The V word

The newest cast member of Real Housewives of Cheshire, Katie Alex, is on a mission to break the taboo surrounding women’s health and intimate rejuvenation. A specialist nurse with more than 10 years of medical experience, the ‘fairy godmother of Cheshire’ speaks to Aesthetic Medicine editor Anna Dobbie about using her public platform to help women struggling with intimate health issues.

AD: Congratulations on joining the cast!

KA: Thanks! It’s been a really good experience. Highs and lows, but incredible for my patients and ladies out there who need to know about what I do fora living.

AD: One of your first episodes was titled the Vagina Monologues, so straight away you were breaking the taboo and getting people talking. I noticed that the men all immediately left the room!

KA: They can’t deal with it. It’s so bizarre, isn’t it? At the end of the day, they’ve seen them before!

AD: Why do you think it is that people find it so hard to talk about?

KA: There’s a huge taboo, isn’t there? The vagina has been sexualised over time. I’ve been brought up to think ‘That’s private. That’s something that we don’t talk about.

That’s yours, just foryou to see. You have babies from it.’ People do seem to feel uncomfortable talking about their intimate area, but all women have one. What’s slightly frustrating is that we’re all happy to talk and be open about other aesthetic procedures. We might have had botulinum toxin, ora nip and a tuck here and there, but when it comes to the intimate area, that over 60% of women struggle with, people don’t particularly talk about it. I do wonder if that’s because we, speaking collectively as women, are ashamed because we are not aware that there is help out there. Perhaps, ifwe are suffering from laxity or incontinence, then we feel that that’s just something we have to live with. We don’t want people to know that we have laxity and are suffering from leaks and dribbles, we can’t go to the gym, and we can’t laugh at our friends without wetting ourselves. That’s a real shame because the more we talk about it, the more women will realise that we don’t have to rely on towels or risky invasive surgery to cure it.

AD: You started your career as a nurse – how did you come to specialise in aesthetics?

KA: I always wanted to work with women and babies, and I worked happily as a health visitor for seven years. During that time, I met hundreds of ladies, and there seemed to be a common theme: ‘the baby’s fine, but I’m not a hundred per cent’. It might be that they want to lose the baby weight but can’t, or they’ve been to the gym and are wetting themselves, or their intimate life isn’t like it used to be so their relationship is struggling, or sensation down there isn’t like it used to be. It was affecting women physically, sexually, and emotionally, and at the time, all I could advise was for the ladies to do pelvic floor exercises, orto see the GPora physiotherapist.

If they have a severe case of stress incontinence, they might have to go down the surgical route, which is quite often unsuccessful and comes with its risks and downtime. A lot of women would prefer to put up with the symptoms for the rest of their life rather than go down that route. That’s understandable – when you’ve got children, going through major surgery isn’t always feasible.

When I had my daughter in 2017, I had a year offto work on myself, so I studied facial and body aesthetics and started to invest in equipment, but I just wasn’t feeling it, if I’m honest. I knew that I wanted to do something that involved helping women, rather than just aesthetically. America is usually one step ahead ofus in innovative treatments and technology, so I did a bit of research.

I came across Ultra Femme 360 – the machine came to the UKthe year after it was launched in the states. Like a lot of women, I speak to, I was apprehensive about how radiofrequency could tighten a lady’s intimate area internally and externally, as well as provide this incredible aesthetic result, and cure stress incontinence. I trialled it and was speechless at the results. Quite immediately, the decision was made.

It sounds like a real cliché, but to change a lady’s life was incredible for me. To hear ladies coming to the clinic saying, ‘I’ve got a bag here and I haven’t got a pad in it.’ or ‘I don’t have to wear black leggings anymore, I can wear coloured leggings’ or ‘I’m back at the gym doing yoga classes and now I can do certain positions that I couldn’t before’ - it’s things like that, which we don’t even think about daily, which are huge for ladies.

AD: On the Vagina Monologues episode, it seemed that several ‘housewives’, despite having had aesthetic treatments, were unaware of the treatment area you work in. How do you plan on changing that?

