O-Shot & P-Shot Training:
What to Look For

If you search "O-Shot training" or "P-Shot certification" right now, you will find dozens of programs — weekend workshops, online video courses, national conference add-ons, and everything in between. Some of them are excellent. Many are not. The difference matters more for sexual wellness procedures than for almost any other training category in aesthetic medicine, for two reasons.

First, the injection landmarks for both procedures are anatomically variable and not intuitive. Female urogenital anatomy has enormous structural variability from patient to patient; male penile anatomy has specific vascular structures that a provider must locate precisely to perform the nerve block safely and effectively. These are not procedures where watching a video, then practicing on a model, then treating your first real patient produces an acceptable preparation level. They require supervised, hands-on repetition on real anatomy before you are ready to work independently.

Second, the patient population for sexual wellness procedures is uniquely vulnerable. Patients seeking treatment for erectile dysfunction, orgasmic disorder, or sexual pain have often struggled with these issues for years, seen multiple providers who couldn't help, and come to a new practice with significant emotional weight attached to the outcome. A technically poor injection that produces no result — or a procedure the patient finds painful because the nerve block was done incorrectly — doesn't just produce a disappointed patient. It produces a patient who may conclude the procedure doesn't work, tell other potential patients the same thing, and not return. The clinical stakes and the reputational stakes are both higher than in most aesthetic categories.

This guide is written to help you evaluate any O-Shot or P-Shot training program — including ours — against a specific, concrete set of criteria.

Why Training Quality Varies So Much

The O-Shot and P-Shot are trademarked procedures developed by Dr. Charles Runels. The trademark means that technically, only providers who complete Runels-approved training can call the procedure by its branded name. In practice, many training programs teach the underlying PRP injection protocol without the branded name, call it "vaginal PRP rejuvenation" or "penile PRP therapy," and offer comparable or better clinical preparation than the branded training network. The trademark is a branding and legal question; it is separate from the clinical quality of the training.

The more important issue is that there is no standardized licensing board, no mandatory credentialing requirement, and no objective quality threshold that a training program must meet before offering O-Shot or P-Shot certification. Anyone can design a course, print a certificate, and charge a registration fee. The certificate itself tells you almost nothing about whether the training was adequate.

What actually determines training quality comes down to five things: whether you inject live patients, how deeply the nerve block is taught (for P-Shot), what the instructor's current clinical practice looks like, what written deliverables you leave with, and how the course handles the consent and documentation requirements your medical director will need to review before you can offer the service compliantly.

The Live Patient Question — Non-Negotiable

Ask any training program, before you pay: will I perform the injection on a real, consented, live patient under direct instructor supervision? If the answer is anything other than an unambiguous yes, do not enroll.

This is not a minor distinction. Models with simulated anatomical trainers, cadaveric tissue, synthetic injection pads, and video demonstrations of technique are all useful teaching supplements — they are not adequate substitutes for supervised injection on real human anatomy. The reasons are specific:

• Tissue resistance is different on a live patient. The feel of the needle passing through real vaginal mucosa or through Buck's fascia into the corpus cavernosum is not accurately replicated by any trainer material. Providers who have only injected models often over-advance the needle on their first live patient because the tissue gives differently than they expect.
• Anatomical variability is real and significant. Female clitoral anatomy in particular varies substantially in terms of external positioning, internal extent, and surrounding tissue density. The injection landmark taught on a standardized model may not map cleanly to the patient in front of you. Supervised live patient injection is where you learn to adapt landmark identification to the patient's actual anatomy — not to a textbook illustration.
• Patient communication during the procedure cannot be practiced on a model. Managing a patient's anxiety, narrating the procedure, confirming anesthesia before injection, and responding to patient discomfort mid-procedure are skills that only develop through real patient interaction. Providers who have only practiced on models often handle their first live patient's questions and reactions awkwardly, which undermines patient confidence in the procedure and the provider.
• Instructor feedback is only meaningful in real time. A trainer watching you inject a model can tell you your angle is wrong or your depth is off — but there are no consequences if you proceed incorrectly. When Naomi watches a provider inject a live patient and provides real-time feedback, the stakes are real and the learning is immediate in a way that model practice cannot replicate.

The Nerve Block — The Skill That Defines P-Shot Training Quality

For the O-Shot, topical anesthetic alone is typically sufficient for patient comfort — the clitoral and vaginal wall injections are uncomfortable without it but not deeply painful for most patients with adequate topical preparation. The technique challenge is injection landmark identification and depth control, not anesthesia management.

