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May 26, 2016

An Interview With Michael Litrel, MD, FACOG, FPMRS – Part 1 of a 3 Part Series

One of your areas of specialty is Cosmetic Gynecology, especially vaginal rejuvenation. Can you expand a little on the subject of vaginal rejuvenation?
Originally, as female reconstructive surgeons, we would operate on the vagina or internal and external genitalia. We took care of medical issues such as bulges or weakness that prevented the organs from working properly.

Vaginal rejuvenation is a more recent elective surgery to enhance the visual appearance of a woman’s genitalia. Over the past twenty years, the field of Cosmetic Gynecology – especially vaginal rejuvenation – has become the fastest growing niche in plastic surgery. As the popularity increased, we began to see patients who’d been encouraged to undergo plastic surgery – from surgeons who don’t specialize in women’s pelvic anatomy. We’d find ourselves called in to correct whatever mistakes had been made in those procedures – but the problems were not always ‘fixable.’ It became obvious that the best thing we could do was to offer Cosmetic Gynecology ourselves, and at least insure that the women who came under our care could avoid the irreversible damage from inexpert surgery, and receive the benefits of surgery from Pelvic Reconstruction Specialists.

Apart from esthetic merits for visual genital distortions, or internal adjustments that restore tautness and sexual pleasure, what other conditions can be corrected, with these procedures?
When it comes to external cosmesis, which is surgery performed outside the body, we mostly treat conditions like elongated genitals or labia which may interfere with clitoral stimulation. It’s mostly anatomical—things are too long, getting in the way, disrupting sexual pleasure or causing orgasmic inability.

Vaginal surgery consists mostly of correcting “bulges,” be they bladder, rectal or intestinal bulging. We increase the caliber of the vagina to allow for better sexual sensation. Since the vagina leads to the internal sexual reproductive organs, if there’s pain or bleeding or scar tissue, lots of times those things have to be corrected surgically as well.

Sexual interest and gratification often diminish over time, due to a number of reasons such as lack of lubrication, the loosening of vaginal tissue and muscle, etc. Can pelvic reconstruction or vaginal rejuvenation give women a renewed sense of sexuality and confidence—and if so – how?
I think it’s a very individual thing. I’ve taken care of thousands of women and sexuality issues can vary. They can come from anatomical differences between partners, hormonal issues– even lack of awareness of proper technique. The list is endless, so I’m not going to say “have surgery and it will fix everything.” I’ve seen the full range of what causes problems, and I deal with them all on an individual basis.

As an example, I saw a patient recently who came from a neighboring state. After asking questions about the pain she was experiencing, I examined her and found there was nothing physically wrong with her. After speaking with her, I was able to pinpoint that the real problem stemmed from sexual abuse. I’m able to treat the anatomical problems, but a lot of these complaints simply must be addressed through counselling. I certainly wouldn’t recommend surgery in her case, but would guide her to other venues of help. It’s a complicated subject and doesn’t really have one answer.

Are the benefits of pelvic reconstruction and vaginal rejuvenation permanent, or does time eventually cause the original problems to recur?
I’ve seen patients I’ve operated on 10 years ago, and they’re doing great. For a lot of anatomical problems, if we fix them and they don’t suffer damage, they stay fixed. For instance, if a woman has a normal sex life and doesn’t have a baby, she probably won’t need surgery, and then, if it’s a cosmetic thing, such as labial elongation (hypertrophy), then once you fix that, it’s not going to grow back. It’s not common to have to re-operate.

For the cosmetic parts, however, sometimes you have to perform a few nips and tucks six months or a year later. But typically, that’s not necessary either. As for the tightening operations, once you do it, you’re done.

Many people might describe the procedures we’ve covered as “frivolous,” “unnecessary,” “a waste of money,” etc. Their assumption might be that you need to accept yourself “the way you are.” Can you describe the positive physical and psychological impact these procedures have had on some of your patients during your extensive career?
Fifteen or twenty years ago, I probably would have said the same thing. I remember I was very much against breast implants at one time, but over years of practicing, I noticed that women with these implants not only looked better, but felt wonderful about themselves. We all want to feel good about ourselves.

Now, in the field of Cosmetic Gynecology, with procedures such as vaginoplasty or, labiaplasty, the reason we, as female reconstructive surgeons are in this field, is because we know we’re the best at fixing it and we know that it’s not just about cosmetic surgery. It’s functional as well. Unlike a breast implant, face lift, or even a tummy tuck, none of which really have a function, internal and external genitalia are functional. Whether it’s sex, urination or defecation, there’s a biological function that’s dependent on the correct anatomical restoration of a woman’s body. So in terms of ‘frivolous,’ well, if you’re fixing a bulge here or there because a woman’s bladder is dropping or leaking, or you’re fixing the rectum bulging out, you can also do a tightening operation because the patient desires it for their sex life. I don’t think a good sex life is frivolous. I think it’s an important part of a relationship and it’s an important part of the way a woman feels about herself.

