What is urogynecology, and who are urogynecologists?
Medically Reviewed by Nassim Assefi, MD, on December 15th, 2023
Urogynecology, a specialized branch of gynecology and obstetrics, effectively deals with female pelvic medicine and reconstructive surgery. Urogynecologists, who are medical professionals specializing in this field, address conditions related to the pelvic floor, such as a weak bladder or pelvic organ prolapse (where organs descend due to muscle weakness). The pelvic floor encompasses the region supporting the bladder, reproductive system, and rectum.
The specialized field of urogynecology emerged after 2011. Before that, various specialists addressed these health issues separately, necessitating women to consult multiple doctors for pelvic floor conditions. The certification of urogynecology as an independent field by the American Board of Medical Specialties in 2011 streamlined the healthcare process, enabling women to receive comprehensive care without the need to visit multiple doctors.
Education and training of urogynecologists
The education and training process for becoming a urogynecologist involves several years of extensive study and hands-on experience. The typical pathway to becoming a urogynecologist includes the following:
- Obtaining an undergraduate degree.
- Completing medical school.
- Participating in a residency program in either obstetrics and gynecology or urology.
- Undertaking a fellowship in female pelvic medicine and reconstructive surgery.
- Passing relevant medical examinations.
- Obtaining certification in reconstructive surgery and female pelvic therapy.
Upon fulfilling these educational and training requirements, urogynecologists are qualified to seek positions at hospitals or private practices. They must also actively maintain their certifications by undergoing recertification exams every few years to ensure they stay current in their field of expertise.
What does a urogynecologist do?
Urogynecologists can actively address concerns related to the pelvic floor and bladder, encompassing issues such as ovarian cancer, overactive bladders, weakened pelvic muscles, reproductive challenges, and bladder or rectal incontinence (loss of control during bathroom visits). These professionals conduct assessments, provide diagnoses, and administer treatments.
Treatment plans are curated based on the specific problems and their underlying causes. Standard therapeutic approaches employed by urogynecologists include:
- Medications: While not all incontinence issues require prescriptions, some conditions may benefit from pharmaceutical intervention. Similarly, specific pelvic floor issues may benefit from medication treatment.
- Injections: Urogynecologists employ "bulking agents" to address problems related to bladder control and other incontinence issues. Injection procedures can be conducted with local anesthesia, either in an outpatient setting or in the office.
- Vaginal pessary: Medical devices known as pessaries, inserted into the vagina, provide support for organs experiencing prolapse issues. Available in various shapes and sizes, these soft devices can be fitted by your doctor during an office visit and removed for cleaning as well.
- Pelvic floor muscle training: Exercises like Kegels, including the relaxation and contraction of pelvic floor muscles, can be beneficial for issues such as prolapse. While these exercises can improve more severe symptoms, they may not completely correct them.
- Nerve stimulation: Similar to acupuncture, nerve stimulation treatments help address overactive bladder conditions.
- Surgery: Urogynecologists may recommend surgical interventions, including vaginal wall repair, bladder installations, uterus removal, and bladder control surgery.
What conditions can you see a urogynecologist for?
While pelvic floor problems are common and can affect any individual, regardless of their sex, a urogynecologist is a specialist who can understand the specific health experiences of females. For example, they can diagnose and treat risk factors that lead to the development of developing pelvic floor disorders, such as menopause, pregnancy, and vaginal deliveries, which are unique to women.
Here are some conditions for which you can consult a female urogynecologist near you:
- Urinary incontinence: Affecting the urinary system, this condition occurs when an individual loses control of their bladder and leaks urine. The risk of incontinence increases as you age and has been more commonly reported in females aged 20 and above compared to males. Incontinence can occur when a person leaks urine while bending over, sneezing, coughing, laughing, or even exercising. Other symptoms typically include the urge to urinate frequently (more than 8 times a day), needing to use the bathroom but very little urination occurs, and enuresis or wetting the bed. This condition can happen due to multiple reasons, such as a urinary tract infection, pregnancy or postpartum, constipation, certain medications like diuretics, and an overactive bladder. Incontinence due to pregnancy normally occurs due to pressure against the bladder or weak pelvic floor muscles after birth.
