Eva (00:03):
The purpose of this podcast is simple. We want you to get to know your doctor before meeting them in person because you're making a life-changing decision and time is scarce. The more you can learn about who your doctor is before you meet them, the better that first meeting will be. There is no substitute for an in-person appointment, but we hope this comes close. I'm your host, Eva Shea, and you're listening to Meet the Doctor. Today is a very special episode of Meet the Doctor. My very first gynecologic surgeon is on the show, Wesley Ann Brady from Dallas, Texas. I'm so happy to meet you.

Dr. Wesley Ann Brady (00:41):
Good afternoon. It's an honor to be here.

Eva (00:44):
Now you're in Dallas. Have you always been in Dallas?

Dr. Wesley Ann Brady (00:47):
Yes. I started my practice back in 2002, did my training here in Dallas in residency, and then private practice right after that.

Eva (00:56):
Did you ever deliver babies or did you go straight?

Dr. Wesley Ann Brady (00:59):
Oh Yes. Yeah, you did. I delivered many, many hundreds of babies over about a 10 year period.

Eva (01:06):
Okay, and so what made you not want to deliver babies anymore?

Dr. Wesley Ann Brady (01:11):
The hours. I love delivering babies between 7:00 AM and about midnight. It was the midnight to 7:00 AM shift. That was the hardest. And when I started my own family with my husband, I needed to be there for my babies and my kids and my husband. So that's when I stopped delivering babies. It was hard to stop, but it was the right thing to do at the time.

Eva (01:32):
Makes a lot of sense. I know when I had my first one, it was such a surprise that the doctor was not working in the middle of the night like, wait, what? Why not?

Dr. Wesley Ann Brady (01:41):
Yeah, it's hard.

Eva (01:44):
She missed both of mine actually, but she was in an awesome group. And so were you in a big group too back then?

Dr. Wesley Ann Brady (01:51):
Yes, there were nine of us back then. We did lots of deliveries, very involved with a Medicaid clinic and just delivered tons of kiddos.

Eva (02:02):
So you have worked with a lot of women in your career?

Dr. Wesley Ann Brady (02:06):
Yes.

Eva (02:07):
Both as colleagues and patients?

Dr. Wesley Ann Brady (02:10):
Yes. I think communicating with women and working with women and educating women is my favorite thing to do professionally.

Eva (02:19):
What does that look like in your current practice? Which has a cosmetic component and a lot of people don't think about cosmetic gynecology together. Those two words for a lot of people still are kind of strange. So can you tell us about how you transitioned from those days to these days?

Dr. Wesley Ann Brady (02:38):
Yes. So in the early 2000's, I started having, or actually I had a couple of patients who came in and requested that I perform a labiaplasty surgery for them because their labial tissue was very long and uncomfortable causing pinching and clothing, interfering with activity choices like goodness, riding a bicycle, placing intercourse, and they requested surgical management to address their symptoms. And then they sent their friends and their mothers and their sisters and I had this whole little population of patients who were requesting labiaplasty surgery. And then I did some research and realized there was no one in this part of the country who had specialized in that field. And it was something that I was becoming more and more interested in. And I certainly realized there was quite a bit of demand and that's when I started to research different training programs. There was not at that point, and there still isn't a specialized fellowship and cosmetic gynecology. I expect eventually one day there will be, but in doing my training, I needed to meet with lots of different doctors who had already specialized and operate with them, learn from them wonderful men and women who are my mentors to this day and just started my own specialized boutique practice here in the Dallas area back in 2006 is when I specialized at that time

Eva (04:00):
Plastic surgeons also do labiaplasty. What would the difference be if you were thinking about doing this between choosing your own gynecologist or going to a plastic surgeon?

Dr. Wesley Ann Brady (04:14):
Well, I think like with any surgery, you want to work with a surgeon who has significant years and years of experience, hundreds of cases. I think most plastic surgeons do quite a few breast augmentations, abdominoplasties, but I don't know of a single plastic surgeon who specializes in labiaplasty surgery and certainly not vaginal plasty surgery, which is vaginal reconstruction after we deliver babies, there can be lots of changes. I'll get back to that, but that's kind of all I specialize in is labiaplasty and vaginal plasty. So I've got thousands of patients, thousands of cases under my belt, hundreds of photos before and after photos I can review with patients. And most plastic surgeons don't have that. A general gynecologist in residency. Part of residency is learning how to do a partial ectomy, which is the medical term for labiaplasty on patients who have cancer of the vulva.

