  Skin Anatomomy of Genital & Intimate Areas
• Hyperpigmentation, Laxity & Dermatoses – Diagnosis & Treatment
• Clinical Case Discussion : Vulvar Melanosis, Lichen Sclerosus, Frictional Pigmentation

1. General Overview: Regions Considered “Intimate” in Aesthetics

A. In Females                              

• Mons pubis
• Labia majora
• Labia minora
• Clitoris
• Vestibule & vaginal introitus
• Perineum
• Perianal region
• Inner thighs (considered aesthetically in pigmentation concerns)

B. In Males

• Pubic area
• Penile shaft & glans
• Scrotum
• Perineum
• Perianal region
• Inner thighs

 2. Skin Structure in Genital & Intimate Areas

Layer	Description
Epidermis	Thin and delicate, especially in labia minora and glans penis. Keratinized in external structures like labia majora and penile shaft.
Dermis	Contains loosely organized collagen and elastin; highly vascularized and innervated.
Subcutaneous tissue	Contains fat in mons pubis, labia majora, and scrotum. Thin or absent in labia minora and penis.

Clinical Notes:

• Thinner skin in these regions means higher absorption of topical agents → caution with acids/retinoids.
• Highly sensitive to hormonal changes, aging, friction, and trauma.
• Prone to post-inflammatory hyperpigmentation (PIH) and chronic dermatoses.

3. Specialized Features of Genital Skin

A. Pigmentation

• Intimate areas are naturally more pigmented due to higher melanocyte density.
• Hormonal influences (estrogen, progesterone) can further increase pigmentation.
• Fitzpatrick IV–VI skin types are more prone to visible darkening.

B. Hair Follicles

• Found in labia majora, mons pubis, scrotum, and pubic region.
• Absent in labia minora, clitoris, glans penis.

C. Sebaceous Glands

• Prominent in non-hair-bearing areas like the inner labia, glans, and foreskin.
• These glands can form Fordyce spots—normal but often mistaken as pathology.

D. Sweat Glands

• Both eccrine and apocrine glands are present.
• Apocrine glands are responsible for body odor and hidradenitis suppurativa.

E. Nerve Supply

• Extremely rich innervation → high sensitivity to touch and pain.
• Important for aesthetic procedures like PRP or laser: require effective topical anesthesia.

4. Male vs Female Genital Skin Differences

Feature	Female	Male
Hair Distribution	Mons pubis, labia majora	Pubis, scrotum, penile shaft
Pigmentation	Increases with age, hormonal changes	Often uniform, mild increase with age
Laxity Changes	Post-childbirth, menopause	Aging, weight fluctuation
Sensitivity	High (clitoris, labia minora)	High (glans, frenulum)

5. Clinical Relevance in Aesthetic Medicine

A. Why Know the Anatomy

• Prevent complications during lasers, microneedling, PRP, peels
• Ensure accurate depth during filler or PRP injections
• Know the safe vs risky zones (vascularity, nerve density)
• Understand how hormonal changes or trauma affect skin quality
• Design safe & ethical treatments in sensitive areas

6. Aesthetic Implications & Treatments Involving Genital Skin

Concern	Procedure
Hyperpigmentation	Low-fluence laser toning, peels, PRP
Laxity/Dryness	RF tightening, laser rejuvenation, PRP
Texture Improvement	Microneedling, CO2 fractional laser
Scar Correction	Subcision, PRP, laser
Hair Removal	Laser hair reduction (caution in skin types IV–VI)

7. Safety & Ethical Considerations

• Always obtain informed written consent.
• Discuss realistic outcomes and treatment limitations.
• Respect cultural and personal sensitivities.
• Maintain strict hygiene and infection control.

 

Hyperpigmentation

1. Types of Genital & Intimate Hyperpigmentation

Type	Description
Physiological	Normal darker tone of genitalia due to high melanocyte activity
Post-inflammatory (PIH)	After infections, dermatitis, waxing, shaving
Hormonal	PCOS, pregnancy, menopause
Frictional	Obesity, tight clothing, physical activity
Melanosis	Benign pigmented macules on vulva or scrotum
Drug-induced	Oral contraceptives, minocycline

2. Clinical Evaluation

• History: Onset, triggers, trauma, cosmetic use
• Physical exam: Symmetry, color, texture, margins
• Dermoscopy: To rule out melanoma or melanocytic lesions
• Wood’s lamp: To detect depth (epidermal vs dermal pigmentation)
• Biopsy: Rare, unless suspecting malignancy

3. Treatment of Hyperpigmentation

A. Topical Agents (use with caution in genital area):

• Depigmenting agents:
  • Kojic acid (1–2%)
  • Arbutin
  • Azelaic acid (10–20%)
  • Niacinamide (2–5%)
  • Glycolic acid (very low % only)
• Mild retinoids: Tretinoin 0.025% (not for mucosa, limit use)

B. Chemical Peels (performed by trained aesthetic physicians):

• Mandelic acid 20–30%
• Lactic acid 10–30%
• TCA 10% (only on outer labia/pubic skin; NOT mucosa)

C. Laser Treatments:

• Q-switched Nd:YAG 1064 nm (low fluence): Toning effect
• 4–6 sessions at 3–4 week intervals

D. PRP + Microneedling:

• Safe for pigmentation and rejuvenation
• Enhances melanocyte regulation and skin remodeling

E. Lifestyle & Preventive Measures:

• Weight reduction
• Loose cotton clothing
• Avoid friction, shaving, harsh soaps

SECTION B: Laxity of Intimate Areas

1. Causes of Genital Laxity

• Vaginal childbirth
• Aging (collagen degradation)
• Hormonal decline (menopause)
• Weight fluctuations
• Pelvic floor weakness

2. Clinical Assessment

• Subjective complaints: “looseness,” dryness, decreased sensation
• Physical examination
• Vaginal laxity questionnaires
• Gynecological evaluation if prolapse suspected

