Pelvic Health Beyond Leaks: How Emsella Supports Confidence, Core and Intimacy
- Pelvic floor weakness affects far more than bladder control: it can diminish core stability, sexual confidence, exercise performance and overall quality of life in both women and men.
- Emsella uses HIFEM1HIFEMHigh-Intensity Focused Electromagnetic technology. Delivers electromagnetic pulses that trigger deep, involuntary pelvic floor muscle contractions far beyond what voluntary exercise can achieve. technology to deliver thousands of deep pelvic floor contractions in a single, fully clothed, 28-minute session.
- Clinical studies report up to 95% patient satisfaction, significant reductions in urinary incontinence symptoms sustained for up to one year, and measurable improvements in sexual function for both women and men.
- Emsella is not a replacement for physiotherapy or lifestyle modification. The best outcomes come from combining it with targeted pelvic floor exercises, core strengthening and, where appropriate, hormonal support.
- Not everyone is suitable: pregnancy, cardiac pacemakers, metal implants in the pelvic area and certain bleeding disorders are absolute contraindications.
- At Harley Street Injectables, every Emsella course begins with a clinical consultation to rule out contraindications and build a treatment plan that makes sense for your goals, not just your symptoms.
Why Pelvic Health Matters More Than Most People Think
Let me start with something I say to patients at least three times a week: your pelvic floor is not just a bladder-control switch. It is a complex group of muscles, ligaments and connective tissues that form a supportive base for your bladder, bowel, uterus (or prostate, if you are reading this as a man) and, frankly, for your entire core structure. When those muscles are strong, you probably never think about them. When they weaken, they can affect everything from your posture and lower back stability to your confidence during exercise, intimacy and even day-to-day social interactions.
I see this in the clinic constantly. A woman in her early forties who stopped running after her second child because she leaked every time she increased her pace. A man in his late fifties, referred by his urologist after prostatectomy, who had not been intimate with his partner in months. A menopausal patient who described her pelvic floor2Pelvic FloorThe group of muscles forming a sling-like structure at the base of the pelvis. They support the bladder, bowel and reproductive organs, and play a crucial role in continence, core stability and sexual function. as "having given up." These are not unusual stories. Urinary incontinence alone affects an estimated one in three women over the age of 35 in the UK, and the number among men is far higher than most people assume, particularly after prostate surgery or with age-related pelvic floor dysfunction3Pelvic Floor DysfunctionA condition in which the pelvic floor muscles become weakened, overly tight or poorly coordinated, leading to symptoms such as urinary leakage, pelvic pain, sexual difficulties and reduced core stability..
The trouble is that the conversation around pelvic health has been narrowed to one word: leaks. And while incontinence is a real and often distressing symptom, it is only one part of the picture. I wanted to write this piece to broaden that conversation, because the patients I treat are not just looking for fewer pad changes. They want to feel strong. They want to feel confident. Many of them want to enjoy intimacy again without anxiety. That is a fundamentally different starting point, and it changes the way we approach treatment.
How Emsella Works, and What a Session Actually Feels Like
The Emsella chair is an FDA-cleared medical device manufactured by BTL. It uses HIFEM1HIFEMHigh-Intensity Focused Electromagnetic technology. Delivers electromagnetic pulses that trigger deep, involuntary pelvic floor muscle contractions far beyond what voluntary exercise can achieve. (High-Intensity Focused Electromagnetic) technology to deliver focused electromagnetic pulses directly into the pelvic floor musculature. These pulses induce supramaximal contractions4Supramaximal ContractionsMuscle contractions that exceed what is achievable through maximum voluntary effort. In the context of Emsella, these contractions recruit 100% of the pelvic floor muscle fibres, including those normally impossible to activate through conscious exercise., meaning contractions that exceed what you could ever achieve through conscious effort, even with perfect Kegel technique. A single 28-minute session delivers the equivalent of approximately 11,200 Kegel exercises.
I always explain this to patients with a practical comparison. If you are doing Kegel exercises at home (and doing them correctly, which most people are not), you might manage 50 to 100 quality contractions in a session. You are relying on your ability to isolate the right muscles, maintain focus and contract with sufficient intensity. Many women bear down instead of lifting, and many men have no idea where to even begin. Emsella removes that entire variable. You sit on the chair, fully clothed, and the electromagnetic field does the work, recruiting 100% of the pelvic floor muscle fibres in a way that is physiologically impossible through voluntary effort.