KA: Through promotion and asking my ladies, if they feel comfortable, to talk about the procedure and spread the word. Part ofmy aim in doing the show was to spread the word. I work hard on social media, to educate ladies on the benefits. On my website, there are before and after pictures. I’ve found it incredibly difficult, especially on social media where a lot of ladies search for procedures and information. Because it’s intimate, and Instagram classifies it as a procedure that changes the body, I struggle to pay to promote it and have it sponsored. Straight away, it’s blocked and there’s no way around that, so I rely on other forms, like people following my page and doing this show.

Since it has been televised, I’ve had a lot of inquiries – probably three or four times more than I usually would – but generally speaking, my inquiries are from word of mouth, which is great because they are referrals from clients that it has worked on. Nine times out of 10, I’ve treated their friend or their auntie or their sister, which is great because I know that it’s working. I need to spread the word country-wide, but to be fair, a lot of my ladies aren’t particularly local.

I feel as though I’ve treated most of Cheshire because it is quite a close-knit community, but a lot of my ladies are travelling to me on the train orhave two to three-hour car journeys from all over the country. It’s a shame they have to travel that distance. The aim is to open a few hubs across the UK, but currently, they’re coming to me to have the treatment and it’s working.

AD: Have you had to turn any patients away who approached you due to your celebrity status, as opposed to a genuine need for treatment?

KA: I haven’t had anybody come to see me for my ‘celebrity status’. However, yes, I do turn ladies away. There is a list of contraindications. If a lady has a contraindication, I won’t treat them. We also have a long discussion about expectations, and during that conversation, I get an insight into their emotional well-being, and if anything is underlying. A couple of ladies have come to me who have been encouraged to attend by partners. Ethically and morally, that’s not them giving consent. Even if they sign the piece of paper, that’s not them choosing the treatment forthe right reason. As a nurse, I then must explain that to them and discuss the other options available to them, but unfortunately, send them away.

AD: You have been nicknamed the ‘fairy godmother of Cheshire” – how did that start?

KA: I’ve no idea how I got that nickname, but it’s stuck since day one. I would love to expand, don’t get me wrong, but it would involve employing other nurses, which gives me huge anxiety because I’m a total control freak and it’s my baby. I like to see my ladies myself because I know how I like to treat them. We have a lovely conversation, and hopefully, I make them feel relaxed. The common theme is ‘I can’t believe how quickly that treatment’s gone’ or, ‘I’ll miss coming to see you’, so I know that I have a good rapport with these ladies. Not saying that other nurses won’t, I will not employ anybody that I think would not meet my standards.

AD: How long would a typical treatment take and how many sessions would it take? KA: Every lady has three sessions, seven to 14 days apart. When we tighten the internal vaginal canal, that takes eight minutes. It’s radiofrequency, it’s not a laser or surgical, so there’s no downtime or discomfort. It doesn’t feel hot, it just feels warm. Externally, you have your labia majora, your labia minora, your clitoral hood, your introitus, and your perineum, which is three and a half minutes. Most ladies that come to me, if they are having internal, they’ll have external as well and vice versa, but some have one or the other, which is even shorter. The first session takes a little bit longer because I read through the medical history that they’ve already completed. We revisit the contraindications and I explain the treatment fully, then we go through the consent process and expectations. They’re generally with me for about 45 minutes for the first session, and then the subsequent two sessions, it is a case of them walking through the door, I ask them if anything’s changed medically since I last saw them, and, if they’re fit and healthy, we treat them again. Depending on the individual, the results last around 18 months. Some ladies come back to me after 12 months if they have a severe case of stress urinary incontinence, but I’ve had a lady go three years. It all depends on the severity of the original condition, lifestyle factors, age, levels of collagen, etc.

AD: What advice would you give to clinicians considering training in this field?

KA: Make sure you’re doing it for the right reasons – because you genuinely want to help these ladies. It’s imperative, that you’re personable and have great communication skills because let’s face it, there is a taboo. It can take patients a long time to pluck up the courage to come and see you. You must spend time with them, understand their concerns and be empathetic. If you’ve got those qualities and you’re a nurse, then go for it. I do a lot of training, as well as selfdirected research and study. I’m part of the European Society of Aesthetic Gynecology, so I’ll go to conferences and listen to consultants from all over the world talk about aesthetic gynaecology. You’ve got to be passionate about it before you take the plunge. 

AD: What is the future for vaginas? 

KA: We should all talk about them. I think that the majority of ladies will end up having this treatment when they realize that it is available because it is life-changing.