The shot heard (not quite) round the world

Money talks and, at up to $2500 per patient, it practically shouts.

No, this isn’t about the historical gunshot in Lexington, Massachusetts that marked the start of our revolutionary war of independence. I am referring to a shot much less revolutionary and much more controversial: the O-shot for women. What’s that you say? What is the O-shot?

If you are a woman and watch television, read women’s magazines, or access social media, you have probably come across the O (for orgasm)-shot. It is the brain child of Dr. Charles Runels, an internist with an extensive, somewhat checkered, resume best known for his use of platelet rich plasma (PRP) for everything from facial rejuvenation, also known as the Vampire Facelift, to enhancing sexual responsiveness with the O-shot and its male equivalent, the P (for priapism or penis)-shot.

The O-shot involves taking a woman’s own blood, spinning this in a centrifuge to isolate a small fraction of plasma with a high concentration of platelets, then injecting this into the clitoris and “G-spot” (anatomists and physicians still doubt the existence of this mythical spot which has never been pinpointed). Why platelets? Platelets are tiny fragments in the blood that play a crucial role in blood clotting. They are not true cells, lacking some fundamental structures, like a nucleus. They contain a great deal of growth factor hormone and this is supposed to be the source of their therapeutic properties, some of which sound a little too good to be true.

The goal of injecting PRP into these highly sensitive, erogenous areas is to enhance responsiveness in achieving an orgasm , as well as stronger orgasms. How does it do this? Well, no one really knows. You see, there are really no studies to determine how the O-shot works, or whether it truly works at all. In theory at least, the O-shot increases blood flow to the area and “regenerates” the tissues. “Regenerate” as used here sounds suspiciously like a weasel word; it sound great but means little without further explanation.

Clinical use of PRP is analogous to the use of stem cells. Both are supposed to have amazing regenerative effects but no one knows how they work, or how best to use them. While the science of both is intriguing and, in some cases, promising, the promotion and marketing of these products for a dizzying array of purposes has far outstripped the science and proof of efficacy in nearly all cases is lacking. That has not dissuaded practitioners like Runels and the many who have followed in his footsteps, paying him for the use of his trademarked “O-shot” label. Money talks and, at up to $2500 per patient, it practically shouts. How long the effect lasts is variable but is on the order of eight months to a year or so. Like Botox, the O-shot must be regularly repeated.

It is disconcerting how many supposedly legitimate gynecologists and other practitioners have leaped onto this particular bandwagon. When I Googled “O-shot”, I came up with 1.67 BILLION results!! Scrolling through the first few dozen pages of results to find unbiased articles in the mass of hits for practices extolling its virtues and offering the procedure, was like looking for the proverbial needle in a haystack. I did find one on the website for the National Center for Biotechnology Information (NCBI) of the National Library of Medicine, a usually reliable database. This was submitted by a pair of Egyptian gynecologists who appeared to accept the claims of the O-shot uncritically, drawing their conclusions from Runels himself. This isn’t science.

I have to hand it to Dr. Runels. Many promoters of questionable medical treatments are loathe to undergo those treatments themselves. Not him. He began by injecting his own penis with PRP  around 2010 and, as the story goes, the results were so impressive that his sexual partner insisted that he inject her and share the wealth. Reportedly, both reaped the benefits of explosive post-treatment sexual performance. Voila, the O-shot was born. Medicine advances in mysterious ways.

What about all the positive reviews from former patients? As I have repeatedly said, testimonials are an unreliable and unscientific way to assess medical treatments. This goes double for online reviews. For one thing, positive reviews ignore the large role that the placebo effect may play, especially in something which is as much mental as it is physical. For another, I suspect women for whom the O-shot doesn’t work are going to be slow to admit they wasted thousands of dollars on an unproven procedure. Despite claims that the O-shot is painless, with near immediate results, I have read several reviews of painful injections followed by painful swelling and tenderness for weeks afterwards. Procedures which claim near universal success with no downside make me skeptical as few invasive procedures, especially in an area so charged with psychological, psychosocial, emotional, relational, and sexual overtones, are so uniformly effective. In addition to its supposed sexual benefits, the O-shot is also touted as a treatment for urinary stress incontinence and certain vaginal conditions, such as lichen sclerosis. Again, there is little support for this from reputable studies.

Jen Gunter, MD

One staunch critic of Dr. Runels and the O-shot is Dr. Jen Gunter, a Canadian obstetrician/gynecologist and pain medicine specialist who takes Runels and his O-shot to task for failing to offer any data supporting the claims made for this procedure. She has uncovered a number of disturbing facts from his past, which are readily accessible. In 2009 he was disqualified as a clinical investigator by the FDA for injecting vulnerable subjects with an unnamed vaccine without approval for this from an institutional review board, a requirement for just about any study involving human subjects. The subjects in this case were homeless persons from a local shelter.

Also in 2009, he was fined $5000 by the Alabama State Board of Medical Examiners for misuse of hormone replacement therapy in two women and was restricted from prescribing hormones for two years. In addition, Dr. Gunter raises ethical concerns about Runels’ experimenting in the manner described above using his sexual partner, which appears to be a breach of the doctor/patient relationship according to the American Medical Association’s Code of Medical Ethics Opinion 9.1.1.

The topic of orgasms is one guaranteed to generate great interest. Given the poorly understood and often elusive nature of the female orgasm, it is not surprising that many women uncritically seek out methods to achieve what they believe they are entitled to and, for whatever reason, are not getting. Even for me, as a physician, it was difficult to sort through the hype from legitimate information regarding the O-shot. I fear what it will come down to is that women have to decide who is the more credible, Dr. Runels or Dr. Gunter. I know who I would choose.

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