What does it feel like? Patients describe a strong tingling sensation and deep rhythmic contractions in the pelvic area. It is not painful. Some people find it slightly unusual for the first few minutes, but most settle in quickly. I have had patients answer emails, read the newspaper and, on one memorable occasion, fall asleep. You walk out and carry on with your day. There is no recovery time, no undressing, nothing invasive.
A standard protocol at Harley Street Injectables is six sessions over three weeks (two per week), though we adjust this depending on individual assessment. Improvements often begin within the first few sessions, but the full effect builds progressively as the muscles strengthen and neuromuscular control5Neuromuscular ControlThe brain's ability to coordinate and regulate muscle contraction. In pelvic floor rehabilitation, restoring neuromuscular control means retraining the muscles to respond appropriately to signals such as coughing, laughing or physical exertion. is restored.
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Women's Stories: Leaks, Confidence, Relationships
The clinical data on Emsella for women is, at this point, fairly robust. In 2019, Samuels and colleagues published the landmark safety and efficacy study in Lasers in Surgery and Medicine, evaluating 75 women with stress, urge or mixed urinary incontinence. After six HIFEM sessions, the average ICIQ-SF score (a standardised measure of incontinence severity) improved significantly, pad usage decreased, and patients reported additional benefits including increased sexual desire and better urination control. No adverse events were reported. These improvements were sustained at the three-month follow-up.
But the numbers only tell part of the story. What I find more telling is what happens in the consultation room three or four weeks into a course. A patient who has not been to a gym class in two years because she was terrified of leaking during squats. A woman who stopped wearing light-coloured trousers. Someone who has been declining invitations to dinner because she was anxious about laughing too hard. These are real quality-of-life impacts, and when patients tell me they have started running again, or that they went to a wedding and danced without a single thought about their bladder, that is the outcome that matters.
The Sexual Health Conversation Nobody Wants to Start
If incontinence is taboo, the impact of pelvic floor weakness on sexual function is doubly so. But it is clinically significant. The pelvic floor muscles are directly involved in arousal, vaginal sensation, orgasm intensity and lubrication. When those muscles weaken, whether from childbirth, perimenopause6PerimenopauseThe transitional phase before menopause during which oestrogen levels fluctuate and decline. Commonly begins in the early to mid-forties and can last several years. Associated with changes in menstrual cycle, sleep, mood, skin quality and pelvic floor function., ageing or simply disuse, intimate satisfaction can decline in ways that are difficult to articulate and even more difficult to raise with a doctor.
A multi-centre pilot study by Hlavinka, Turcan and Bader (2019), published in the Journal of Women's Health Care, evaluated 30 women with limited arousal, difficulty achieving orgasm and painful intercourse. After six HIFEM sessions, the average FSFI (Female Sexual Function Index) score improved by 53%, with significant gains in desire, arousal, lubrication, orgasm and satisfaction domains. The correlation between stronger pelvic floor muscles and better sexual function was highly statistically significant.
Evans, Berenholz, Samuels, Pezzella and DeLucia extended this work in a prospective multi-centre study published in the Journal of Women's Health Care (2023), tracking 31 women for a full year after treatment. At 12 months, FSFI scores remained significantly elevated, with patients reporting more frequent orgasms and increased lubrication. The ICIQ-UI SF scores (measuring incontinence severity) also remained improved, confirming that the benefits were not just short-term.
I share these studies with patients who feel embarrassed raising the subject. You are not imagining it. The weakness is real, the impact is measurable, and the improvement with treatment is documented. Emsella is one tool in that conversation, and for many women, it is the first time anyone has offered them something concrete beyond "do your Kegels."
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Men's Stories: Performance, Control, and Stigma
Pelvic floor weakness in men is one of the most under-discussed areas in clinical practice. Most men do not know they have a pelvic floor, let alone that it can weaken and cause symptoms. But the anatomy is the same principle: a sling of muscles at the base of the pelvis supporting the bladder, bowel and, critically, the structures involved in erectile function and ejaculatory control.