The P-Shot is different. Injection into the corpus cavernosum without a properly performed penile nerve block is painful enough that most patients rate the experience as significantly unpleasant — and a significant minority will not return for follow-up or re-treatment. The nerve block is not a nice-to-have add-on to the P-Shot procedure. It is the foundational clinical skill that determines whether the procedure is tolerable and whether patients come back.

Specifically: the penile dorsal nerve block — and in some techniques, a ring block supplementing it — must produce reliable anesthesia of the glans, dorsal shaft, and ventral skin before injection begins. Done correctly with appropriate lidocaine concentration and volume, the patient feels pressure but no sharp pain during the injection itself. Done incorrectly — wrong needle depth, wrong angle, insufficient volume, or wrong entry point — the block is partial and the injection is painful.

At Beso Provider Hub, the nerve block receives its own full module in the P-Shot course — covering dorsal nerve anatomy, anesthetic selection and volume, ring block vs. targeted nerve block approach, needle selection, confirmation of anesthesia, and management of incomplete blocks. Naomi does not proceed to the live patient injection session until each participant has demonstrated the block technique on the anatomical trainer and she is confident in their ability to execute it on a real patient. This is not a pace that works for a one-day course that tries to cover everything in equal time. It requires specifically allocating more time to the nerve block than to most other modules, because that is where the technical risk is highest.

What the Curriculum Must Cover for Each Procedure

Beyond the live patient and nerve block questions, here is what a complete O-Shot or P-Shot course curriculum should contain. Use this as a checklist when reviewing any program's published curriculum.

For the O-Shot

For the P-Shot

Evaluating the Instructor

The most important question about any hands-on clinical training is not about the curriculum — it is about the instructor. A mediocre curriculum taught by someone who performs these procedures weekly and gives real-time, specific, clinically grounded feedback will produce a better-prepared provider than an excellent curriculum taught by someone who last injected a patient two years ago.

There are three things worth verifying about any O-Shot or P-Shot instructor before you commit:

Do they actively perform the procedures in their own practice?

Ask specifically — and ask for a number. Not "yes, I offer the O-Shot" but "how many O-Shots have you personally performed in the last 12 months?" An instructor who cannot answer that question with a specific number is likely teaching from memory or from someone else's protocol rather than from current clinical practice. The subtleties that make the difference — how to adjust approach for a patient who finds topical anesthetic insufficient, what the tissue resistance feels like on a patient with vaginal atrophy versus a premenopausal patient, how to handle a patient whose nerve block has an incomplete distribution — these only come from ongoing practice, not from having done the procedure a few times years ago.

Is their experience specific to the procedures they teach?

An experienced injector who primarily does Botox and filler is not automatically well-positioned to teach O-Shot or P-Shot. The anatomical territory, tissue characteristics, patient population, and clinical considerations are completely different from facial aesthetics. Look for instructors whose primary clinical practice includes sexual wellness and regenerative medicine, not just general aesthetics with sexual wellness as an occasional add-on.

What is their complication and adverse event experience?

This is a question few providers think to ask, but it is one of the most useful. An instructor who has never seen a complication, never managed a patient with incomplete response, never dealt with a nerve block that produced a hematoma — is not teaching you what to do when those things happen. Real clinical experience includes adverse events and difficult cases. An instructor who can speak honestly about what they've seen go wrong and how they handled it is a more credible clinical educator than one who only presents the procedure's successes.

What You Should Leave With

A training program's value is not fully realized on the course day — it is realized over the first months of offering the service in your practice. What you take home determines whether you can set the service up correctly, present it compliantly to patients, and document it in a way that protects you if something goes wrong.

These are the written materials a quality O-Shot or P-Shot course should provide at completion:

• A written procedure protocol — specific enough to serve as the basis for a standing order. It should name the centrifuge system used, document the spin parameters, specify injection volumes, and describe the procedure sequence step by step. Your medical director needs this document to write or countersign your standing order.
• A patient consent form — specific to the procedure, reviewed by a licensed clinical authority. It should describe the procedure, its mechanism, its expected outcome range, its known risks and adverse events, and the informed consent standard for the off-label or experimental status of PRP for sexual wellness indications where applicable.
• A patient intake and screening form — including the validated screening tool used (FSFI for O-Shot, IIEF for P-Shot), contraindication criteria, and the history elements relevant to patient selection.
• Post-procedure patient instructions — what to expect in the first 24–48 hours, activity restrictions, follow-up timing, and how to contact the practice if they have concerns.
• A procedure note template — what to document in the chart for each session, including consent confirmation, PRP preparation details, injection sites and volumes, and patient response assessment.

