"If There's at Least One Woman in Your City, You Already Have Patients for Aesthetic Gynecology"

Expert Profile

Ekaterina Nikolaevna Zhumanova – MD, PhD, Head of Center of Gynecology, Reproductive and Aesthetic Medicine at Clinical Hospital No. 1 JSC "HC "MEDSI," Professor of Department of Restorative Medicine and Biomedical Technologies at Russian University of Medicine, Professor at Federal State Budgetary Institution B.V. Petrovsky Russian Scientific Center of Surgery, Board member of ASEG. Physician coach, regular participant in Russian and international scientific-practical conferences on obstetrics and gynecology. Author of over 50 publications, including methodological guidelines for physicians.

Education and Qualifications

• 2001 – "General Medicine" at First Moscow State Medical University named after I.M. Sechenov.
• 2003 – Residency in "Obstetrics and Gynecology" at I.M. Sechenov Moscow State Medical University.
• 2006 – Postgraduate studies in "Obstetrics and Gynecology" at I.M. Sechenov Moscow State Medical University.
• 2017 – Advanced training "Physiotherapy," RMAPO.
• 2017 – Advanced training "Obstetrics and Gynecology (new approaches to diagnosis and treatment of reproductive system diseases)," A.I. Evdokimov Moscow State University of Medicine and Dentistry.

Professional Experience

Over 23 years in gynecology.

• 2009–2017 – Head of gynecological service at Federal State Autonomous Institution "Medical Rehabilitation Center" of the Ministry of Health of Russia.
• 2017 – present – Head of Gynecology Department at Clinical Hospital No. 1 JSC "HC "MEDSI."

Professional Skills and Research Interests – Vaginal and uterine prolapse, female urinary incontinence, endometriosis, uterine fibroids, endometrial and cervical canal polyps, ovarian cysts, intrauterine adhesions, labia minora hypertrophy, minimally invasive surgical interventions for uterine fibroids, endometriosis, adenomyosis, endometrial hyperplasia, endometrial polyps, intimate contour plastic using modern techniques, infertility problems, pregnancy preparation, planning and management of normal and complicated pregnancies.

Modern Approaches to Women's Health

– Tell us, how is the modern approach to women's health changing at your MEDSI center?

– I head the Center of Gynecology, Reproductive and Aesthetic Medicine at MEDSI Clinical Hospital No. 1 in Otradnoe. As Doctor of Medical Sciences, professor of restorative medicine departments at TsGMA and Presidential Administration UD, physiotherapist, clinical psychologist, presidium member of ASEG and international society of pelvioperioneologists ISPP, I represent an extensive spectrum of professional interests.

We created a unique "sub-brand," conditionally calling it "different gynecology." This is a satellite center in a woman's life that accompanies her at all stages: from infancy and adolescence through reproductive period to menopause and postmenopause. Such a comprehensive approach combines high-tech surgery, aesthetic gynecology, physiotherapy, and long-term observation, offering personalized solutions for complex cases.

A gynecologist for a woman is like a trusted hairdresser or manicurist: a specialist completely trusted and not changed for years. Of course, our main area of interest is the full spectrum of modern gynecological operations: from standard interventions to high-tech reproductive and aesthetic medicine procedures.

We work with all current methodologies, providing patients advanced solutions at any life stage, focusing mainly on reconstructive-plastic operations and can confidently call ourselves leaders in aesthetic gynecology.

This is not only surgery but a complex of services helping women lead full sexual lives, elegantly enter menopause, maintain urinary control during sports, and avoid suffering from organ prolapse or prolapse in mature age.

Of course, we offer a full spectrum of rehabilitation measures: both after operations and in preparation for them. The clinic has the entire fleet of modern hardware methods, allowing a strictly individual approach to each patient.

Not everyone suits the same treatment – we carefully select an approach for each patient. One could say, and this may sound ambitious, that at our center there's no gynecological pathology we couldn't treat or operate on.

– You head the center of gynecology, reproductive and aesthetic medicine and perform the full spectrum of operations. How has the portrait of patients coming to you changed over these years?

– The patient portrait has noticeably evolved. Women began seeking care more often and actively, but the old tendency persists: "if nothing hurts, no need to see a gynecologist."