Real Self PicThe word ‘surgery’ can be frightening and intimidating. It usually sparks the fear of pain, long convalescence, operative and postoperative complications, etc. On average, what is the recovery period for most of your procedures?
Typically – because we do less invasive surgery with laparoscopes and robots – one to three weeks. Certainly some healing processes can go on for three months, but after one to two weeks, people generally feel pretty good.

At one time, the standard treatment for conditions related to pelvic prolapse was a hysterectomy. It’s now possible to treat Pelvic Floor Disorders with pelvic reconstructive surgery. How has the specialty of pelvic surgery changed since you began? What conditions are fixable that women forty years ago would just suffer with?
Nowadays, the biggest changes have been the minimally invasive laparoscopic surgeries. We can visualize things better. We can access things and also repair things less invasively. Additionally, surgery is less risky than it used to be—better antibiotics, smaller holes. Tumors and organs can be removed with much tinier incisions. We do a lot more uterine saving surgery as opposed to hysterectomies nowadays.

What diseases, conditions or illnesses prevent a person from being a suitable candidate for pelvic reconstruction or gynecology cosmetics?
We have office procedures so that we can make things look better and work better without doing any surgery. If someone is sick with underlying medical problems, I don’t think they’ll be presenting with issues of vaginal laxity or problems of cosmetic appearance. They have bigger issues such as being unable to breathe, walk, etc. Typically I don’t see patients whose medical problems prevent them from having surgery. We can do more minimally invasive things for patients today.

I had a patient recently from North Carolina who was convinced I would have to perform countless surgeries. As it happened, all I had to do was a ThermiVa, a procedure which is a low frequency energy treatment we deliver in the office. It requires (3) thirty minutes treatments over a period of three months. I also have an 82 year old patient suffering from diabetes, and I’m still able to do something to help her.

Other than natural processes in the body such as aging, giving birth, etc., can your procedures repair such things as birth defects, accidental injuries, or physical trauma—and can these things be corrected even years after the damage has occurred, or is time of the essence?
Birth defects occur during birth and we certainly have to perform reconstruction because of that. This is not done in childhood, but when the person is diagnosed as an adult. If you’re referring to something like an anatomical variance, for instance, something like size and shape, or a congenital problem such as not having a uterus, vaginal septums, having two uteruses, or a hymen that doesn’t allow blood flow, typically, we do not address these issues until a woman is older. In fact, we may not become aware of them much before 15 years of age.

Defects can also happen during such occurrences as miscarriages. Typically, injury is not common. Unlike breaking an arm or something like that, the uterus and a woman’s genitals are very well protected, because they’re in the midline of the body and the center of gravity. So if injury does occur, it’s usually quite easy to repair.

To prevent such problems as infections, flaccidity, sexual discomfort, or sexual disinterest, what can women do to maintain personal gynecological health, other than general cleanliness, yearly pap smears and Kegel exercises?
I think that probably the most important thing that women can do is limit their number of sexual partners and just be sexually active with people that are faithful to them, love them and want the best for them. I think multiple partners are the number one cause of the problems that women have. If you marry someone, and have a good sexual monogamous relationship with them, it would solve most of the problems we see.

I have a 22 year old patient who is beautiful. She’s had several sexual partners. I did cosmetic surgery on her and some tightening, but she hates herself because of things her partner said to her regarding her genital appearance. Had she waited for the right, committed partner, he most likely would not have said anything and accepted her the way she is.

Many physical issues also come with a related psychological issue such as fear, shame, religious inhibition, etc. As a women’s health specialist, how do you personally deal with the psychological deterrents to put your patients at ease?
I think we’re all a little inhibited. It’s just part of being a person. Inhibitions tend to disappear when you’re in the process of having a baby come out of your body. Nothing will stop you from pushing out that baby. My specialty is OB/GYN, and my subspecialty is reconstructive surgery, so I’ve delivered thousands of babies, and women are generally comfortable with that. Many of my patients have gone through a lot, and I’ve gotten very close to them, but I think that’s only due to good communication. People want someone to help them, and if you let them know it’s okay to feel a certain way, then it’s okay to feel and express the pain, etc. They just need to be nurtured in such a way that we can open up the lines of communication.

May 24, 2016

incontinence photoOveractive Bladder Syndrome, also referred to as OAB, is an uncontrollable need to urinate, often at the worst possible times.

For most of us, when the bladder fills to about half its capacity, the urge to void is triggered. Much like a snooze button on an alarm clock that lets us sleep awhile longer, we can hold off until we’re closer to a bathroom, or the timing is more convenient.

Not so for OAB sufferers. Their urgency is more like the constant demand of a malfunctioning alarm clock without that button—intense, shrill and non-stop until it’s turned off. OAB sufferers feel more like their bladders are overflowing. They don’t have the luxury of waiting, needing relief immediately. If they’re unable to void right away, leakage may occur.