The most common scenario I see is post-prostatectomy. When the prostate is removed surgically, one of the valves that regulate urine flow is removed along with it. Many men experience stress incontinence afterwards, particularly during heavy exercise, coughing or towards the end of the day when the muscles fatigue. This is often compounded by erectile difficulties, because the ischiocavernosus7Ischiocavernosus MuscleA paired muscle of the pelvic floor that compresses the crus (root) of the penis, contributing to erectile rigidity by restricting venous outflow. Strengthening this muscle can improve the firmness and duration of erections. and bulbospongiosus8Bulbospongiosus MuscleA pelvic floor muscle that contributes to ejaculatory force and urethral emptying. In men, strengthening this muscle is associated with improved ejaculatory control and orgasm intensity. muscles that contribute to erectile rigidity are the same muscles that have been weakened.
Brandeis (2024) published a pilot study in Reproductive System and Sexual Disorders: Current Research evaluating 28 men aged 27 to 72 who underwent ten weekly HIFEM sessions. The results showed a 46.2% reduction in nocturia (night-time urination frequency), a 38.2% improvement in overall urinary control measured by IPSS scores, and a 37% improvement in the ability to maintain erections measured by the IIEF. Penile ultrasound scans performed before and after treatment showed measurable changes in penile tissue, supporting the mechanism of improved blood flow through stronger pelvic floor compression.
Seventy percent of patients in the study showed improvements. These are not dramatic, overnight transformations, but they are clinically meaningful. For a man who has been leaking during his morning run, or who has avoided intimacy because he cannot trust his body, a 38% improvement in urinary control or a 37% improvement in erectile function can be genuinely life-changing.
The stigma is the biggest barrier. Most men will not bring this up with their GP, let alone an aesthetics clinic. But pelvic floor health is a health issue, not a cosmetic one, and our approach at Harley Street Injectables treats it as such. The consultation is clinical, private and entirely focused on what is actually going on. No euphemisms, no judgement.
What the Research Actually Shows (and What It Does Not)
I want to be transparent about the evidence base, because I think honesty serves patients better than marketing claims.
What the evidence supports strongly:
HIFEM technology significantly improves urinary incontinence symptoms in women, with results sustained for up to 12 months. Guerette, Molden, Gopal and Kohli (2023) published a randomised trial in the Journal of Women's Health Care comparing HIFEM directly against standard pelvic floor muscle exercises in 38 women. At six months, the HIFEM group showed a 35% improvement in quality-of-life scores (ICIQ-LUTSqol), while the exercise-only group showed only a 13% improvement that was not statistically significant. At 12 months, the HIFEM group maintained significant improvements in daily pad usage and UDI-6 scores, while the exercise group did not.
A 2025 study by Jongjakapan and colleagues, published in the International Urogynecology Journal, further confirmed that six HIFEM sessions significantly improved urinary incontinence symptoms, quality of life and some aspects of sexual function in women, with improvements sustained at three months.
What the evidence is still building on:
Male-specific data is more limited. The Brandeis pilot study is encouraging but involved only 28 men without a control group. Randomised controlled trials in male populations are underway but not yet published. The mechanism of action is well-established (HIFEM strengthens the same muscles that physiotherapy targets, just with greater intensity and consistency), but we need larger, longer-term male studies before making definitive claims.
Similarly, while the sexual function data in women is consistent across multiple studies, most are single-arm or small-sample designs. The Guerette randomised trial is the strongest comparator, but even that had only 38 participants and was partly affected by COVID-19 related follow-up challenges. Larger, multi-centre randomised trials with extended follow-up are needed.
What I tell patients: the evidence is very encouraging. The safety profile is excellent. The mechanism is logical and well-understood. But Emsella is not a miracle chair, and anyone who sells it to you as one is doing you a disservice.
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Combining Emsella with Other Care: Why It Works Best as Part of a Plan
One thing I want to make very clear: Emsella is not a standalone solution for everyone. The best outcomes I see in the clinic come from patients who combine it with a broader approach to pelvic health.