I still encounter patients who haven't been to a doctor for 15 years, despite living in a capital metropolis with developed medicine. However, progress is encouraging: women now come at early stages of urinary incontinence, refuse to tolerate discomfort with pads, consider quality sexual life and harmonious relationships with partners.

Cancer screening has become mass practice – modern patients regularly take tests allowing early cervical cancer detection and actively engage in prevention.

About Professional Path

– You started as a classical obstetrician-gynecologist; today you're Doctor of Sciences, surgeon, and center head. What key professional turning points shaped your current treatment approach?

– Yes, that's true. I started in a maternity hospital and still consider obstetrics one of the most wonderful professions – it's the joy of first breaths, the magic of new life, the moment when physicians literally accept the future in their hands. But at some point, my and my obstetrician-husband's schedules stopped overlapping: we endlessly drove to deliveries.

The turning point was an offer from my teacher, Konstantin Viktorovich Lyadov, then heading Federal State Budgetary Institution "Medical Rehabilitation Center," to head the gynecology department. I was 32 then, and for me it was absolutely unexpected. I was a maternity hospital doctor accustomed to delivery dynamics, and here, completely different specifics, surgery, complex cases.

But his approach to young specialists remains unchanged and inspiring: "You can do everything." This faith in my abilities became the foundation – then I understood I could not only deliver babies but radically change women's lives through restorative medicine, reconstructive surgery, and comprehensive approach.

Konstantin Viktorovich's approach to young specialists remains unchanged and inspires still. The main thing, find your niche, that unique area where your talents reveal.

15 years ago, much less was said about physician personal branding and constant professional development – this was rather an exception than rule. Today, expertise formation, publicity, and continuous learning became the absolute norm for ambitious medical professionals. Precisely this transition from closed clinical practice to open professional positioning allowed me to grow from maternity hospital doctor to major center head.

– Your personal brand is very well represented in the digital space. How do you build communication with an audience?

– We indeed have a cool site, actively developing YouTube and Telegram channels. We do this not as service advertising but rather as a women's magazine – with an enlightenment mission.

Despite the information era, we live in puritanical society where women often poorly know even their genital organ structure. Hence the concept of different gynecology was born, implying not only treatment but educational work changing stereotypes. This became a starting point: a cohesive colleague team that's been with me for 15 years, and together we form a caring patient attitude. We destroyed the gloomy gynecologist image – now it's a partnership based on deep trust and sincere care.

Complex Gynecology Cases

– Let's talk about complex gynecology cases. How often do people come for second opinions?

– Quite often. This comes with experience, certain recognition, when patients hear about specialists and are ready to trust them with the most complex. People come not only "for operation" but primarily for advice, understanding what's happening to them.

I have free preoperative consultations, and there I always emphasize: absolutely not necessary to operate specifically with me. One can come only for a second opinion – to calmly understand diagnosis, understand whether an operation is really needed, and form one's attitude toward treatment.

– In what situations, in your opinion, should a patient seek a specifically large medical center with a serious scientific base and good equipment?

– It would be utopian to say that everywhere in the country has an equally high level of care. Unfortunately, not so. Therefore a large center is especially needed when a patient has doubts: is diagnosis correctly established, is this specific operation really indicated, are there no alternatives. Doubting is normal; not asking questions is dangerous.

There's another important point – continuity. Now many physicians well understand their competence boundaries and refer patients to institutions with greater capabilities when they see a case goes beyond their level. This is a healthy professional position: timely say "specialized center needed here."

Gynecology, Aesthetics and Surgery

– Pelvic floor surgery is one of your center's key directions. What complaints do women most often silence for years and what do you actually work with in the operating room?

– For me this is, honestly, personal pain, a topic I speak about literally at every conference. Still in women's consultations one can hear: "This is age, this is aging, everyone has it, endure it." But it's not so. Prolapse, urinary incontinence, and other pelvic floor problems are not "old age sentences."

Very often young women already after childbirth encounter this. They develop urinary incontinence, prolapse, sensation changes in sexual life, ability to exercise decreases, freely move, plan trips. Quality suffers not only in intimate but also in most ordinary daily life. This isn't about whims but basic social and personal activity.