OAB is unbiased. Whether you’re at work or play, it disrupts concentration, performance and pleasure, negatively impacting your life. In time, those afflicted with OAB may become depressed, withdrawing socially.

What Causes Overactive Bladder?

No one really knows, but it’s believed that involuntary contractions of the detrusor muscle in the bladder transmits false messages to the brain.


  • A sudden, inconvenient urgency to urinate that is difficult to control: Just as your child is about to blow out those birthday candles or receive that diploma, you suddenly you have to run, not walk, to the nearest toilet.
  • Frequent urination (more than 8 times daily): Your bladder seems to control your life. You need to know where every bathroom is located when you go out. Maybe you even carry a change of clothing, “just in case”.
  • Voiding two or more times nightly, disrupting sleep (nocturia): You awaken during a delectable dream or restful sleep more than once to urinate.
  • Involuntary, uncontrolled leakage (see also urge incontinence): You can usually hold it in, but just barely, and sometimes experience embarrassing drips.

Contributing factors

  • Overweight or obesity
  • Stress
  • Drinking large amounts of caffeine, alcohol and other liquids
  • Nerve related conditions such as Parkinson’s, Dementia, Diabetes, spinal cord injuries, Multiple Sclerosis, and strokes.
  • Chronic pelvic pain
  • Limited mobility (being unable to move freely or quickly)
  • Some medications

Age may contribute to, but does not always cause Overactive Bladder Syndrome. Never assume you’re doomed to live with OAB based on the number of years you’ve roamed the earth. Speak to your gynecologist. Don’t be ashamed. They’ve heard it before—often. They can help.


You will need to provide your doctor with your medical history, including all drugs, vitamins and supplements you are taking. A physical examination will also be necessary.
Sometimes, a urine culture, ultrasound, and neurological tests may be needed to rule out any sensory or reflex problems. If necessary, you might need more extensive analysis such as:

  • Urodynamic testing (studying bladder, sphincter and urethra performance; measuring urine flow, bladder pressure, and residual urine left after voiding)
  • Cystocopy (using a scope to study the bladder and urinary tract).

You may be asked to keep a journal that includes information like fluid intake, urinary outflow, any leakage, and a time chart of bathroom visits to assess your condition more accurately.

Treatment options

  • In milder cases, your doctor may recommend the following:
  • Drink less: Fluid is vital to the body, preventing dehydration and maintaining proper kidney function, but too much can exacerbate OAB symptoms. Try to cut back on diuretic beverages such as coffee, tea and alcohol, limiting yourself to eight cups of water daily. Avoid liquids too close to bedtime so you can finish those happy dreams.
  • Use liners or pads: Annoying, we know, but they help with trickles, stains and odor.
  • Lose a little weight: It’s not easy, but it can make a difference. Extra weight increases pressure on the pelvic muscles, causing more urination.
  • Teach your bladder who’s boss: Bladder re-education is a method that trains you to urinate at certain times, eventually allowing more time between bathroom visits. Your doctor can guide you, teaching your bladder to obey you–not the other way around.
  • Kegel exercises and biofeedback: Kegels strengthen pelvic floor muscles. Recommended biofeedback devices can help you pinpoint those muscles. Kegels can be done anywhere, are painless, sweat-free, and can be beneficial for OAB.
  • Double void: Sometimes trying to urinate again shortly after the first void may coax some shyer little droplets to make an appearance.

Medications and Treatments

Other treatments may include:

  • Prescribed Medication (Antimuscarinics, anticholinergics)
  • Gentle electrical stimulation (ThermiVa)
  • Bladder Injections ( botulinum toxin A)
  • Vaginal weight training

For more resistant cases, surgery, bladder augmentation, or the use of catheters may be necessary.

Overactive bladder does not have to isolate you. Help is available. Speaking to your doctor is always the first step to overcoming the problems associated with this syndrome, restoring your confidence, happiness, and quality of life.

March 10, 2016

by Michael Litrel, MD, FACOG, FPMRS

Dr. Litrel April Fools article graphicThe year my sons were seven and ten, I asked for my wife Ann’s help playing an April Fools’ joke on them.

Sunrise on the big day found me crawling like a Ninja across the floor of my eldest son Tyler’s bedroom. With barely a sound, I rolled on to my back and shifted my body directly beneath his bed. I took a deep breath, and then, using all my strength, began shaking the entire bed frame.

Ann’s timing was perfect. She burst into the bedroom. “Tyler!” she shouted. “Get up! It’s an earthquake – it’s an earthquake! Go downstairs – HURRY!”

Tyler hardly moved. “It’s okay, Mom,” he mumbled, still half asleep. “It’s just Dad under my bed.”

I was demoralized, with only bruised knees and a scraped back from my efforts. But it was not going to be for nothing. Nursing my wounded pride, I hushed Ann and went to the next room. “Let’s try it on Joseph.”