(05:11):
And so we're trained to do a functional labiaplasty but not necessarily an aesthetic. So I see lots of patients here in my current practice who have had labiaplasty performed by their general gynecologist who certainly do a great job, but from an aesthetic standpoint, that's not something that they are trained to focus on. And so if a patient's goal or aesthetic as aesthetic sources and aesthetic goals, then the general gynecologist probably isn't the best physician to work with. And so I'll do lots of revisions for patients just to make it a little bit prettier in that respect. So for those reasons, I really think a cosmetic gynecologist who's done hundreds of aesthetic labiaplasties is the best choice there unless there is, I mean there are a few plastic surgeons who do a lot of them, but you want to find a surgeon who really specializes in the surgery you're considering.

Eva (06:01):
What other kinds of issues might you be able to handle at the same time as a labiaplasty?

Dr. Wesley Ann Brady (06:08):
Vaginoplasty is actually a surgery that I do just as often as labiaplasty and a vaginolplasty surgery addresses what's called vaginal relaxation when patients deliver babies. And as we age, we lose lots of collagen in the vaginal area. We can experience tearing of the pelvic floor muscles with deliveries. And as a result with time and genetics, we can experience quite a bit of relaxation. It becomes more difficult to enjoy intercourse and intimacy, and there can be sometimes pain associated with intercourse. There can be what's called pelvic organ prolapse. When our bladders can fall down or the rectum can fall down, our uterus can start falling out. So there's lots of changes that can occur over a woman's life and vaginoplasty addresses those by fixing any pelvic organ prolapse and then sewing them pelvic floor muscles back together. The goal for most patients, they request that their vaginal anatomy be preserved and returned to what it was before they conceived and had a baby.

(07:10):
So that's certainly something that I address all the time. Vaginoplasty surgery is performed on women usually in their thirties, forties, fifties who finish their childbearing and want everything put back and ready for the next chapter of their lives. Whereas plasty surgery, I have kind of two main categories and populations of patients. I have my late teens, twenties, early thirties who will tell me that they noticed the labial tissue become an issue. Usually when we go through puberty, our breasts can develop and our labia can develop. And for women, if they develop larger labia, they can have quite a bit of discomfort and problems with that. So that's the first population of patients who request labiaplasty surgery. And then the second population are my patients in their usually fifties, sixties, early seventies who complain that as they age, the labia majora, so the labia on the outside can start to sag.

(08:03):
We kind of giggle, like with any anatomy as we age, our face can sag and our tummys can sag and our labia can sag too. And for some patients it can cause an unsightly bulge and just from a self-confidence standpoint, they want that addressed. So for my older ladies, it's more of the labium marere being an issue versus the labia menorah. But bottom line is if it's something that's bothering a patient from an intimate aesthetic issue, there's things that we can do about it. And for most women, they don't know that those are options for them. It's such a new field.

Eva (08:34):
I recently learned a very strange fact about the pelvic floor in that it can be damaged for sometimes 15 or 20 years before any kind of symptom will come along. And then the other sort of fun fact that I learned was that often we don't even know that there's an injury because the muscle has completely deactivated. And so I went down a rabbit hole and I looked at pelvic floor muscles and my honest reaction when I came out of this research mode was anyone who thinks there's no, God has never seen the pelvic floor because it is miraculous what it does,

Dr. Wesley Ann Brady (09:14):
It's true and how it heals and everything that it accomplishes for women and further than those babies. I mean, they're miraculous and wonderful, but they certainly can change things from an anatomy standpoint. And another issue that patients have often after delivering babies is urinary incontinence. So leaking of urine if they cough or sneeze, that's called stress urinary incontinence. And then there's also something called urgent incontinence, which is also called overactive bladder, that women will complain that they'll feel an urge to urinate, and then if they rush the toilet and don't get there in time, they can have some urine that leaks. And that's something that I deal with quite a bit in my practice as far as treating that. We always want to try to treat it non-surgically, ideally without having to go to the operating room and do any kind of surgery or mesh placement, the best thing is to address it before it gets bad so that a patient never needs surgery.