Against this background, an entire large layer of reconstructive-plastic pelvic floor operations arose. They're often incorrectly called "aesthetic gynecology," though essentially it's functional surgery. Essence not in beauty but function: it's bad when a woman cannot run a marathon or simply calmly reach the metro because fear leaks.

Fortunately, as we talk more about these problems, women became more active seeking care and even insisting on referral where they can really be helped. This is especially noticeable in elderly patients: many for years reach a severe organ prolapse state simply because they're told: "You're already old, no one will operate on you." This is absolutely the wrong approach.

There's no age limit for such operations: if a problem interferes with a woman's life, she needs help, even if she's over 80 or 90. Question not in passport number but intervention safety and expediency.

– How do patients leave you? What is the criterion of good and long-term results?

– The most important criterion is quality of life change. The patient should leave with the feeling that part of life disease took was returned. One can discuss suture forms and incision types endlessly, but in reality a woman cares whether she can again live habitually.

Imagine a patient with severe urinary incontinence: spends hours getting to work and enters every passing toilet ten times, afraid to go to the theater because won't sit through a performance, refuses trips to relatives from fear of odor or leaks. And after the operation she can calmly travel, sit in the hall, plan trip, without constant anxiety. Agree, this is real happiness.

Or another situation: woman with uterine fibroid who was told everywhere the uterus must be removed, and we manage to preserve organs. For her this is colossal emotional relief and feeling she was heard and her values respected. Such stories are examples of long-term results.

What is Aesthetic Gynecology

– You mentioned "intimate" or aesthetic gynecology is often confused with something secondary. What actually stands behind this term?

– Honestly speaking, there's not so much pure "aesthetics." Yes, we can rejuvenate external genitals, use various techniques – from laser to plasma therapy. But almost always this goes in conjunction with function restoration.

Female genitals are created, of course, also for beauty, but primarily for function: sexual, reproductive, hormonal. And external beauty is also closely related to function. Today, fortunately, women increasingly openly discuss sexual health and don't consider intimate life officially ended after menopause.

Problems of dryness, discomfort, pain during intercourse significantly limit quality of life – even if women cannot or doesn't want to take hormonal drugs. Here aesthetic gynecology just helps.

Using hyaluronic acid, plasma, hardware techniques, mucosal condition can be improved, its function restored, comfort and desire to live a full sexual life returned. Any competent intervention in this area ultimately leads not to picture beauty but to woman's well-being and confidence improvement.

– Aesthetic gynecology often causes skepticism: "why improve this, it's not about health." How do you explain to patients where aesthetics ends and medical indications begin?

– Actually women are easy to motivate if you talk honestly with them. I often say: our intimate area, our perineum – is our "second face." We generally care for facial skin: wash, use creams, decorative cosmetics. But forget about perineum, though skin and mucus there age exactly the same way and carry colossal functional load.

If you don't care for this area, sooner or later dryness, discomfort, chronic discharge, itching appear. And women begin treating this with whatever – most often antibiotics and antifungal drugs, though often something completely different is needed.

If talking not about beauty but health, genitals are truly our second face, and care culture for this area should become as natural as skin care.

Even if a woman doesn't live a sexual life, mucosal dryness and atrophy still lead to discomfort, microtraumas, and inflammations. Much wiser to timely engage in prevention and maintenance therapy – including using special intimate products, procedures, sometimes hardware techniques.

– You train physicians in aesthetic gynecology. What mistakes in this area can become truly risky for patient health?

– We indeed have many educational projects and schools, especially on anatomy. And, despite this, specialists maintain skepticism: at courses regional colleagues often say: "We don't have such patients, they don't need this." I always answer: if at least one woman lives in your city, you already have patients for aesthetic gynecology.

Women age, and with age – sometimes much earlier – problems arise that can and should be solved. Our task as physicians is to clearly explain these problems are not "normal fate" but condition medicine knows how to work with. Yes, regions don't yet everywhere have a full equipment fleet, but understanding routing is important: where patients can be referred to receive quality care rather than hear: "This is age, accept it."