But by the time I had crawled under Joseph’s bed, Ann reported that Joseph was smiling, his eyes closed, pretending to sleep.

Luckily, I had prepared a backup trick the night before. I’d slid a rubber band around the kitchen sink nozzle so it would spray as soon as the water came on. It pointed up to the exact spot for dousing whichever of my beloved offspring washed his hands first.

Tyler came downstairs still half asleep.

“Would you please wash your hands before you eat,” I reminded him. It was hard to hide the eagerness in my voice. I watched Tyler as he came to the sink and reached for the soap. He stopped, looked at the faucet, and yawned.

“You know, Dad,” he said with a trace of patronization, “if you use scotch tape, it won’t show as much.”

I wasn’t in the mood for advice. “Just be quiet, and let’s wait for Joseph,” I replied testily.

“AAUGHH!” screeched Ann. Oops. While I was distracted, Annie had turned on the water. Her pajamas were soaked. I apologized profusely, but Ann was not amused.

Well, at least I’d gotten someone.

But my real quarry was Tyler. He was just too cocky for his own good. I spent the day mulling it over, playing a few jokes to pass the day. Pregnant patients made the easiest targets.

“Gosh, I hope you have two girls’ names picked out.”

Or, “Wow, we haven’t had triplets in the practice in four or five years.”

Back at home that evening, Tyler wouldn’t fall for anything. I found myself growing amateurish in my desperation.

“There’s a spider on your shoulder!”

“Your teacher just called. You’re in trouble!”

Tyler just rolled his eyes. April Fools was obviously beneath him. Indeed, he hadn’t played a single joke on me all day. I finally gave up and trudged upstairs to bed. Just as Ann and I climbed between the sheets, we were met with an impediment.

Tyler had short-sheeted our bed.

Ann was dead tired. She began to complain and laugh simultaneously as she stripped the bedcovers to remake the bed. I tried to shush her so Tyler wouldn’t have the satisfaction of knowing his trick had succeeded.

But it was too late. I could hear him snickering outside our bedroom door.

My mind was unsettled. Although I was tired, I lay awake in bed for a while, unable to sleep. Finally, after some honest introspection, I came to a resolution which allowed me to drift off at last.

Just wait ‘til next year.


Excerpted from Dr. Litrel and his wife Ann’s book of “he-said, she-said” stories about love and family.  A MisMatch Made In Heaven: Surviving True Love, Children, and Other Blessings In Disguise is available in the office, and online at www.createspace.com/4229812

February 18, 2016

Dr. Michael Litrel volunteers in Honduras photo
by Michael Litrel, MD, FACOG, FPMRS

When my son Tyler was fifteen, I brought him with me on a church mission trip to Honduras. It seemed an inspired idea: I was seized with a vision of him forsaking his Xbox for a transformative week of caring for poor people in a third world country.

Twenty of us boarded the plane headed for rural Central America. Our physical task was to repair homes. Our spiritual task was to learn and teach about God’s love.

Tyler was shocked by the poverty. Forty people lived in the remote village in mud and stick huts. They had no running water or electricity. Wandering the village were dogs so emaciated you could count each rib.

Over the days that followed, Tyler took me to the side several times to sort through his feelings. How could we have so much at home when others in the world have so little?

I was proud of him, growing up, asking the right questions… But as it turned out, he was still an obtuse adolescent. On the last day, we faced a grueling three-mile hike through the steaming jungle to the work site. Tyler assured me he had filled all our water bottles. But when we arrived, I discovered only three of the eight bottles were full. Tyler had gotten lazy and just hadn’t bothered.

I was livid. We had an entire afternoon of physical labor ahead. Don’t you realize we have four THOUSAND pounds of cement to mix? How can we work without water? Blah, blah, blah…

I’m sorry, DAD!!! I GET it! Tyler threw up his hands in exasperation.

I could tell Tyler was more angry than sorry. But I stopped and sulked away, muttering dark thoughts under my breath. I had been proud that Tyler had chosen to come – the youngest in the group by five years. Heaven knows it was gratifying to see his hands finally off the game controller and wielding a shovel full of dirt.

But I didn’t want to hear any adolescent fibs about filling water bottles.

Our project was a hut with a dirt floor, to be replaced with cement. Twenty bags of mix had already been carried to the site. The choice of tasks were these: carry buckets of water from the stream, mix the cement on the ground, carry the wet cement into the hut, or lay down the floor. There were eight of us. It was back-breaking work.

Holding water in cupped hands photoThree hours later, we lay exhausted under the hot equatorial sun. A feeling of discouragement began to creep over us. The floor was only a third done, and we were running out of both cement and energy.

I slumped on a stool. A small village girl named Amalia crept quietly next to me. Her dress was worn, her face dirty, but her smile was glowing. She was one of eight children who lived in this tiny hut. A cement floor would keep her young body off the ground at night.