Five Questions to Ask Before You Enroll

Red Flags in Course Marketing

The marketing language around O-Shot and P-Shot training programs can be misleading in ways that are worth knowing before you spend several hundred to several thousand dollars on a course. These are specific claims and framings to be skeptical of:

• "Certification" without specifying what the certification covers. There is no standardized O-Shot or P-Shot certification with a defined minimum competency standard. A certificate from a training program means you completed that program — it does not mean you met an objective clinical readiness threshold. A certificate from a program that uses only models is the same document as one from a program with live patient injection; ask what the certificate actually represents.
• "Learn in just one afternoon." A full-day course for either procedure is the minimum reasonable training duration, and even that is tight if it includes adequate nerve block practice for P-Shot. An afternoon course cannot adequately cover anatomy, patient selection, PRP preparation with hands-on practice, and a live patient injection session. Something is being skipped.
• Outcome claim language that violates FTC rules. Any course that teaches you to market the O-Shot or P-Shot using guaranteed outcome language — "restore your sex life," "cure erectile dysfunction," "guaranteed results" — is teaching you to violate FTC advertising standards and expose yourself to board complaints. The FTC is actively enforcing against sexual wellness marketing claims. A quality course teaches you what you can and cannot say, not just how to generate leads.
• No mention of contraindications, adverse events, or patient selection. A course curriculum that reads as purely positive — "learn to offer this high-demand, high-margin procedure" with no mention of contraindications, adverse events, or appropriate patient selection — is not a clinical course. It is a revenue pitch dressed in clinical language. These procedures have real contraindications and real adverse events; a course that doesn't cover them is leaving you unprepared for the patients who should not receive the procedure.
• Instructor credentials that don't include active clinical practice. "Nationally recognized educator," "speaker at major conferences," or "trained by Dr. [name]" are not the same as "actively performs this procedure in clinical practice." Credentials in adjacent fields — general aesthetics, facial injectables, obstetrics — do not transfer directly to the specific anatomical and procedural requirements of O-Shot and P-Shot training.

What to Expect Clinically and Financially After Training

One of the legitimate values of a quality training program — beyond the clinical preparation — is giving you an accurate picture of what the service looks like in practice before you set it up. Here is an honest overview:

O-Shot: what to expect

The O-Shot has a response rate that varies by indication. For stress urinary incontinence, published studies show meaningful improvement in a significant proportion of patients — this is probably the best-evidenced indication and the one where expectations can be set most confidently. For arousal and orgasmic enhancement, results are more variable and patient-specific. Patients who respond well often describe results within two to eight weeks; patients who don't respond to one treatment may respond to a series of two or three. Setting this expectation clearly in your consultation is both ethically necessary and practically important for patient satisfaction. The procedure commands $800–$1,500 in most Phoenix metro markets depending on positioning, and the consumable cost (PRP kit, topical anesthetic, supplies) is typically $75–$150 per procedure — making it one of the highest-margin individual procedures in a sexual wellness practice.

P-Shot: what to expect

For erectile dysfunction, the P-Shot produces the most consistent results in patients with mild-to-moderate organic ED — those with documented vascular contribution where oral PDE5 inhibitors work but produce side effects, or where they work but the patient wants to reduce dependence on them. For severe vascular ED, the P-Shot alone is typically insufficient and is better positioned as part of a combination protocol with low-intensity shockwave therapy. For Peyronie's disease, the evidence supports reduction in plaque-related curvature with a series of injections, particularly in the stable phase. Setting these outcome boundaries clearly in consultation is what separates a practice that builds a sexual wellness reputation from one that gets a wave of disappointed patients. The procedure commands $1,200–$2,000 in most Phoenix metro markets, with similar consumable costs to the O-Shot.

The combination opportunity

Providers who complete both O-Shot and P-Shot training and offer them as part of a comprehensive sexual wellness program — alongside hormone evaluation, peptide protocols, and couples-based consultation — build a differentiated practice that is genuinely difficult to replicate. Sexual wellness patients who get meaningful results are among the most loyal, highest-referral patient types in any practice. The first few patients who have a strong outcome from the O-Shot or P-Shot in your practice will generate more appointments than most marketing campaigns.

Frequently Asked Questions