3. Treatment Modalities

A. Non-Surgical Aesthetic Treatments

Procedure	Mechanism	Frequency
Fractional CO2 or Er:YAG Laser	Stimulates neocollagenesis & tightening	Monthly x 3
Radiofrequency (RF)	Heats dermis → collagen remodeling	Weekly x 4–6
High-Intensity Focused Ultrasound (HIFU)	Deep tightening	Once every 3–6 months
PRP (Platelet-Rich Plasma)	Stimulates fibroblasts, neovascularization	Monthly x 3–4
Microneedling + RF or PRP	Combined tightening + collagen remodeling	Monthly

B. Adjunctive Measures

• Vaginal moisturizers & lubricants
• Pelvic floor physiotherapy (Kegel exercises)
• Estrogen creams (in postmenopausal women – gynecology-supervised)

SECTION C: Dermatoses of Intimate Skin

1. Common Conditions

Disease	Features	Diagnosis	Treatment
Lichen Sclerosus	White, thin plaques, itching, fissures	Clinical ± biopsy	Topical clobetasol, PRP
Lichen Planus	Purplish erosions, painful ulcers	Clinical ± histopathology	Topical steroids, Tacrolimus
Frictional Dermatitis	Redness, burning, hyperpigmentation	History + exam	Barrier creams, antifungals
Candidiasis	White curd-like discharge, erythema	KOH smear	Fluconazole, topical antifungals
Vulvar Melanosis	Flat brown macules, asymptomatic	Dermoscopy	Cosmetic laser if desired
Hidradenitis Suppurativa	Recurrent boils, sinus tracts	Clinical staging	Antibiotics, surgery, laser
Contact Dermatitis	Itching, redness after products	Patch testing	Discontinue agent, topical steroid

2. Diagnosis Tips

• Examine under good lighting with privacy & consent
• Dermoscopy can help rule out neoplastic conditions
• Use biopsy selectively (e.g., if melanoma or VIN suspected)
• Consider STD screen in persistent ulcerations

3. Treatment Principles

• Gentle cleansing: pH-balanced intimate washes
• Barrier repair: petroleum jelly, ceramide-based creams
• Anti-inflammatory agents: steroids, tacrolimus, pimecrolimus
• Antifungals/antibiotics: based on culture or clinical suspicion
• Aesthetic intervention: laser or PRP for resistant pigment or scars

Clinical Pearls

• Treat the underlying cause first before cosmetic management.
• Always start with least invasive, most biocompatible options in genital skin.
• Educate patients on hygiene, product use, hair removal methods, and clothing.
• Consider psychosexual counseling in patients with body-image concerns.

Summary

Condition	Diagnosis	Aesthetic Treatment
Hyperpigmentation	Clinical + Wood’s lamp	Peels, PRP, lasers
Laxity	History + gynecological exam	RF, CO2 laser, PRP
Dermatoses	Clinical ± biopsy	Topicals, PRP, scar therapy

Vulvar Melanosis

1. Introduction

• Definition of Vulvar Melanosis
• Epidemiology and prevalence
• Importance in aesthetic dermatology & sexual medicine
• Clinical relevance: differentiation from malignant lesions
• Patient concern: cosmetic and psychological impact

2. Anatomy and Physiology of the Vulvar Skin

• Vulvar skin histology
• Distribution of melanocytes in the genital area
• Hormonal influence on pigmentation
• Areas most affected (labia minora, majora, perineum)

3. Etiopathogenesis

• Primary (Idiopathic Vulvar Melanosis)
• Secondary (Post-inflammatory hyperpigmentation, chronic irritation, lichen planus, etc.)
• Role of hormones, trauma, and inflammation
• Genetic predisposition

4. Clinical Presentation

• Asymptomatic flat, brown to black macules/patches
• Unilateral or bilateral, irregular but well-defined borders
• Color range: light brown to slate gray
• Sites: labia minora, vestibule, introitus, perineum

Differential Diagnosis

• Vulvar melanoma (most critical to differentiate)
• Lichen planus pigmentosus
• Fixed drug eruption
• Post-inflammatory pigmentation
• Lentigo/simple lentiginosis
• Nevus (junctional or compound)

5. Diagnostic Evaluation

• Clinical Examination: Dermatoscopic evaluation
• Biopsy/Histopathology: Indications for biopsy to rule out melanoma
  • Atypical features: asymmetry, rapid growth, variegated color
• Histological features: increased melanin in basal layer without atypia

6. Aesthetic and Medical Management

a. Counseling

• Benign nature of the condition
• Psychological support for aesthetic concerns
• Importance of avoiding unnecessary invasive procedures

b. Topical Treatments

• Hydroquinone 2–4% (limited and cautious use)
• Kojic acid, azelaic acid, arbutin, niacinamide
• Combination depigmenting creams (under supervision)

c. Laser Treatment

• Q-switched Nd:YAG (1064 nm) – Gold standard
• Fractional CO2 laser – cautious and selective use
• Risk of PIH (post-inflammatory hyperpigmentation)

d. Microneedling + Topicals

• Microneedling with depigmenting agents (e.g., tranexamic acid)

7. Complications & Considerations

• PIH due to aggressive treatment
• Skin barrier compromise
• Allergic/irritant reactions from topical agents
• Risk of misdiagnosing melanoma

8. Follow-Up and Monitoring

• Regular photographic documentation
• Repeat dermoscopy in 6–12 months
• Re-biopsy if any sudden change in color, size, or border

9. Academic Case Discussion

• Present real or simulated patient cases:
  • History, dermoscopic image, biopsy report, treatment approach
  • Ask students to differentiate from melanoma
  • Decision-making in choosing aesthetic procedures

10. Key Takeaways for MBBS Aesthetic Students

• Vulvar melanosis is benign but requires expert evaluation
• Dermoscopy and histopathology are key for diagnostic confidence
• Treatment is optional and aesthetic-focused
• Laser and microneedling are advanced approaches
• Importance of multidisciplinary approach – Dermatology, Gynecology, Psychology