Tyler rested motionless, his back against a tree. His work efforts had been listless at best. But I kept my criticism to myself. At least he was here.

Just when the job seemed hopeless, a few neighboring villagers arrived to help. Recharged, we resumed mixing cement, carrying bucket after bucket into the hut. Somehow, we now had so much that we could not only cover the entire dirt floor but even make a front porch.

Remarkably, too, our water bottles never ran out. Tyler and I had enough to last all afternoon.

It was a strange and wonderful day in Honduras. Tyler and I had partaken in a kind of miracle: plenty of cement, a floor for Amalia, and even enough water.

For me, it was a spiritual reminder that we are always given enough – an ironic lesson to learn while helping a family whose belongings could fit in the trunk of my car.

It was only later, as I was falling asleep, that I figured out – Tyler had left all the water for me.

Excerpted from Dr. Litrel and his wife Ann’s book of “he-said, she-said” stories about love and family.  A MisMatch Made In Heaven: Surviving True Love, Children, and Other Blessings In Disguise is available in the office, and online at www.createspace.com/4229812


February 3, 2016

For ten years, without fail, Ann and I kept our razors side by side in the shower. Then I switched to the Mach 3 triple blade razor, and suddenly the ever-present disposable pink lady razor disappeared. I didn’t give it much thought at the time. I figured such a sissy razor was an embarrassment beside my macho marvel of modern technology.

The truth was more horrific. One morning I walked into the bathroom while Ann was in the shower, and I discovered that my Mach 3 triple blade marvel was being used to shave her legs. It didn’t take much to surmise that it might be getting some time under her arms, too.

I kept my mouth shut until our morning coffee.

“Doesn’t it repulse you,” I said calmly, “to know that the razor you’re using under your arms is the same one that I’m using on my face?”

Ann laughed, and then quickly reached for my hand. “Sometimes…” she replied with a serious voice. “But love is a strange and wonderful thing.” She gave me an angelic smile.

All was forgiven.

Disagreement between a husband and wife occurs in the best of marriages.  Sometimes this manifests as open argument.  Other times, marital conflict can be more subtle, an unspoken tension permeating the relationship for years, like an uncomfortable humidity.

When I met Ann at that fraternity costume party, she was supposedly dressed as a Greek goddess, in a skimpy toga no father would have permitted his daughter to wear in public.

I fell in love.

After our three years apart, there was nothing I looked forward to more than marriage and spending my life with Ann. My attraction to her was more than just her physical beauty; I admired her talent, kindness, intelligence and discipline.

I still admire her. But after twenty-five years of marriage, the intelligence and discipline thing sometimes gets on my nerves.

Ann has tendencies towards frugality that do honor to her Scottish heritage. She also endeavors to be environmentally aware. These two qualities are evidenced in the temperature settings Ann prefers for the household thermostat. During the hot Georgia summer the air conditioning is set at 80. During the cold of winter the heat is set at 65. In January when I am cold, Ann tells me to put on a sweater. In July when I am hot, Ann tells me to take my sweater off.

thermostatLast year it was another hot, humid summer. So one day when Ann wasn’t looking, I sneaked to the thermostat and deftly dropped the temperature five degrees.

It didn’t take Ann long to notice. “Who turned the air conditioning so low, Michael?”

“Those kids,” I responded, shaking my head disapprovingly. I was not lying. I was simply making a declarative statement designed to misdirect.

“The boys say they didn’t touch the thermostat, Michael.”

“Those kids,” I repeated, shaking my head disapprovingly.

Ann laughed and moved the thermostat back to “where it belongs.” I didn’t argue. I could understand her perspective: why burn fossil fuels to lower the temperature of my house just so I could be a tad bit more comfortable?

But sometimes it was annoying. It was like I was married to Al Gore, and every time I touched the temperature control I was sinking an axe into the trunk of the last giant redwood.

Over the years, Ann had successfully colored our “thermostat decision” in spiritual terms. With artful language she conveyed to me sophisticated thoughts about the needs of the body versus the needs of the soul. Essentially, her argument boiled down to this:
Jesus didn’t have air conditioning, so why don’t you spend more time praying for strength, and less time whining about the heat?

One summer Ann left town to visit her sister for a week. It was like Dorothy’s house had plopped down in Oz, and ding dong, you-know-who was dead!

I ran to the thermostat like an unsupervised teenager and lowered it not five degrees, but ten. I was going to get all the air conditioning that compressor could muster. That night my house was so cold I needed another blanket from the closet. Immobilized by comforters, I slept like it was the dead of winter.

Condensation covered all my windows when I awoke. I shivered when I sat down to my morning coffee. Now this was what July in Georgia should feel like!  I thought about getting out that dang sweater. Maybe I should light a fire too?

But after an hour of reflection, I simply turned the air conditioning off.