Pelvic Floor Physiotherapy
Emsella and PFMT9Pelvic Floor Muscle Training (PFMT)A structured programme of voluntary pelvic floor contractions (Kegel exercises) guided by a physiotherapist. Often combined with biofeedback to ensure correct muscle recruitment. Remains the first-line conservative treatment for urinary incontinence. are complementary, not competing. Emsella provides the raw muscular stimulus, contracting the muscles at an intensity and consistency that manual exercises cannot match. But physiotherapy teaches you how to use those muscles in context: how to brace before a cough, how to engage during a lift, how to coordinate pelvic floor activation with breathing and core stabilisation. I often recommend that patients begin pelvic floor physiotherapy alongside or shortly after their Emsella course, so the strength gains are reinforced by functional control.
Core and Exercise Rehabilitation
The pelvic floor does not work in isolation. It functions as part of a system that includes the deep abdominals (transversus abdominis10Transversus AbdominisThe deepest layer of the abdominal muscles, wrapping around the torso like a corset. Works in coordination with the pelvic floor and diaphragm to provide core stability. Weakness in this muscle is commonly associated with lower back pain and pelvic floor dysfunction.), the diaphragm and the multifidus muscles of the lower back. Strengthening the pelvic floor without addressing the wider core is like reinforcing the foundation of a building without checking the walls. Treatment planning should always consider the bigger picture.
For post-natal patients, this is particularly important. Pregnancy and delivery can affect diastasis recti11Diastasis RectiA separation of the left and right sides of the rectus abdominis (the "six-pack" muscle) along the midline of the abdomen. Common after pregnancy. Can contribute to core instability and pelvic floor dysfunction if not addressed alongside pelvic floor rehabilitation., hip alignment, breathing mechanics and thoracolumbar stability as well as the pelvic floor. Emsella addresses one piece of that puzzle efficiently and non-invasively, but it should not be the only piece. If you are navigating the postpartum recovery journey more broadly, our post-pregnancy body recovery plan maps the full clinical timeline from pelvic floor through to stretch marks, skin laxity and veins.
Hormonal Considerations
For menopausal and perimenopausal women, oestrogen decline directly affects the pelvic floor tissues, reducing elasticity, mucosal thickness and blood flow. In some cases, topical vaginal oestrogen can support the tissue health that underpins the muscular strength Emsella builds. This is a conversation to have with your GP or menopause specialist, and we are happy to coordinate with your existing healthcare team.
Lifestyle Factors
Hydration, weight management, caffeine reduction, smoking cessation and correct toileting posture all affect pelvic floor function. They are not glamorous interventions, but they matter. A strong pelvic floor fighting against chronic constipation from poor hydration or excessive straining from incorrect toileting habits will not deliver its best results. We discuss all of these in the initial consultation.
Who Is Not Suitable, and Why That Matters
Emsella is FDA-cleared and has an excellent safety profile. But it is not suitable for everyone, and being upfront about that is part of responsible practice.
Absolute contraindications include:
Pregnancy (or suspected pregnancy). The electromagnetic field could stimulate uterine contractions and is not tested for safety during pregnancy.
Cardiac pacemakers, implantable defibrillators and other electronic implants. HIFEM technology generates a powerful electromagnetic field that can interfere with the function of these devices, potentially causing malfunction or dangerous rhythm disturbances.
Metal implants in or near the pelvic area. This includes metal plates, screws, hip replacements and copper IUDs12IUD (Intrauterine Device)A small device inserted into the uterus for contraception. Copper IUDs are contraindicated with Emsella because the electromagnetic field can cause the metal to heat. Hormonal IUDs (e.g. Mirena) may also need clinical assessment before treatment.. The electromagnetic energy can cause metal to heat, risking discomfort or internal burns.
Bleeding disorders or active anticoagulation therapy. The intense muscle contractions could theoretically exacerbate haemorrhagic conditions.
Malignant tumours. HIFEM should not be applied over or near active malignancies.
Recent surgical procedures in the pelvic area where muscle contraction could disrupt healing.
Relative considerations include pulmonary insufficiency, heart disorders and areas of skin that lack normal sensation. We assess all of these during your consultation at Harley Street Injectables. If Emsella is not right for you, we will tell you, and we will discuss what is.
What Happens at Harley Street Injectables
At our CQC-registered clinic at 106 Harley Street, every Emsella course begins with a clinical consultation. This is not a sales meeting. It is a medical assessment. We review your medical history, discuss your symptoms and goals, rule out contraindications and, if appropriate, build a treatment plan.