📚 Suggested Reading / References

• Bolognia’s Dermatology, Chapter on Pigmentary Disorders
• Fitzpatrick’s Dermatology in General Medicine
• Journal of Clinical and Aesthetic Dermatology (JCAD)
• Vulvar Disorders Guidelines – ACOG, AAD

Lichen Sclerosus

1. Introduction

• Definition: Chronic, inflammatory dermatosis predominantly affecting anogenital skin
• Epidemiology: Bimodal distribution – prepubertal girls and postmenopausal women
• Relevance in aesthetic dermatology, gynecology & sexology
• Chronicity, scarring, and quality of life impact

2. Etiology & Pathogenesis

• Etiology: Idiopathic, but multiple contributing factors:
  • Autoimmune association (thyroiditis, vitiligo, diabetes)
  • Genetic susceptibility
  • Hormonal factors (low estrogen)
  • Local trauma (Koebner phenomenon)
• Pathogenesis: T-cell mediated chronic inflammation → epithelial atrophy & sclerosis

3. Clinical Features

a. Symptoms

• Itching (intense), burning, soreness
• Dyspareunia (pain during intercourse)
• Dysuria or painful defecation (in severe cases)

b. Signs

• Porcelain-white plaques
• Thinning of skin, wrinkling, fissuring
• Atrophic labia minora, clitoral hood involvement
• Telangiectasia, purpura (due to skin fragility)
• Fusion/scarring leading to anatomical distortion

c. Sites Affected

• Vulva, perineum, perianal region (forming “figure-of-8” or “keyhole” pattern)
• Extragenital LS (rare – trunk, upper limbs)

4. Complications

• Scarring: Labial fusion, clitoral phimosis, introital narrowing
• Functional impairment: Painful intercourse, urinary obstruction
• Malignant transformation: ~5% risk of vulvar squamous cell carcinoma (long-standing cases)
• Psychological distress due to chronicity, sexual dysfunction, and appearance

5. Diagnosis

a. Clinical Diagnosis – Based on history and classical morphology

b. Dermatoscopic Features:

• White structureless areas
• Telangiectasia, follicular plugging

c. Histopathology (when needed):

• Epidermal atrophy
• Basal cell degeneration
• Homogenized collagen in upper dermis
• Band-like lymphocytic infiltrate

d. Indications for Biopsy:

• Atypical lesions
• Suspicion of malignancy
• Poor response to therapy

6. Management Approach

a. Patient Counseling

• Chronic, relapsing course
• Importance of adherence to treatment
• Monitoring for complications

b. Medical Treatment

• Topical High-potency Corticosteroids:
  • Clobetasol propionate 0.05% ointment (first-line)
  • Application protocol: Daily × 4 weeks → taper
• Topical Calcineurin Inhibitors:
  • Tacrolimus/pimecrolimus for maintenance (off-label)
• Other Options:
  • Topical estrogen (in postmenopausal)
  • Oral retinoids (in resistant cases)
  • Phototherapy (narrowband UVB)

7. Aesthetic & Functional Interventions

a. PRP (Platelet-Rich Plasma):

• Emerging therapy for vulvar rejuvenation
• Promotes tissue regeneration & reduces symptoms

b. Laser Therapy (Selective Use):

• Fractional CO₂ laser
• Improves vulvar texture, flexibility, dyspareunia

c. Surgical Management (Advanced Cases):

• Lysis of adhesions
• Introital widening
• Vulvectomy (for malignant transformation)

8. Follow-Up and Monitoring

• Regular follow-up every 3–6 months
• Monitor for malignant transformation signs (new nodules, bleeding, non-healing ulcers)
• Long-term use of maintenance therapy to prevent flares

9. Differential Diagnoses

• Lichen planus
• Vulvar intraepithelial neoplasia (VIN)
• Chronic candidiasis
• Vulvar atrophy (senile)
• Vitiligo (non-inflammatory depigmentation)

10. Academic Case Discussion

• Case 1: A postmenopausal woman with chronic itching and white vulvar plaques
• Case 2: Prepubertal girl with anal-vulvar itching and scarring
• Evaluate based on history, examination, biopsy, and develop treatment plan
• Emphasis on counseling, aesthetics, and long-term follow-up

11. Key Points for MBBS Aesthetic Academic Students

• LS is chronic, inflammatory and can lead to anatomical, functional, and psychological consequences
• Early diagnosis and corticosteroid therapy prevent scarring and cancer
• Aesthetic interventions (PRP, laser) can improve patient comfort and cosmetic outcomes
• Multidisciplinary care: Dermatology, Gynecology, Psychology, Aesthetic Medicine

📚 Recommended References

• Fitzpatrick’s Dermatology in General Medicine
• Bolognia: Dermatology – Vulvar Disorders
• ACOG Guidelines on Vulvar Skin Disorders
• British Association of Dermatologists Patient Information Leaflet
• Journal of the European Academy of Dermatology and Venereology (JEADV)

Frictional Pigmentation

 

 

1. Introduction

• Definition: Chronic localized hyperpigmentation caused by repeated friction, pressure, or irritation on the skin
• Importance: Common in South Asian and darker skin types
• Relevance in aesthetic dermatology, particularly in skin of color patients
• Aesthetic concern due to disfigurement, especially in exposed or intimate areas

2. Etiopathogenesis

• Repeated friction → epidermal hyperplasia → increased melanogenesis
• Mechanical triggers:
  • Tight clothing (waistbands, undergarments, brassieres)
  • Rubbing from belts, sandals, hijab/veil edges
  • Intertriginous friction: thighs, axilla, groin, neck folds
  • Cosmetic practices: loofahs, scrubbing
• Role of sweat, obesity, poor hygiene, heat
• Melanocyte stimulation by low-grade trauma → persistent post-inflammatory hyperpigmentation (PIH)

