37 yo mother of two from Denver, Colorado came across the website of Urogynecologist and cosmetic surgeon, Dr. Oscar Aguirre through an internet search. She has a seven-year history of undesired cosmetic appearance of her vulva. Since before her pregnancies she has been bothered by labia asymmetry, which has led to discomfort with intercourse and feeling self-conscious during intimacy. She also reports a lifelong history of extreme difficulties with achieving orgasm and is also bothered by vaginal looseness, decreased lubrication and anal skin tags. Dr. Aguirre performed, in an office surgical setting, Laser Reduction Labiaplasty of the minora, Clitoral Hood Reduction with Pexy as well as Clitoropexy with PRP and Anal Tag Excision. Dr. Aguirre also performed an O-Shot to help with achieving an orgasm and due to the patient not being satisfied with results from a previous Thermiva treatment, Labia Majora Vampire Puff with PRP to address the issue of Labia Majora Laxity was done.