A separate big topic is rehabilitation. I operate a lot, and then my patients disperse to different Russian cities and beyond. Often local specialists don't understand how to manage a patient after complex reconstructive operation, what she can, cannot, what recovery stages exist. This is a serious complication risk. Therefore at aesthetic gynecology schools we pay very great attention specifically to postoperative management, not only the operation "beautiful" stage.

Gynecological Surgery Standards

– What minimally invasive surgery techniques do you use and how do they fundamentally differ from "heavy" classical surgery? For which diseases do you primarily choose a minimally invasive path?

– If there's a possibility to perform intervention minimally invasively, it must be used. This is especially important in pelvic floor surgery and reconstructive-plastic operations. Paradoxically, in institute and residency we're practically not taught such operations: gynecologists traditionally taught to remove the uterus, not preserve it.

This leads to many women being offered only one option – radical organ removal. Yet our operations are generally short, minimally traumatic, designed for adult patients with serious somatic load who are often refused in ordinary hospitals. Moreover, they're maximally organ-preserving.

Not that an 80-year-old woman needs the uterus as a feminine symbol. It is important to understand the uterus is part of the pelvic floor supporting framework. If uterus removal itself solved the prolapse problem, we'd long have no prolapse: every hospital would remove uterus, and that's it. But problems remain, sometimes intensify. Therefore each organ and each function must be treated maximally carefully and choose for the patient not an operation convenient for the surgeon but an optimal option specifically for her.

– Patients find it difficult to navigate terminology: minimally invasive operations, organ preservation, laser instead of scalpel. What, in your opinion, should they pay attention to when choosing a clinic and specialist?

– First, it is important that the clinic be well equipped. Meanwhile, much equipment itself guarantees nothing – behind it must be specialists understanding what and why they use. But modern technology presence indicates the center invests in development.

Second, choose not only the clinic but the physician. Regalia, titles, publications – this is important but doesn't always help patients make choices. I always advise: select several comparable level specialists and talk. It is important that you're comfortable, that the physician can explain, and doesn't devalue your fears and questions.

If a patient is offered uniform, maximally radical operation with organ removal, this is a serious reason to get a second opinion. Often there are less traumatic, organ-preserving, minimally invasive options. Not always, but checking this is a patient's right and obligation.

Trust is a key criterion. We still choose physicians emotionally: by how they speak, how they react to our questions, and how honestly they describe possible risks. If a surgeon assures "complications never happen and everything will go perfectly," this is reason to be wary. Everyone has complications; professionals aren't scared but don't hide risks.

About Patient Management

– You talk a lot about trust. What communication techniques help you not only explain operation necessity but also ensure the patient doesn't postpone treatment for years?

– Most important is honesty. The patient doesn't need to be frightened but also cannot be left in illusions. Women must understand what refusal of operation will lead to, what are possible intervention consequences, how recovery will look.

I always tell in detail and very often – draw. Use models, diagrams, explain in simple language what we'll do and why. The patient may not remember terminology, but she must understand logic: what's currently wrong, what we want to change, what limitations will be after the operation. When a person is oriented in a situation, it's easier to make decisions and endure the treatment path.

If talking about pelvic floor surgery, here it's extremely important to discuss recurrence topic. We cannot "sew iron glass into vagina" and forever fix everything possible. A person continues walking, lifting heavy, aging, and repeated prolapse risk always exists. Therefore we discuss in advance that after the operation the patient will have to participate in own treatment: follow rehabilitation recommendations, weight control, physical activity.

When a patient understands this is a joint project, not "service by price list," her treatment and rehabilitation adherence significantly increases. I'm very proud that even with complex operations and complications we never leave patients: we go through the entire path with them – to result. In response we see their support, participation, and trust – and this is probably most valuable in our profession.

For me personal communication is fundamentally important. I'm available on social networks, and give patients my phone. Perhaps this isn't the most gentle life mode for a physician, but a feeling person can ask questions and get answers significantly reduces anxiety level and helps not postpone important decisions.

– You've essentially built a complete patient management cycle: from first consultation to postoperative observation. How is rehabilitation organized, what place does it occupy in your work?

– If a patient lives nearby and can come regularly, this is an ideal situation: we indeed manage her for years – from operation planning stage to pregnancy preparation, pregnancy management itself, postpartum recovery, and of course postoperative rehabilitation. This is such a long but very logical route when no stage "falls out."