3. Common Clinical Sites

• Nape of the neck
• Inner thighs
• Axillae
• Groin/genital folds
• Abdomen (waistband area)
• Ankles (from footwear straps)
• Underarms, inframammary area (in females)

4. Clinical Features

• Hyperpigmented, ill-defined, symmetric or asymmetric patches
• Brown to grayish-black coloration
• No scaling, no induration
• Usually asymptomatic (may be mildly itchy if irritation persists)

5. Differential Diagnosis

Condition	Key Differentiators
Acanthosis Nigricans	Velvety texture, insulin resistance association
Post-inflammatory hyperpigmentation	Follows eczema, infection, or trauma
Lichen planus pigmentosus	Ashy-gray, inflammatory history, lichen planus elsewhere
Dermatosis Papulosa Nigra (DPN)	Papular lesions
Lichen simplex chronicus	Thickened skin due to chronic scratching
Fixed drug eruption	Recurrent at same site, dusky patches post-drug exposure

6. Diagnostic Evaluation

• Clinical diagnosis (primarily visual inspection)
• Dermoscopy: May show pigment network, accentuated skin markings
• Wood’s lamp: To assess epidermal vs dermal pigmentation
• Skin biopsy: Rarely needed; shows basal layer hyperpigmentation and epidermal thickening

7. Management Approach

a. Elimination of Cause

• Patient education: avoid tight clothing, change friction-causing habits
• Use soft fabrics, breathable undergarments
• Reduce friction in obese patients: weight loss counseling, anti-chafing powders

b. Topical Therapy

• Depigmenting agents:
  • Hydroquinone 2–4% (short-term use)
  • Kojic acid, azelaic acid, niacinamide
  • Alpha arbutin, licorice extract
• Keratolytic agents:
  • Lactic acid, glycolic acid (6–12%)
  • Urea-based creams
• Topical retinoids:
  • Tretinoin 0.025–0.05% (for thickened skin + pigmentation)

c. Adjunctive Treatments

• Sunscreen application – especially on exposed areas (e.g., neck)
• Barrier creams or moisturizers – reduce friction and repair skin barrier

8. Aesthetic Treatment Options

a. Chemical Peels

• Superficial peels (Mandelic, Lactic, Glycolic acid)
• Weekly or bi-weekly sessions over 6–8 weeks
• Caution in skin of color – avoid strong peels to reduce PIH risk

b. Laser Treatments

• Q-switched Nd:YAG 1064 nm – for dermal pigmentation
• Low-fluence sessions at intervals
• Risk: PIH if aggressive in darker skin types

c. Microneedling + Topical Depigmenting Agents

• Enhances penetration of actives like tranexamic acid or vitamin C
• Safer option for intimate or sensitive areas

9. Complications

• Psychological impact due to cosmetic disfigurement
• Long-standing pigmentation may be difficult to reverse
• Risk of treatment-induced PIH, especially with aggressive modalities

10. Follow-Up & Prognosis

• Reversible if friction is removed early
• Pigmentation fades over months with combined therapy
• Maintenance needed in recurrent friction-prone areas
• Periodic reassessment of cosmetic progress and patient satisfaction

11. Case Discussion & Clinical Scenarios

• Case 1: Obese female with inner thigh pigmentation from friction + tight leggings
• Case 2: Male patient with pigmentation over neck due to collar friction
• Case 3: Adolescent girl with dark underarms due to shaving and tight clothing
• Discuss diagnosis, treatment plan, and aesthetic counseling

12. Key Learning Points for MBBS Aesthetic Students

• Frictional pigmentation is common, benign, and preventable
• History and inspection are key to diagnosis
• Topical and aesthetic treatments must be selected carefully in darker skin types
• Counseling on habits and lifestyle is essential
• Multimodal therapy (peels, topicals, microneedling) yields best results

Advance Diploma Course in Aesthetic Dermatology & Sexology

• Day 02
•  Clinical Sexology – Sexual Dysfunction & Male & Female Sexual Dysfunctions – ED, PE, Low Libido, Vaginal Dryness
• Hormone Balancing, PRP
• O-Shot, P-Shot
• Role of Cosmeceuticals & Nutra-pharma in Sexual Wellness

Clinical Sexology

Module 1: Sexual Health – Anatomy & Physiology

• Male and female sexual anatomy (penis, clitoris, vagina, erectile tissue, pelvic floor)
• Neurovascular and hormonal regulation
• Hormones involved: Testosterone, Estrogen, Oxytocin, Dopamine
• Human sexual response cycle (Desire → Arousal → Orgasm → Resolution)

Module 2: Classification & Diagnosis of Sexual Dysfunction

• WHO / DSM-5 / ICD-11 criteria
• Types of dysfunction:
  • Male: ED, PE, Hypoactive Sexual Desire
  • Female: FSIAD, Vaginal Atrophy, Anorgasmia
• Biopsychosocial model of dysfunction
• Sexual history taking (PLISSIT model)
• Patient questionnaires: IIEF, FSFI

Men Erectile Dysfunction (ED)

Course Structure:

Module	Topic
1	Introduction & Physiology of Penile Erection
2	Epidemiology & Classification of Erectile Dysfunction
3	Etiology: Organic, Psychological & Mixed
4	History Taking & Clinical Evaluation
5	Investigations & Diagnostic Tools
6	Pharmacological Management
7	Lifestyle & Psychosexual Therapy
8	Aesthetic & Regenerative Interventions

Module-wise Breakdown:

 Module 1: Introduction & Physiology of Penile Erection

• Anatomy of penis: Corpora cavernosa, corpus spongiosum, vascular supply
• Neurovascular regulation of erection
• Role of NO (Nitric Oxide) and cGMP pathway
• Endocrinology: Role of testosterone and other hormones
• Types of erection: Reflexogenic, Psychogenic, Nocturnal