I missed Ann. Morning coffee was more fun with her. It’s far better to have a home that is too hot in the summer and too cold in the winter than to suffer again through the fires and chills of a long distance relationship.
A prescription for tolerance is an occasional few days apart. In our human struggles, we can sometimes fixate on small problems.

Absence gives God a chance to direct our focus on the big picture –

Excerpted from Dr. Litrel and his wife Ann’s book of “he-said, she-said” stories about love and family.  A MisMatch Made In Heaven: Surviving True Love, Children, and Other Blessings In Disguise is available in the office, and online at www.createspace.com/4229812

December 3, 2015

An Interview With Michael Litrel, MD, FACOG, FPMRS

What was your first job?
I was a waiter at Kennedy Airport, at the international arrivals building. I was seventeen years old, and had to wear a bow tie. It was great preparation for being a doctor. I met people from around the world, served people with their basic needs, and I had to utilize my time efficiently. I shuttled between tables just like I do between exam rooms – and I tried not to drop anything.

What is your legacy? How do you want to be remembered?
As the longest living person alive? (He laughs.)

I want to have always done my best, and to have always been honest, and to accomplish what God had put me on the planet for.

What book has influenced you most?
In 1984 I read The Road Less Traveled by Scott Peck – that really influenced me a lot. I also really like Richard Bach’s book, Illusions.

Other books include Mere Christianity, by C S. Lewis, and The Prophet, by Kahlil Gibran, which has influenced me a lot again this year. One of my all-time favorites that I’ve re-read for several years is The Holy Man, by Susan Trott. It’s short, funny, and quite profound.

A book that’s influenced me this year is The Life-Changing Magic of Tidying Up by Marie Kondo. I especially recommend it to young mothers.

Dr. Litrel study photoWhat words of wisdom would you pass on to your childhood self?
I think believe in yourself and know that the dreams in your heart are gifts from God to pursue. And I would say that I think there’s so much bad stuff – and it’s so easy to believe the bad stuff – but what’s most important is to believe the good stuff, and to then pursue. Never give up. Keep endeavoring despite the pain and the sadness.

If you could master one skill right now, what would it be?
Surgery. That’s the skill I’m most endeavoring to master. You don’t cut into the human body willy-nilly. During each and every individual operation, I try to master the surgery.

I think the pursuit of mastery is the purpose of life. You have to seek mastery. You can master the ability the walk at two years old, but that doesn’t mean you don’t trip sometimes. When performing surgery, I think that I serve, not that I’ve mastered. In every surgery, my goal is to serve each patient and God at the same time.

Okay, a question just for fun – If you could only eat one meal for the rest of your life, what would it be?Dr. Litrel Santa hat photo

Chinese food. I really like Szechuan beef, but now I’m a vegetarian. I’m an aspiring vegan, following in the footsteps of Dr. Hale and Dr. Crigler, so I’ve given up a lot of my favorite foods.

Cookies, a personal favorite, are sadly not on the list.


chris-and-dr-litrel-twin-pic2Unexpected Twin
Dr. Litrel is an identical twin. Born before the technology of ultrasound, he was unexpected until the very day he and his brother Chris were delivered. His first birth certificate named him “Baby B”

Chinese-Italian Culinary Mutt
Dr. Litrel grew up eating custom ravioli from his Italian father’s pasta shop on Long Island, and authentic Chinese dishes homemade by his Chinese grandmother in the Bronx

Healer With a Black BeltDr. Litrel Karate photo
Dr. Litrel is a lifelong martial arts student. He has studied karate, chi gong, bando, tai chi, and has a black belt in tae kwon do. He has also studied the Japanese healing art of Reiki.

POP QUIZ:  How well do you know Dr. Litrel?

Which of these jobs has Dr. Litrel NOT had?

A. EMT (Emergency Medical Technician) on ambulance
B. High School Chemistry Teacher
C. Forensic Intern (assist with autopsies)
D. Waiter

Sorry – trick question! Dr. Litrel has worked in ALL these jobs.

November 4, 2015

by Michael Litrel, MD, FACOG, FPMRS

My doctor partners and I take turns being on call for the holidays.  Two years ago, my turn fell on Thanksgiving, and as I looked across the table at my loved ones and listened to their loud and animated conversation, I remember noticing they all seemed to be in various states of inebriation. I began to wish the hospital would call me.

Nothing is more annoying than being the only sober one at the dinner table.

Especially when you paid for all the wine.

I realized there were three ways to handle my unhappiness.

One, I could make sure I wasn’t on call the following year so I could join in the frivolity.

Two, I could cultivate new friends and family who were less inclined to intoxicate themselves at holiday meals.

Or three, I could view this moment of unhappiness as a spiritual lesson and walk more strongly the path of Love.

The decision was easy. I decided not to be on call again.

Holidays are stressful, but particularly so for women. Women are more aware of the subtleties of celebration. They put effort into aesthetic touches that would never dawn on a man. The intention, I believe, is to manifest beauty.

But sometimes the result is marital conflict.