When a woman from another city or country, more difficulties: no possibility to often come, and here clear instructions are especially important. Therefore we give detailed memos, maintain channels with typical situation analysis – so patients can at any moment open and see what to do next. This reduces anxiety and helps not "get lost" after discharge.

After reconstructive-plastic operations rehabilitation is critically important. However well the operation went, there are always scars, changed tissues, and after some time the woman returns to sexual life and usual activity. Our task is to help mucosa recover, make scars more elastic, preserve achieved effect, and minimize recurrence risk. The ambulatory link handles this: we have all modern devices and techniques, and all department physicians master them.

– You have many scientific publications, you teach, conduct schools for physicians. What topics in gynecology today, in your opinion, remain underestimated in the professional community?

– Definitely aesthetic and reconstructive-plastic gynecology, as well as rehabilitation. These directions are still perceived as addition, though actually they're directly about quality of life. Problem not so much in underestimation as in topic complexity itself: it requires from gynecologist completely different approach.

We're traditionally taught to fight disease: remove, cut off, cure – and consider that victory. In reconstructive and aesthetic gynecology everything is different: result depends not only on operation technique but also on how a woman herself sees her body, sexuality, age. Here equally important are both large prolapse operation and seemingly small laser rejuvenation.

This is work at surgery and psychology intersection. Cannot simply "cut something off" or prescribe pills, have to talk a lot about expectations, fears, self-image. Working with negativity, disappointments, inflated expectations is not easy, and not all specialists are comfortable in this zone. That's why I teach so much: I want more physicians to engage in this agenda and share ideas of improving women's quality of life, not only treating "big" diagnoses.

Aesthetic Gynecology in Russia

– Do you have foreign patients? Do their expectations differ from Russian women's expectations?

– Yes, there are foreign patients, though not many. Mainly these are women who emigrated from Russia and live abroad. There are indeed many now, and precisely they demonstrate systems differences very well: many come because they have already managed to compare.

I'll say perhaps not an entirely popular thing but absolutely sincerely: gynecology level in Russia is now in many ways higher than in several European countries. I myself studied abroad a lot and can compare: in care quality we're at a very worthy level and generally competitive with most countries. This is seen by our former compatriots who return for treatment here because here they receive a more comprehensive approach and different levels of physician involvement.

Their expectations noticeably differ. They value accessibility and care depth more because they already face situations where they cannot simply call an ambulance "just in case" or do an ultrasound when wanted. Our patients, even from remote regions with non-ideal equipment level, are still accustomed to getting to the clinic, perhaps not immediately but in the foreseeable future. Abroad many encounters that are simply unavailable at the moment when needed. Therefore, coming here, they treat physicians and the system with very great respect and gratitude.

– What technologies and approaches, in your opinion, will determine aesthetic gynecology development in coming years?

– Most hope not so much for technologies as for changing physicians' attitude toward women's problems. I want focus to shift from exclusively "big" tasks – like "remove tumor" or "stop bleeding" – to quality of life: sexual, social, psychological. This is already happening but would like this trend to become systemic.

There's another important topic – harmonization. Today, a woman's face is often unable to determine her age: cosmetology has stepped so far that a 50-year-old patient can look like a 30-year-old. But when she lies on a gynecological chair, by intimate zone condition age typically guessed very accurately. To this harmony of face and body – when self-care doesn't end at makeup and skincare level – we need to move.

– You're not only a gynecologist but also a clinical psychologist. How do these areas intersect in your practice?

– The path was quite natural. Like many gynecologists, first I received a second specialty in ultrasound diagnostics. Then it became clear that a huge layer of problems is rehabilitation, and I underwent physiotherapy training, which I never regretted: this is a key recovery tool.

Next step – working with sexual dysfunctions. Very quickly became clear: engaging in this without understanding psychology is impossible. If approaching all women equally, ignoring where the purely gynecological problem ends and psychological begins, can discredit any, even most effective methods.

I don't conduct appointments as a separate psychologist without a gynecology connection. But clinical psychology knowledge allows helping patients understand the root of her sexual difficulties – in anatomy, in partner relationships, in attitudes that came from family and upbringing. This is a different conversation quality and different quality of decisions we make together.