 Module 2: Epidemiology & Classification

• Global and regional prevalence (including South Asia)
• Classification:
  • Organic (vascular, neurogenic, hormonal, drug-induced)
  • Psychogenic (anxiety, relationship issues, trauma)
  • Mixed ED
• Associated comorbidities: Diabetes, CVD, obesity, smoking

 Module 3: Causes of Erectile Dysfunction

• Vascular: Atherosclerosis, endothelial dysfunction
• Neurological: Spinal cord injuries, multiple sclerosis
• Endocrine: Hypogonadism, thyroid dysfunction, hyperprolactinemia
• Drug-induced: Antihypertensives, antidepressants, alcohol, smoking
• Psychological: Performance anxiety, depression
• Post-surgical or trauma-related

 Module 4: History Taking & Clinical Evaluation

• Sensitive patient communication techniques
• Sexual health history (IIEF – International Index of Erectile Function)
• Physical examination: Secondary sexual characteristics, penile/scrotal exam
• Mental health assessment
• Screening for cardiovascular risk

Module 5: Investigations & Diagnostic Tools

• Blood tests: Testosterone, LH, FSH, Prolactin, TSH, HbA1c, Lipid profile
• Penile Doppler ultrasound with injection test
• Nocturnal Penile Tumescence (NPT) test
• Psychological evaluation if needed
• Penile biothesiometry (optional)

Module 6: Pharmacological Treatment

• PDE-5 Inhibitors: Sildenafil, Tadalafil, Vardenafil
  • Mechanism of action
  • Dosing guidelines
  • Contraindications (e.g., nitrate use)
  • Side effects
• Intracavernosal Injections: Alprostadil
• Vacuum Erection Devices (VED)
• Hormone Replacement Therapy (TRT) for hypogonadism
  • Indications and risks
  • Monitoring protocols

Module 7: Lifestyle & Psychosexual Counseling

• Lifestyle modifications:
  • Diet, weight loss, smoking cessation
  • Regular aerobic exercise
• Stress reduction: Meditation, yoga, counseling
• Psychosexual therapy and couple’s therapy
• Addressing unrealistic expectations
• Referral to psychiatrist/sex therapist if needed

Module 8: Aesthetic & Regenerative Interventions

8.1 Platelet-Rich Plasma (PRP) – “P-Shot”

• Mechanism: Angiogenesis, nerve regeneration
• Indications and outcomes
• Procedure steps, safety, and aftercare

8.2 Low-Intensity Shockwave Therapy (LI-ESWT)

• Mechanism: Neovascularization, smooth muscle repair
• Evidence-based outcomes
• Protocol and machine settings

8.3 Stem Cell Therapy & Exosomes (Advanced/Research-level)

• Emerging therapies
• Ethical and legal considerations

8.4 Aesthetic Counselling

• Addressing body image, genital self-perception
• Penile enhancement myths vs reality

Female Sexual Dysfunction (ED)

Course Objectives:

By the end of the course, MBBS students will be able to:

• Understand the anatomy and physiology of female sexual response
• Classify and diagnose different types of female sexual dysfunctions
• Take detailed sexual and psychosocial histories with sensitivity
• Conduct relevant investigations for hormonal or structural issues
• Explore conventional, hormonal, psychological, and aesthetic treatments
• Incorporate PRP, laser, fillers, and other regenerative techniques into management

Course Structure:

Module	Topic
1	Female Sexual Anatomy & Physiology
2	Sexual Response Cycle & Hormonal Regulation
3	Classification of Female Sexual Dysfunctions
4	History Taking, Assessment & Diagnosis
5	Psychosexual Aspects & Counseling
6	Pharmacological & Hormonal Treatments
7	Aesthetic & Regenerative Treatments

 

Module 1: Female Sexual Anatomy & Physiology

• Anatomy: Clitoris, G-spot, A-spot, vagina, vulva, labia, Skene & Bartholin glands
• Nerve supply (pudendal, pelvic) and blood supply
• Pelvic floor musculature and its role in orgasm and arousal
• Physiology of arousal, lubrication, engorgement, and orgasm

 Module 2: Sexual Response Cycle & Hormonal Regulation

• Phases: Desire → Arousal → Plateau → Orgasm → Resolution
• Role of hormones:
  • Estrogen: vaginal health, lubrication
  • Testosterone: libido and sexual drive
  • Oxytocin & dopamine: bonding and pleasure
• Menopause and its impact on sexual function

Module 3: Classification of Female Sexual Dysfunctions

As per DSM-5 and ICD-11:

• Female Sexual Interest/Arousal Disorder (FSIAD)
• Female Orgasmic Disorder
• Genitopelvic Pain/Penetration Disorder (GPPPD)
• Vaginismus
• Vulvodynia and dyspareunia
• Hypoactive Sexual Desire Disorder (HSDD)

Module 4: History Taking, Assessment & Diagnosis

• Sexual history using PLISSIT and BETTER models
• Psychosocial factors: relationship status, trauma history, stress
• Physical examination: vaginal atrophy, dryness, tone
• Use of validated tools:
  • FSFI (Female Sexual Function Index)
  • GRISS (Golombok-Rust Inventory of Sexual Satisfaction)
• Hormonal testing: Estradiol, Testosterone, FSH, LH, SHBG, TSH
• Vaginal pH, elasticity assessment

Module 5: Psychosexual Aspects & Counseling

• Psychosocial contributors: fear, trauma, self-image, relationship issues
• Communication training: empathetic, non-judgmental consultations
• Role of cognitive-behavioral therapy (CBT)
• Couples therapy basics
• Referral pathways: Psychologist, sex therapist, gynecologist

Module 6: Pharmacological & Hormonal Management

A. Desire Disorders

• Flibanserin (FDA-approved for HSDD)
• Bremelanotide (injectable on-demand drug for HSDD)
• Off-label testosterone therapy (gel/cream)
• Herbal supplements: maca root, ginseng, tribulus terrestris