Sessions are conducted in a private treatment room. You remain fully clothed throughout. The chair is positioned, the intensity is gradually increased to your comfort level, and the session runs for approximately 28 minutes. Most patients schedule during a lunch break and return to work immediately afterwards.
We typically recommend the standard protocol of six sessions over three weeks, with a follow-up assessment to evaluate progress. Some patients benefit from maintenance sessions every six to twelve months, depending on their individual response and goals. Pricing starts from £300 per session.
The team at Harley Street Injectables includes CQC-registered practitioners with extensive experience in intimate health treatments, including vaginal polynucleotides, vaginal tightening and intimate laser hair removal. Emsella fits within a broader clinical framework for pelvic and intimate wellness, not as a standalone gimmick.
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Frequently Asked Questions
How many Emsella sessions will I need?
The standard protocol is six sessions over three weeks (two per week). Some patients benefit from additional sessions or maintenance treatments every six to twelve months. This is assessed individually during your consultation at Harley Street Injectables.
Does Emsella hurt?
No. Patients typically feel a strong tingling sensation and deep rhythmic contractions. The intensity is gradually increased to your comfort level. There is no pain, no recovery time and no need to undress.
Can men have Emsella treatment?
Absolutely. Emsella is FDA-cleared for both male and female urinary incontinence. Men with post-prostatectomy weakness, age-related pelvic floor decline, erectile difficulties or urinary urgency may benefit significantly from HIFEM-based pelvic floor strengthening.
Will Emsella improve my sex life?
Multiple clinical studies have documented improvements in sexual function following HIFEM treatment. In women, this includes increased arousal, stronger orgasms, improved lubrication and reduced pain during intercourse. In men, improvements in erectile rigidity and ejaculatory control have been reported. Results vary between individuals.
Is Emsella safe during pregnancy?
No. Pregnancy is an absolute contraindication for Emsella. The electromagnetic field could stimulate uterine contractions. If you are pregnant or suspect you may be pregnant, you should not undergo treatment. Post-natal patients can typically begin Emsella once they have been cleared for exercise by their midwife or GP. For a full guide to postpartum treatment timing, read our post-pregnancy body recovery plan.
Can I have Emsella if I have a copper IUD?
No. Copper IUDs are a contraindication because the electromagnetic energy can cause the metal to heat. If you have a hormonal IUD (such as a Mirena), this should be discussed during your clinical consultation, as individual assessment may be required.
How long do the results last?
Published studies show significant improvements sustained for up to 12 months after a standard six-session course. As with any muscle-strengthening programme, ongoing maintenance (through exercise, lifestyle factors and, for some patients, periodic top-up sessions) helps sustain results over the longer term.
Is Emsella a replacement for pelvic floor physiotherapy?
No, and I would be wary of any provider who positions it that way. Emsella is a powerful complement to physiotherapy. It provides the muscular stimulus; physiotherapy teaches you functional control. The best outcomes combine both.
- Bulbospongiosus Muscle ↑
- A pelvic floor muscle that contributes to ejaculatory force and urethral emptying. In men, strengthening this muscle is associated with improved ejaculatory control and orgasm intensity.
- Diastasis Recti ↑
- A separation of the left and right sides of the rectus abdominis (the "six-pack" muscle) along the midline of the abdomen. Common after pregnancy. Can contribute to core instability and pelvic floor dysfunction if not addressed alongside pelvic floor rehabilitation.
- HIFEM (High-Intensity Focused Electromagnetic) ↑
- A technology that delivers electromagnetic pulses triggering deep, involuntary pelvic floor muscle contractions far beyond what voluntary exercise can achieve. The core mechanism behind the Emsella chair.
- Ischiocavernosus Muscle ↑
- A paired muscle of the pelvic floor that compresses the crus (root) of the penis, contributing to erectile rigidity by restricting venous outflow. Strengthening this muscle can improve the firmness and duration of erections.
- IUD (Intrauterine Device) ↑
- A small device inserted into the uterus for contraception. Copper IUDs are contraindicated with Emsella because the electromagnetic field can cause the metal to heat. Hormonal IUDs (e.g. Mirena) may also require clinical assessment before treatment.