Eva (10:03):
You guessed. My next question was does this always have to be treated with surgery?

Dr. Wesley Ann Brady (10:07):
No, no. There's quite, over the last 10 years, there have been lots of new inventions and technologies that have come forth from radio frequency technologies to CO2 lasers to electronic muscle stimulation devices to help with muscle tone, creating collagen, supporting the bladder, addressing sexual function, things that we can do here in the office to avoid the operating room altogether, which of course is the goal.

Eva (10:33):
Do you like trying the new technologies and seeing what's out there?

Dr. Wesley Ann Brady (10:36):
Yes, yes, I do. I'm always reading and on the lookout for the newest technologies. I like to have the technologies for practice on myself because I'm a 52-year-old mother of three, so I've pretty much tried everything that there is out there. Whenever something new comes along, I would like to try it and see if it really works and there's lots of new things that don't work, and for those technologies, I don't want to get tricked into using it. So I think that that's been good for my patients, that I'm able to try them myself first.

Eva (11:08):
I suppose if it doesn't work, it also hasn't done any damage, right? It didn't hurt anything.

Dr. Wesley Ann Brady (11:14):
Well, you hope that you have to be really, really careful and do all the research and make sure that it's evidence-based and safe. I mean that's the most important thing.

Eva (11:24):
Is there anything you're particularly excited about that you can share with us?

Dr. Wesley Ann Brady (11:30):
Yes. Exosomes is the new up and coming technology, and in my field, physicians are starting to use it to treat lichen sclerosis, which is a painful rash that women can develop in the labial area or in the vaginal area. And for many years, all we really could do was prescribe steroid cream, but now we're able to inject platelet rich plasma and now the exosomes to treat that exosomes can be used to enhance sexual function into the clitoris, into the G-spot to help with achieving climax and just sexual satisfaction for women. The guys have all these treatments available to them and have for years, and finally in the last five or six years, there are newer treatments that are out there are available to women. That's how it should be. We deserve to feel good and have fun too.

Eva (12:21):
I totally agree. I want to go back to things that we don't know are normal because you mentioned a number of things that affect female self-confidence, and I think we carry a lot of these things around with us and we don't ask and we don't tell anyone about it because we think we're weird. Can you give us 1, 2, 3 things that are totally normal that you think we don't know are normal?

Dr. Wesley Ann Brady (12:52):
Well, when you asked that question, the first thing that jumped to mind is in my practice, we talk a lot about sexual satisfaction and climax and orgasms. And I would say when I meet a patient for the first time and we do our initial consultation, almost all patients are concerned that they cannot achieve climax from internal stimulation at the G-Spot. They say, oh, Dr. Brady, I can have orgasms externally at the clitoris, but not on the inside with internal stimulation. What's wrong with me? The answer is, nothing's wrong with you. The large majority of women can't achieve climax from internal stimulation. It's from the clitoral stimulation external. So whether that's oral stimulation or manual or a vibrator, there's nothing wrong with only achieving clitoral climax. The most important thing is that a patient can achieve climax and everyone's nerves are a little bit different. So that's the first thing that jumped to mind when you asked me that question.

(13:43):
The other thing that jumped to my mind when you said that or asked that question, what I see more often is patients who think something's normal when it's not, or they have to live with something when they don't. And an example of that is painful intercourse. I've got patients who think, oh, well, I'm 55, sex hurts. That's just normal. I just have to, yeah, I just have to put up with that until I'm bleeding so much within intercourse that my husband will finally just let me be. That's not normal. Having pain with intercourse, bleeding with intercourse, that's not something a patient has to live with, and there's plenty of safe options to address that. Same thing with leaking of urine. For hundreds of years, women have been told, oh, you're a mom. You're going to leak some urine when you cough or sneeze, just wear a pad or wear, depends.

(14:30):
That's just the way it is. It's normal. You're fine. Just getting older and bull corn, that's not normal. We don't have to live like that. So those things certainly jump to my mind. Those are the two that I see most often, that patients think that that's just the norm. And with sexual function, I'm able with my patients. I've got patients in their eighties who are having very satisfying, physical, intimate lives with their husbands, and that's wonderful. That's the way that it should be, and we all have that opportunity if that's something that we choose to pursue. But we know that couples that have healthy sex in their seventies and eighties typically are healthier. It's good exercise. It's good for our mental health, and sex is good.