Every Thanksgiving, Ann makes six dozen homemade crackers called “Cheddar Crisps” that come in three flavors: cracked blacked pepper, caraway seed, and something called nigella seed.  Ann carefully sequesters her crackers in a tin box to be doled out at the right moment.

Every guest is given three crackers just after saying grace, one of each flavor – and a bowl of butternut squash soup.  It’s such a big deal to Ann that you handle each cracker like Grandma’s antique tea cup.  Unfortunately, I am more a Ritz cracker kind of guy, accustomed to shoveling large quantities into my mouth until I am full. So for me this homemade cracker stuff is holiday stress.

How do I express genuine appreciation for the work my wife has put into this pre-Thanksgiving snack, without conveying my true thoughts?

Stop wasting so much time already – they’re just crackers!

Instead, I channel Effete Cracker Connoisseur, solemnly critiquing the subtleties of each flavor and commenting about how the steam from the soup opens up the palate so one can fully appreciate the differences. But truthfully, I just wanted Ann to stop making them.

Last year I got my wish. I was not on call, and no homemade crackers were to be found!

But I noticed a few things.

Free to imbibe a glass of wine, I found I did not want any, but instead chose sparkling water.

And the sodden idiots inclined to boorish conversation I remembered from the year before were actually beautiful people I am so very blessed to have in my life.

But what surprised me most was that I actually missed Ann’s homemade crackers.

It’s not always easy for a man to appreciate the attention to detail an effortful woman brings into her family’s life. Sometimes what she does seems frivolous – and God knows, sometimes it’s expensive. But there is a reason for a woman’s efforts, and this I understand – as a father, as a husband of twenty-eight years, and also as a physician who has listened to women carefully over the years.

A woman gives life to her children, brings beauty to her home, and creates ties in her community.  A woman makes life more beautiful for us men –

Whether we want her to or not.

September 22, 2015

by Dr. Michael Litrel, FACOG, FPMRS

Our Vaginal Rejuvenation patients continue to be extremely happy with their results, whether they’ve received their surgery in the hospital or as an in-office procedure.

Patient Testimonial
“Dr. Litrel performed my vaginoplasty and he’s simply amazing! I feel absolutely wonderful and have done nothing but brag about him and his staff. I highly recommend your office. I was expecting more pain and downtime but I feel great! I sit at a desk all day and I’m going to work today. No pain meds for 24 hours. I had contacted another doctor’s office in your area prior to contacting you. I received your email response right away and it just felt right! From the time I first got in contact with your office, things fell into place and went so smoothly! I’ve never experienced this kind of excellent service at any doctor’s office I’ve ever been to. I was treated with such amazing courtesy and respect. I could not be happier with the care I received.” Juana L.

With all the discussions surrounding vaginal rejuvenation, many women considering the procedure may still find themselves with questions about it. This is completely normal, as vaginal rejuvenation is surgery, and should be treated as such. Here’s a look at three of the most common questions patients ask about the vaginal rejuvenation procedure.

Am I a Good Candidate?
Following vaginal births, women lose the strength and elasticity in the vaginal and perinatal area. These post-delivery complications can include urinary incontinence, pelvic or rectal prolapse, or loosened elasticity of the labia (the inner and outer vaginal lips) that may cause discomfort during physical activities. All of the above complications can benefit from the repairing and tightening of the vaginal tissue.

How Should I Prepare?
If you’ve made the decision that vaginal rejuvenation surgery is something you want to have done, the most important thing you can do for yourself is to do your research. Find a specialist who is trained in Female Pelvic Reconstructive surgery, not just a plastic surgeon who claims they can perform the procedure to make sex more enjoyable.

At your pre-surgery consultation, be ready with questions. Ask your surgeon about how long the surgery will last, what types of incisions will be performed, and if your surgery is considered a medically necessary procedure, find out about what insurance will and won’t cover.

What Can I Expect Post-Surgery?
The first 24-48 hours, patients can use ice packs to reduce the swelling. Routine everyday activity is permitted, and wearing loose clothing is highly recommended. You will be able to resume showering after the surgery, but use a soft washcloth and be careful not to scrub the incision areas. You will also need to avoid baths, pools, and hot tubs for four weeks post-surgery. Most patients can return to work after a week, unless the nature of your work involves strenuous activity.

For most women, the $10,000 question after having vaginal rejuvenation surgery is “When can I have intercourse again?” This, of course, is dependent on the procedure and how well you take care of yourself afterwards. Most patients can resume intercourse within 8 weeks depending upon the complexity of their surgery.

To schedule a consultation about vaginal rejuvenation surgery, please call our female representative on her private and confidential line at 770-720-7733 ext. 2232, or contact us here.

May 12, 2015

I received this wonderful handwritten card from my patient Steffanie. She also gives thanks to our great staff. It is humbling when our patients take time out of their busy days to let us know that we made a difference.