- Neuromuscular Control ↑
- The brain's ability to coordinate and regulate muscle contraction. In pelvic floor rehabilitation, restoring neuromuscular control means retraining the muscles to respond appropriately to signals such as coughing, laughing or physical exertion.
- Pelvic Floor ↑
- The group of muscles forming a sling-like structure at the base of the pelvis. They support the bladder, bowel and reproductive organs, and play a crucial role in continence, core stability and sexual function.
- Pelvic Floor Dysfunction ↑
- A condition in which the pelvic floor muscles become weakened, overly tight or poorly coordinated, leading to symptoms such as urinary leakage, pelvic pain, sexual difficulties and reduced core stability.
- Perimenopause ↑
- The transitional phase before menopause during which oestrogen levels fluctuate and decline. Commonly begins in the early to mid-forties and can last several years. Associated with changes in menstrual cycle, sleep, mood, skin quality and pelvic floor function.
- Pelvic Floor Muscle Training (PFMT) ↑
- A structured programme of voluntary pelvic floor contractions (Kegel exercises) guided by a physiotherapist. Often combined with biofeedback to ensure correct muscle recruitment. Remains the first-line conservative treatment for urinary incontinence.
- Supramaximal Contractions ↑
- Muscle contractions that exceed what is achievable through maximum voluntary effort. In the context of Emsella, these contractions recruit 100% of the pelvic floor muscle fibres, including those normally impossible to activate through conscious exercise.
- Transversus Abdominis ↑
- The deepest layer of the abdominal muscles, wrapping around the torso like a corset. Works in coordination with the pelvic floor and diaphragm to provide core stability. Weakness in this muscle is commonly associated with lower back pain and pelvic floor dysfunction.
Sources
- Julene B. Samuels, Andrea Pezzella, Joseph Berenholz, Red Alinsod. "Safety and Efficacy of a Non-Invasive High-Intensity Focused Electromagnetic Field (HIFEM) Device for Treatment of Urinary Incontinence and Enhancement of Quality of Life." Lasers in Surgery and Medicine, 2019, Volume 51, Issue 9, Pages 760-766. DOI: 10.1002/lsm.23106. PMID: 31172580.
- Tina C. Hlavinka, Peter Turcan, Amanda Bader. "The Use of HIFEM Technology in the Treatment of Pelvic Floor Muscles as a Cause of Female Sexual Dysfunction: A Multi-Center Pilot Study." Journal of Women's Health Care, 2019, Volume 8, Issue 455. DOI: 10.4172/2167-0420.1000455.
- Kimberly L. Evans, Joseph Berenholz, Julene B. Samuels, Andrea Pezzella, Carolyn A. DeLucia. "Prospective Multi-Center Study on Long-term Effectiveness of HIFEM Procedure for Treatment of Urinary Incontinence and Female Sexual Dysfunction." Journal of Women's Health Care, 2023. Available at: Longdom Publishing.
- Nathan Guerette, Scott Molden, Madhu Gopal, Neeraj Kohli. "Randomized Trial of HIFEM Pelvic Floor Stimulation Device Compared with Pelvic Floor Exercises for Treatment of Urinary Incontinence." Journal of Women's Health Care, 2023, Volume 12, Issue 9, Page 680.
- Judson Brandeis. "Improving Male Pelvic Health: Efficacy of HIFEM Muscle Stimulation for Urinary Function and Sexual Dysfunction in Men." Reproductive System and Sexual Disorders: Current Research, 2024.
- Apiwat Jongjakapan, Teerayut Temtanakitpaisan, Krantarat Pinjaroen, Chamsai Chongsomchai, Amornrat Temtanakitpaisan. "Effectiveness of High-Intensity Focused Electromagnetic (HIFEM) Therapy in Women with Urinary Incontinence." International Urogynecology Journal, 2026, Volume 37, Issue 4. DOI: 10.1007/s00192-025-06362-0. PMID: 41051574.
All injectable and device-based treatments carry risks, and results are not guaranteed. Individual anatomy and medical history affect outcomes. Always attend a face-to-face consultation before any procedure. Treatments referenced in this article are performed at Harley Street Injectables by qualified practitioners. This article is not a substitute for professional medical advice.
This article is intended for informational purposes. It does not constitute medical advice. For personalised treatment recommendations, please book a consultation.