Eva (15:14):
Are you telling me that people still have sex in their eighties?

Dr. Wesley Ann Brady (15:17):
Oh, yes. Oh yes.

Eva (15:20):
I don't want to think about it.

Dr. Wesley Ann Brady (15:22):
Well, you will when you're 80.

Eva (15:25):
I guess maybe I'll have time then. What kinds of things do you do to help women who are going through menopause? I think that's another thing that we think, oh, it's just going to be terrible and there's nothing I can do about it.

Dr. Wesley Ann Brady (15:40):
Oh, there's so many things to do. Well, the first thing you want to do is get a baseline hormone panel. I prefer that my patients get that around the age of 35 or 40 because that's when we start to lose testosterone. That's when our thyroid starts to slow down. So just getting that baseline and then the sooner you start the longer we'll have optimal hormones basically. So we typically start to lose our testosterone and thyroid in our thirties. It just gets lower into our forties. And on average, between 48 and 51 in this country is when our ovaries stop making estrogen, and that's probably the most well-known. You mentioned menopause. That's the definition of menopause is when a woman goes a whole year without having a menstrual cycle. And that's of course associated with the hot flashes and night sweats and vaginal dryness. The first thing we have to do is obviously diagnose that with labs.

(16:27):
We look specifically at a hormone called FSH that our brains produce to trigger our ovaries to produce estradiol, estrogen. And so by looking at those two hormones, we can find out how long a patient's been menopausal and how of course low her estradiol level is. And then the goal is to give, I prefer bioidentical estradiol specifically, which could be given either with pellets or creams or goodness. I don't recommend pills, but the pellets or the creams or the patches. And by replacing that estradiol, that is going to eliminate the night sweats. It helps certainly with goodness, with our skin, with vaginal dryness. It's good for our bones, good for our brains help prevent heart disease. Estradiol taken through the skin does not increase your risk of blood clots, so it does not increase your risk of stroke. It does not increase your risk of heart attack.

(17:18):
If we take estrogen through pills so orally, then that does increase our risk of blood clots. So it's important for patients to understand that they shouldn't do estrogen orally. They should do it topically. We also know that estradiol does not increase your risk of breast cancer. If a patient has breast cancer that's estrogen receptor positive, it can make it grow faster. So patients who are on hormone replacement therapy need to of course, have their annual mammograms and see their gynecologist annually to check on that. But big picture protecting the bones know that when women have a hip fracture that half of those women will pass away within a year when they lose that mobility. So many women don't understand osteoporosis, which is the thinning of our bones, how dangerous that can be for older women and just protecting bone mass and preventing osteoporosis, which estradiol does so well is certainly beneficial to all women.

(18:11):
And then as far as the, going back to your question, the estradiol just helps with all those symptoms. Some patients prefer to take testosterone as well, which is fine. Testosterone is not FDA approved for women, but women choose to take it off label all the time, whether that's for decreased libido, it's also good for muscle mass, it's good for sleep. So lots of benefits there. If a woman has a uterus and is taking estrogen or estradiol, she also needs to take progesterone. And progesterone is usually given in the oral form, but if we take estrogen by itself, if we have a uterus that can trigger the thickening of the uterine lining, which over time can trigger uterine cancer, so the progesterone keeps that uterine lining nice and thin, so that's when we add progesterone. And then of course the thyroid. We want to keep our patients' thyroid levels optimized.

(19:01):
We don't just want normal hormone levels, we want optimal hormone levels, and I think traditionally in medical school, we're trained to focus on the normal, whereas what I've learned is we want things to be optimal. If they're just normal, then they could be better. So that's how I run my practice is we want optimal levels. There are some patients who can't take estrogen, for instance, a patient who's had estrogen receptor positive breast cancer, if she's experiencing vaginal dryness, we have quite a few technologies which can address the vaginal dryness, specifically CO2 lasers. I like the Mona Lisa, but for those women, we do three CO2 laser treatments, and then within one to two months after that, when patients see full benefit, it just triggers the glands to start secreting natural lubricant again, and that can just make the biggest difference to patients when they're experiencing painful intercourse and can't take estrogen. There's also tiva, which is radiofrequency technology, which can do the same.