December 12, 2013

We listen to our patients! And we can say with certainty that women feel the stress of the holidays more than men. Many of the activities that make the holidays special are carried out by the woman – gifts for loved ones, holiday cooking and celebrations, hosting guests and family in your home.

Those responsibilities can lead to a sense of being overwhelmed, and even take a toll on your health. Here are three important but easy tips to keep in mind during your holiday celebrations: 

1. Don’t abandon healthy habits. Don’t let the holidays become a free-for-all. Overindulgence adds to your stress and guilt. Have a healthy snack before parties so you don’t go overboard on sweets, cheese or drinks. Continue to get plenty of sleep and physical activity.

2. Take a breather. Make some time for yourself. Spending just 15 minutes alone, without distractions, may refresh you enough to handle everything you need to do. A short walk outside can do wonders. Look around at what you see to get “out of your head”. You will be amazed at what this simple action can do!

 3. Be realistic. The holidays don’t have to be perfect or just like last year. As families change and grow, traditions and rituals often change as well. Choose to hold on to a few, and be open to creating new ones. For example, holiday dinners can be potlucks, with shared responsibilities; they don’t have to be an exercise in perfect decorations and menus.

Dr. Litrel talks about a family holiday celebration that didn’t start off in quite the right way in this excerpt from his new book “Family – A MisMatch Made In Heaven: Surviving True Love, Children, and Other Blessings In Disguise“. 


Holiday Crackers

My doctor partners and I take turns being on call for the holidays: one of us has to be ready to run to the hospital if needed. Last year, my turn fell on Thanksgiving, but with no patient emergencies, I found myself, to my surprise, sitting down to the big dinner with my friends and family.

As I looked across the table at my loved ones and listened to their loud and animated conversation, I noticed they all seemed to be in various states of inebriation. I was not joining in the festivities of the fermented grape. No, I was on call and had responsibilities. After a while, I began to wish that the hospital would actually call me. Nothing is more annoying than being the only sober one at the dinner table.

Particularly when you paid for all the wine.

I sat at the table and thought about my unhappiness. The way I saw it, I had three choices

One, I could make sure I wasn’t on call the following year so I could join in the frivolity worry-free.

Two, I could cultivate new friends and family relations, ones less inclined to intoxicate themselves at holiday meals.

Or three, I could view this moment of unhappiness as a spiritual lesson and walk more strongly the path of Love, steadfastly refusing to experience unworthy, lesser emotions.

It was a no-brainer; I decided just not to be on call again.

Holidays are stressful, but particularly so for women. Women are more aware of the subtleties of celebration. They put effort into esthetic touches that would never dawn on a man. The intention, I believe, is to manifest beauty.

But occasionally the result is marital conflict instead.

Every Thanksgiving, Ann makes six dozen homemade crackers called Cheddar Crisps. They come in three flavors: cracked blacked pepper, caraway seed, and something called nigella seed.

I never heard of nigella seed either; she orders it special online.

After watchfully monitoring the baking time and removing these handmade creations from the oven to cool, Ann carefully sequesters them in a tin box to be doled out at the proper moment. She serves them with a small bowl of homemade butternut squash soup – right after we say grace, and before we sit down for the main meal.

Every guest is given three crackers, one of each flavor. You feel yourself handling each one as though it’s Great Grandma’s favorite antique tea cup.

As far as crackers go, the Cheddar Crisps are delicious. Unfortunately, I am more a Ritz cracker kind of guy, accustomed to shoveling large quantities of whatever I am eating into my mouth until I am full. So for me, this cracker moment represents holiday stress. How do I express genuine appreciation for the work my wife has put into this pre-Thanksgiving snack, without conveying my true thoughts? Stop wasting so much time already – they’re just crackers!

So I channel Effete Cracker Connoisseur and solemnly critique the subtleties of each flavor – how the steam from the soup opens up the palate so one can fully appreciate the differences.

The next year I finally got my wish. I was not on call, and there were no homemade crackers to be found!

I noticed a few things that surprised me.

Free to imbibe a glass of wine now that I wasn’t working, I found I did not want any, but chose instead sparkling water. I also noticed that my holiday guests were not the sodden idiots inclined to boorish conversation that I remembered from the year before.  They were actually beautiful people I am blessed to have in my life.

Perhaps the previous Thanksgiving I had been just a tad bit grumpy.

But the thing that surprised me most was that I actually missed Ann’s homemade crackers.

It’s not always easy for a man to appreciate the attention to detail an effortful woman brings into her family’s life. Sometimes what she does seems frivolous. And God knows, sometimes it’s expensive. But there is a reason for a woman’s efforts, and this I understand – as a father, as a husband of twenty-five years, and also as a physician who has listened to so many of his extra effortful patients over the years…

A woman gives Life to her children, brings beauty to her home, and creates ties in her community. And wherever she goes, a woman will make Life more beautiful for us men –

Whether we want her to or not.

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