B. Arousal & Orgasm Disorders

• Sildenafil (experimental use)
• Pelvic floor therapy, vibrator therapy
• Lubricants & vaginal moisturizers

C. Vaginal Dryness & Dyspareunia

• Topical estrogen cream or rings
• DHEA vaginal suppositories
• Hyaluronic acid gel

Module 7: Aesthetic & Regenerative Treatments

A. Platelet-Rich Plasma (PRP) – O-Shot®

• Mechanism: regeneration of nerves, increase in lubrication and sensitivity
• Procedure protocol and aftercare
• Indications: Low libido, orgasmic dysfunction, vaginal dryness

B. Laser Vaginal Rejuvenation (CO₂/Er:YAG Laser)

• Indications: Vaginal atrophy, laxity, dryness, dyspareunia
• Mechanism: Collagen remodeling, improved elasticity
• Procedure steps and safety considerations

C. Vaginal Fillers

• Hyaluronic acid-based fillers for hydration and tone
• G-spot & A-spot enhancement techniques
• Precautions and side effects

D. Botulinum Toxin for Vaginismus

• Use of Botox in pelvic floor hypertonicity
• Indications and dosing

E. Radiofrequency & Ultrasound Therapy

• For vaginal tightening and urinary incontinence
• Combined benefits for sexual function

Module 8: Case-Based Discussions & Clinical Integration

• Case 1: Perimenopausal woman with dryness and low libido
• Case 2: Young woman with vaginismus and marital stress
• Case 3: Orgasmic dysfunction with antidepressant use
• Role-play on sensitive counseling and patient consent
• Discussion on ethical practice, informed consent, and privacy

 

 

Low Libido in Females

 

• Understand the biological, psychological, and social determinants of sexual desire in women
• Diagnose Hypoactive Sexual Desire Disorder (HSDD) and distinguish it from other dysfunctions
• Evaluate hormonal, physiological, and relational contributors
• Apply pharmacological, psychosexual, and aesthetic treatment strategies
• Communicate effectively and ethically about female sexual health
• Incorporate regenerative & aesthetic medicine tools like PRP, hormonal creams, and laser therapy

 Course Outline:

Module	Topic
1	Female Sexual Desire – Anatomy & Physiology
2	Epidemiology & Classification of Low Libido
3	Causes of Low Libido: Multifactorial Model
4	Clinical Assessment & Diagnostic Tools
5	Psychological & Relationship Factors
6	Medical & Hormonal Management
7	Aesthetic & Regenerative Interventions

Module-wise Detailed Content:

Module 1: Female Sexual Desire – Anatomy & Physiology

• Central and peripheral regulation of libido
• Role of brain regions: limbic system, hypothalamus
• Neurochemical pathways: dopamine, serotonin, oxytocin
• Endocrine factors: estrogen, progesterone, testosterone, DHEA
• Role of clitoris, vaginal innervation, and genital sensory input

Module 2: Epidemiology & Classification

• Prevalence of Hypoactive Sexual Desire Disorder (HSDD)
• DSM-5 vs ICD-11 classification
• Types:
  • Acquired vs lifelong
  • Generalized vs situational
• Impact on quality of life and relationships
• Cultural and regional perspectives, including South Asia

Module 3: Causes of Low Libido

A. Biological Factors

• Hormonal imbalance (low estrogen/testosterone)
• Menopause and perimenopause
• Thyroid dysfunction, chronic illness, anemia
• Medications: SSRIs, contraceptives, antihypertensives

B. Psychological Factors

• Depression, anxiety
• Past trauma or sexual abuse
• Negative body image, low self-esteem

C. Relational & Social Factors

• Partner issues
• Lack of emotional connection
• Cultural shame or stigma
• Parenting and fatigue

Module 4: Clinical Assessment & Diagnosis

• Taking a detailed and sensitive sexual history
• Use of validated tools:
  • FSFI (Female Sexual Function Index)
  • Decreased Sexual Desire Screener (DSDS)
• Hormonal tests: Testosterone, estradiol, SHBG, DHEA, TSH
• Rule out other sexual dysfunctions: arousal, orgasm, pain
• General and pelvic examination
• Mental health and relationship screening

Module 5: Psychological & Relationship Counseling

• Basic sex therapy and CBT approaches
• PLISSIT model (Permission, Limited Information, Specific Suggestions, Intensive Therapy)
• Addressing myths, guilt, and communication barriers
• Couple therapy
• Stress management techniques

Module 6: Medical & Hormonal Management

A. Pharmacological

• Flibanserin (Addyi): serotonin receptor modulator
  • Indicated in premenopausal HSDD
  • Side effects, contraindications
• Bremelanotide (Vyleesi): melanocortin receptor agonist
  • On-demand injectable treatment for HSDD

B. Hormonal Therapy

• Testosterone therapy (transdermal gel or cream)
  • Off-label use in postmenopausal women
  • Monitoring protocol
• Estrogen therapy (local vaginal rings or creams)
• DHEA intravaginal suppositories

 Module 7: Aesthetic & Regenerative Medicine Options

A. PRP (O-Shot®) – Platelet-Rich Plasma

• Increases sensitivity and arousal
• Protocol, safety, consent, and outcomes
• Indicated in libido loss, orgasmic dysfunction

B. Laser Vaginal Rejuvenation

• CO₂ or Er:YAG laser
• Enhances lubrication, improves elasticity, improves blood flow
• Indirect benefit on desire and comfort

C. Radiofrequency & Ultrasound Therapy

• Improves pelvic floor tone and sexual satisfaction

D. Botox (in special cases)

• For vaginismus contributing to secondary low desire

E. Aesthetic Counseling

• Genital appearance and body image impact on desire
• Vulvar skin treatments, pigmentation reduction