Eva (19:57):
That group of women, women who've had breast cancer, they're an especially challenging group because I think they also might end up being the most surprised that there are things they can do that are not medication. Right,

Dr. Wesley Ann Brady (20:12):
Exactly.

Eva (20:13):
Yeah. We have a breast cancer podcast, and we talked about lots and lots of those things in the course of those conversations, and a lot of the stuff that I've learned since then would've been useful when we talked about it, but you can't learn in reverse.

Dr. Wesley Ann Brady (20:30):
Yes. Lots of those ladies will also develop what's called vaginal stenosis. If the vagina is so dry and they can't take estrogen because of their breast cancer, the vagina can over the years become very tight. And then for those patients, we have to do the CO2 laser to make it stretchier, and then they have to use dilators to dilate the vagina. But when patients make that a priority over a six month period, we can get the vagina dilated back, get it lubricated. The elastin is increased so it's more elastic, and those patients can then enjoy painless intercourse with the men they love.

Eva (21:03):
I bet they're really happy about that.

Dr. Wesley Ann Brady (21:05):
Yes, they are.

Eva (21:08):
Your name is really interesting. Can you tell us about the origin of your name?

Dr. Wesley Ann Brady (21:13):
Well, I can, my daddy liked the name Wesley, whether I was going to be a boy or a girl. So I was Wesley, and then my mom said, well, she's going to have a boy's name. She has to have a very feminine middle name. So that's where the Ann came in. So Wesley Ann, when I was little, I wanted barrettes with my name or a belt with your name in the seventies and eighties. Yeah, there were lots of Tiffany's and Jennifer's, but no Wesley. So I didn't love it when I was a kid, but I like it now. It's kind of different.

Eva (21:41):
There was one time my sister went to Jamaica and found a fake license plate with my name on it, but I've never seen anything in America that said, Eva just isn't out there.

Dr. Wesley Ann Brady (21:52):
Right there with you. Yeah,

Eva (21:53):
No, there's no Wesley Ann. I've always wondered that about your name. If someone's coming to see you for the first time, what should they expect from that?

Dr. Wesley Ann Brady (22:04):
Well, we're detail girls, so we'll of course, first have them fill out their medical history on the portal. And then once they get here, the two of us will sit down here in my office for about 30 minutes or so and just get real detailed about their chief complaints, what brings them in. And most patients, they'll come in for one thing, but once we actually sit down and start talking, they'll have a list of three or four things, and so then we'll kind of put 'em in order, most least important. And we'll start with problem number one, and we'll of course do a very detailed physical exam once I'm clear what their goals are and what their complaints are. And then after the exam, we sit in the consult room and I've got lots of photos. I've got lots of drawings and designs, diagrams to really educate patients about what's happening with their body and why.

(22:50):
And then we go through the treatment options, whether it's going to be medication or nonsurgical treatment, or sometimes if a patient's uterus is falling out, she needs to have, that's not something that a non-surgical management is going to address. So we just talk about, again, in detail. Typically appointments are usually an hour to an hour and 15 minutes or so. We get a plan together, and then based on that plan, we just start addressing issues one at a time, going from the most important to the least important from an aesthetic standpoint. I have my Amy Hadad as the aesthetic nurse practitioner. She does lots of the sexual health and wellness treatments. There's something called O Shots that she does for sexual function for orgasms, and she does lots of the non-surgical vaginal rejuvenation treatments while I'm in the operating room. So it really just comes down to chief complaint.

(23:39):
I have the whole hormone practice, so a big portion of my patients are here for their hormones, and we have the pellets and the creams and the synthetics. So really there's three different options for women, big picture, and there's not one option that's going to work best for everyone. I think patients need to do all the research, find out what's going to work best for them. Sometimes patients have to try a couple of things. They'll try pellets, didn't like those, try the creams and that works better for them. So just finding what's going to work best from a hormone standpoint and teaching a patient why their hormones are good and how to use them safely.

Eva (24:12):
I've heard that you cannot stop pellets once you start. Is that not true?

Dr. Wesley Ann Brady (24:17):
Oh, you can certainly stop them. All you do is just you don't go get another pellet. If you are on hormones and stop hormones, whether it's creams or pellets or patches or anything, once your hormone levels go back to baseline, which is very low, then all the symptoms are going to come back. But you can stop hormones anytime you want to. It just means you're going to start having hot flashes and night sweats, and your bones are going to thin out and all the not fun things.

Eva (24:41):
Don't miss your appointment.

Dr. Wesley Ann Brady (24:44):
Please don't.

Eva (24:47):
You told me earlier that you have three kids. Can you tell us about them?

Dr. Wesley Ann Brady (24:51):
I do. So my oldest, he is in college. He's at Texas a and m in the business school. His name is Sam. And then I have my daughter. She is a junior in high school. Her name's Savannah. And then my baby is Bo Brady and he's a sophomore in high school, and they are just the loves of my life, love them to death, and my husband and I will be empty nesters, goodness, I guess a little over two years. And so we're starting to plan trips we're going to take and kind of that whole new chapter, which is kind of sad to think about, but it's also kind of fun to think about.

Eva (25:28):
What kinds of things do you like to do together outside of work?

Dr. Wesley Ann Brady (25:32):
Ooh, we love to travel. We're big readers. We go to Barnes and Noble at least once a week and just go through all the shelves. He likes nonfiction. I'm more of a fiction girl, but that's always fun. We love dogs. We take the dogs on a walk most days. Let's see. I love antiquing. I can't say that he loves him as much as I do, but he's patient with me. He, he'll let me drag him into some antique stores in different cities and towns that we visit.

Eva (26:01):
Any good book recommendations for us?

Dr. Wesley Ann Brady (26:04):
Oh goodness. Well, the one I just finished, it's called The Horse and it's by the author who won, I think the Pulitzer Prize last year and highly recommend that. It's kind of a historical fiction. Jeff and my husband and I read usually a book together every month, and that was the book we read together in March and really enjoy that. This month we're reading the Thursday Night Murder Club, which is a really cute series of four books so far. They're making movies out of, so wanted to read the books before the movies came out. That's a fun series that we're reading. I mean, I love who done it, so I've read every single Agatha Christie just love the Agatha Christie's

Eva (26:44):
Horse. I found Horse. Someone clued me into this Libby app through the library, and now I can get everything for free. Do you know about this?

Dr. Wesley Ann Brady (26:52):
Yes, I've heard about

Eva (26:53):
That. It's so great. I used to spend tons and tons and tons on Kindle books, and now I just put'em in Libby, and then when they're available, I just put 'em in my Kindle.

Dr. Wesley Ann Brady (27:05):
Yes, that's good. That's very responsible. So we get a lot of books. I still like the paper books. I like to be able to turn the paper page, but lots of the nurses at the hospital. But yeah, everyone brings their books and donates them, and then everyone just kind of takes a book and it'll bring a book. So I've gotten lots of books from the hospital too, so we drop 'em off and share them.

Eva (27:28):
If someone's listening today and they want to come see you or get to know you better, where should they go look for you online?

Dr. Wesley Ann Brady (27:35):
The website for my practice is women's wellness institute.com.

Eva (27:40):
What part of Dallas are you in?

Dr. Wesley Ann Brady (27:42):
We are in North Dallas University Park area in Preston Center at Northwest Highway in Preston.

Eva (27:48):
Oh, awesome. That's a great part of town, but I bet people come from all over to see you.

Dr. Wesley Ann Brady (27:53):
They do. They do. We've got patients from, of course, all over the Dallas for Worth area, and then from a surgical standpoint, we've got patients coming in from all over the country and even other countries at this point. We've got a patient from Australia and South Korea and Germany in the last year or so. So I've just been able to meet the neatest ladies from all over.

Eva (28:13):
Thank you for sharing your story with us. It was so nice getting to know you today.

Dr. Wesley Ann Brady (28:18):
Well, thank you very much. This was lots of fun. This was my first podcast ever and I like it.

Eva (28:23):
Hopefully not the last.

Dr. Wesley Ann Brady (28:25):
Yeah. This is really fun.

Eva (28:29):
If you are considering making an appointment or are on your way to meet this doctor, be sure to let them know you heard them on the Meet the Doctor podcast. Check the show notes for links, including the doctor's website and Instagram to learn more. Are you a doctor or do you know a doctor who'd like to be on the Meet the Doctor podcast? Book your free recording session at Meet the Doctor podcast.com. Meet the Doctor is Made with Love in Austin, Texas and is a production of the Axis THEX i.io.