✅ Module 8: Case-Based Learning, Communication & Ethics

• Case 1: Young woman on SSRI with HSDD
• Case 2: Postmenopausal woman with low libido and vaginal dryness
• Case 3: Couple in therapy with mismatched desire levels
• Teaching students empathetic communication and cultural sensitivity
• Legal and ethical considerations in aesthetic sexology practice
• Informed consent and confidentiality protocol

Vaginal Dryness

Course Objectives:

Upon completion, students will be able to:

• Understand the anatomy and physiology of vaginal lubrication
• Identify causes of vaginal dryness across different life stages
• Diagnose Genitourinary Syndrome of Menopause (GSM) and related conditions
• Implement both hormonal and non-hormonal medical treatments
• Apply regenerative and aesthetic techniques (e.g., laser, PRP, RF)
• Communicate with patients ethically and sensitively

Course Modules:

Module No.	Topic
1	Anatomy & Physiology of Vaginal Lubrication
2	Causes & Classification of Vaginal Dryness
3	History Taking & Diagnostic Evaluation
4	Hormonal & Medical Management
5	Non-Hormonal and Lifestyle Approaches
6	Aesthetic & Regenerative Interventions
7	Psychosexual Impact & Communication
8	Case Studies and OSCE Practice

 

Module-Wise Details:

Module 1: Anatomy & Physiology

• Vaginal wall structure and secretory glands (Bartholin, Skene)
• Estrogen’s role in maintaining vaginal moisture and elasticity
• Neurovascular supply and sensory innervation
• Role of vaginal microbiome and pH balance

Module 2: Causes & Classification

• Life-stage Related:
  • Menopause, perimenopause (GSM)
  • Postpartum, lactation
• Medical/Pharmacological:
  • SSRIs, antihistamines, chemotherapy
  • Low-estrogen contraceptives
• Pathological:
  • Sjögren’s syndrome, lichen sclerosus
  • Atrophic vaginitis
• Lifestyle/Psychogenic:
  • Smoking, dehydration, stress
  • Past trauma and relationship issues

Module 3: Clinical Assessment

• Comprehensive sexual and gynecologic history
• Use of tools: FSFI (Female Sexual Function Index), GSM Questionnaire
• Vaginal pH, elasticity, and moisture evaluation
• Pelvic exam & inspection
• Hormone testing: Estradiol, FSH, DHEA, SHBG
• Differential diagnosis with infections, dermatological conditions

Module 4: Hormonal & Pharmacologic Treatment

• Local Estrogen Therapy:
  • Creams, rings, vaginal tablets (estradiol, estriol)
  • Dosing guidelines, follow-up care
  • Contraindications: hormone-sensitive cancers
• Systemic Hormone Therapy (HRT):
  • When combined with hot flashes or GSM
  • Risk-benefit assessment
• Other Hormonal Agents:
  • DHEA suppositories (FDA-approved)
  • Testosterone therapy (off-label for libido)

 Module 5: Non-Hormonal & Lifestyle Interventions

• Vaginal moisturizers vs lubricants (water/silicone/oil-based)
• Hyaluronic acid vaginal gels
• Aloe vera, sea buckthorn, plant estrogens
• Intimacy exercises and sexual wellness routines
• Hydration, smoking cessation, regular sexual activity

Module 6: Aesthetic & Regenerative Interventions

A. Laser Vaginal Rejuvenation (CO₂ or Er:YAG)

• Enhances collagen and mucosal regeneration
• Effective for GSM and vaginal dryness
• Procedure steps, patient selection, outcomes

B. PRP (Platelet-Rich Plasma – O-Shot®)

• Enhances nerve sensitivity and vascularity
• Step-by-step injection technique
• Results and patient education

C. Radiofrequency (RF) & Ultrasound

• Non-invasive, improves tissue hydration and elasticity

D. Hyaluronic Acid Fillers (experimental use)

• Improves hydration and volume in severe atrophic cases

Module 7: Psychosexual Impact & Counseling

• Impact of dryness on intimacy and self-esteem
• Counseling techniques: PLISSIT model
• Culturally sensitive communication
• Partner involvement and education
• Ethical principles: confidentiality, consent, non-judgment

• Hormone Balancing, PRP
• O-Shot, P-Shot

Course Objectives:

By the end of the course, students will be able to:

• Understand hormonal regulation in male and female sexual function
• Diagnose and manage hormone imbalances clinically and ethically
• Describe the principles and mechanisms of PRP therapy
• Perform or observe the P-Shot® procedure for male sexual enhancement
• Evaluate patients for suitability and consent for regenerative sexual therapies
• Integrate hormonal and PRP-based approaches for ED, low libido, and penile rejuvenation

Course Structure:

Module	Topic
1	Introduction to Hormone Balancing
2	Male & Female Hormonal Pathways in Sexual Health
3	Clinical Assessment & Diagnostic Workup
4	Hormone Replacement Therapy (HRT) – Male & Female
5	Introduction to PRP in Aesthetic & Sexual Medicine
6	P-Shot®: Indications, Procedure, Outcomes
7	Ethics, Consent & Medicolegal Considerations
8	Case Studies, OSCE & Clinical Simulation

 

 Module-Wise Details:

Module 1: Introduction to Hormone Balancing

• Role of hormones in sexual function, libido, energy, and aging
• Concept of “Hormone Optimization” in aesthetic practice
• Differences between conventional HRT and bioidentical hormone therapy
• Hormone decline with age – “andropause” and “menopause”

Module 2: Sexual Hormonal Pathways

A. In Males

• Hypothalamic-Pituitary-Gonadal (HPG) Axis
• Testosterone (free & total), DHT, LH, FSH, SHBG
• Cortisol and thyroid interplay
• Impact on libido, erection, energy

B. In Females

• Estrogen, Progesterone, Testosterone
• DHEA, cortisol, thyroid profile
• Role in vaginal health, libido, mood

Module 3: Clinical Assessment & Workup

• Full sexual and fatigue history
• Hormone panel interpretation
• FSFI, IIEF scores (for sexual function)
• Saliva, serum, and urine hormone testing
• Nutritional and lifestyle assessment

Module 4: Hormone Replacement Therapy (HRT)

For Males:

• Testosterone therapy: gels, injections, pellets
• Monitoring PSA, hematocrit, estradiol
• Risks: fertility suppression, polycythemia, gynecomastia

For Females:

• Estrogen (oral, transdermal, vaginal), Progesterone
• DHEA, testosterone cream (compounded, off-label use)
• Managing GSM, libido loss, mood changes

 Module 5: Introduction to PRP in Sexual & Aesthetic Medicine

• PRP composition: platelets, growth factors, cytokines
• Biological effects: angiogenesis, nerve regeneration, collagen stimulation
• PRP preparation protocol: double-spin method
• Safety and efficacy, autologous nature

Module 6: P-Shot® (Priapus Shot) – Male Sexual Enhancement

• Indications:
  • Erectile Dysfunction (mild to moderate)
  • Penile girth enhancement
  • Peyronie’s disease
  • Sexual confidence/psychogenic ED
• Contraindications:
  • Active infection, bleeding disorders, unrealistic expectations
• Procedure Steps:
  • Consent and photography (if applicable)
  • Numbing cream and penile block
  • PRP extraction and activation
  • Intracavernosal injection technique (2–4 quadrants)
  • Post-care, vacuum device use, follow-up protocols
• Expected Outcomes & Timelines
• Clinical safety and complications (pain, swelling, rare fibrosis)

Module 7: Medicolegal & Ethical Considerations

• Informed consent documentation
• Off-label hormone use and PRP disclaimers
• Transparency in results and expectations
• Contraindications and ethics in sexual enhancement therapy

Cosmeceuticals & Nutra-pharma in Sexual Wellness

Course Objectives:

By the end of the course, students will be able to:

• Understand how nutraceuticals, herbal supplements, and cosmeceuticals influence sexual function
• Identify commonly used agents that enhance libido, erectile function, lubrication, and mood
• Understand the clinical evidence behind topical and ingestible formulations
• Advise patients ethically on complementary wellness strategies for sexual dysfunction
• Integrate nutra-pharma into aesthetic and sexual medicine practice safely and responsibly

Course Modules:

Module No.	Topic
1	Introduction to Sexual Wellness & Functional Aesthetics
2	Basics of Cosmeceuticals and Nutra-Pharma
3	Nutra-Pharma in Male Sexual Health
4	Nutra-Pharma in Female Sexual Health
5	Cosmeceutical Agents in Genital Aesthetics
6	Clinical Evidence & Safety
7	Counseling, Ethics & Regulation
8	OSCE + Case-Based Learning

 

Module-Wise Breakdown:

 Module 1: Introduction to Sexual Wellness

• Understanding “Sexual Wellness” as part of holistic aesthetic care
• Psychosomatic and hormonal aspects
• Integration with aesthetic gynecology/urology and lifestyle medicine

Module 2: Cosmeceuticals & Nutra-Pharma Basics

• Definitions and classifications:
  • Cosmeceuticals: Topical agents with pharmacological benefit
  • Nutra-pharma/Nutraceuticals: Oral supplements with therapeutic roles
• Mechanisms:
  • Boosting nitric oxide, testosterone, estrogen balance
  • Modulating stress, mood, inflammation, circulation

Module 3: Nutra-Pharma in Male Sexual Wellness

• L-Arginine & L-Citrulline – Vasodilation via nitric oxide
• Zinc, Vitamin D, Selenium – Testosterone regulation
• DHEA – Hormonal precursor
• Ashwagandha, Maca Root, Tongkat Ali – Adaptogens for libido and energy
• Tribulus terrestris, Fenugreek – Testosterone-boosting herbs
• Ginkgo biloba – Circulatory support for erectile health
• Omega-3 & Antioxidants – Sperm quality, penile endothelial function

Module 4: Nutra-Pharma in Female Sexual Wellness

• Isoflavones & Phytoestrogens – Estrogen support in peri/post-menopause
• Vitamin E, Omega-3, B-complex – Vaginal health & lubrication
• Maca, Damiana, Ginseng – Libido enhancement
• Evening Primrose Oil – Vaginal tissue hydration
• Magnesium, Adaptogens – Mood, stress & fatigue relief
• Role in managing Female Sexual Interest/Arousal Disorder (FSIAD)

Module 5: Cosmeceuticals in Genital Aesthetics

• Topical Hyaluronic Acid – For vulvar and vaginal hydration
• Niacinamide, Aloe Vera – Brightening, soothing vulvar pigmentation
• Lactic Acid & Prebiotic Washes – Maintaining healthy vaginal flora
• Natural lubricants vs synthetic agents – Cosmetic & sexual use
• Vaginal rejuvenation serums – Marketed ingredients and ethics
• Evaluation of safety, pH, and allergenicity

 Module 6: Evidence-Based Use & Clinical Studies

• Review of key RCTs and meta-analyses
• Clinical use guidelines (ISSM, AACE, etc.)
• Evidence grade for each major supplement and compound
• Limitations and placebo effects in sexual wellness trials

Module 7: Ethics, Patient Education & Regulation

• OTC vs prescription-based supplements
• Avoiding exaggerated claims (anti-aging, aphrodisiac)
• Adverse effects, herb-drug interactions
• Cultural sensitivity and sexual health communication
• Regulatory bodies: DGDA (BD), FDA (US), EMA (EU)

Module 8: OSCE & Case-Based Discussion

• Case 1: Young male with stress-related ED asking about Ashwagandha
• Case 2: Menopausal woman with vaginal dryness & libido loss interested in Maca and topical estrogen-free options
• Case 3: Male patient already on PDE5 inhibitors exploring PRP + L-arginine
• Practice:
  • Supplement counseling OSCE
  • Product label analysis

Evidence appraisal activity