- Pelvic organ prolapse: A POP occurs when the pelvic organs (vagina, uterus, bladder, or rectum) drop or shift out of place from their normal positions. This can happen if your pelvic floor, i.e., the muscles, ligaments, and tissues responsible for supporting the pelvic organs, becomes too weak to hold these organs in place. In severe cases of POP, the organs may extend to the outside of the vagina, causing a bulge. Approximately 3% to 11% of women have pelvic organ prolapse, and nearly 37% of women with pelvic floor disorders, including POP, are between the ages of 60 and 79. The most common risk factors of POP include vaginal childbirth, having a heavier body weight, and the aging process where women have lower estrogen and they approach the menopause stage.
- Fecal incontinence: Also called bowel incontinence, this condition affects a person's control over their bowel movements (or pooping). The condition can be as mild as a bit of leakage or as severe as not being able to control the passing of your stools. Fecal incontinence is highly common, affecting nearly 1 in 3 individuals. Symptoms may include- leaking stools while being physically active or passing gas, finding stool even after a regular bowel movement, and entirely losing the ability to control bowel movements. Depending on how severe the type of fecal incontinence, an individual may be given various treatment options, including dietary changes, bowel training, kegel exercises, medications, or even surgical procedures like a sphincteroplasty that can sew damaged anal sphincter muscles back together.
What happens during a urogynecology appointment?
Various factors can contribute to pelvic disorders, and the specialist you consult with will require essential details to formulate the most effective treatment plan for your specific needs. This includes your:
- Age
- Weight
- History of pregnancy or childbirth
- History of chronic coughing or constipation
Engaging in a conversation about these aspects with a doctor might be uncomfortable. Still, it's crucial to remember that the specialist has likely encountered similar situations before, and there's no need to feel embarrassed. However, if you feel more comfortable sharing such details with other women, you can consult a female urogynecologist near you.
After discussing your personal medical history and symptoms, the specialist will conduct a physical examination. This examination aims to provide a better understanding of any changes or discomfort you might be encountering. Following the physical examination, the clinician will either offer a diagnosis and a treatment plan or suggest further tests to obtain a more comprehensive understanding of your condition.
How do you find the most suitable female urogynecologists near you?
If persistent pelvic symptoms are affecting your well-being or overall quality of life, seeking guidance from a doctor or healthcare professional is essential. They can refer you to a urogynecologist for the diagnosis and treatment of conditions such as organ prolapse, incontinence, and other pelvic floor issues.
Locating a urogynecologist that meets your medical needs can be time-consuming and may postpone your visit. However, Zocdoc streamlines the process of discovering the ideal urogynecologists in your vicinity, connecting patients with the most qualified healthcare providers.
On the Zocdoc website, you can input information about your condition, preferred location, date, and insurance plan. If you need clarification about your insurance plan, you can clear your doubts with Zocdoc's insurance checker. If you are not able to find your particular health plan, upload an image of your medical insurance card to your Zocdoc account. Zocdoc will then find and display information regarding your insurance plan (this facility is not available for vision or dental plans). You can also check out Zocdoc's patient help center for more information and solutions related to insurance. Additionally, you can use built-in filters to narrow your search for doctors based on their specialization in treating specific conditions, including those affecting children. You can also sort the doctor profiles by gender if you feel more comfortable discussing your health concerns with a female urogynecologist near you.
Zocdoc emphasizes transparency by providing comprehensive information about each specialist, including their qualifications, experience, areas of expertise, certifications, licenses, and more. The platform compiles and regularly updates patient reviews, allowing you to read verified reviews and ratings to choose the best urogynecologists in your area. Additionally, Zocdoc offers the option for video consultations, identified by a purple-colored video button on the practitioner's profile or through a search filter for video availability.
All appointments facilitated through Zocdoc are easy, free, and secure!
Statistics on ovarian cancer
As per the 2023 estimates by the American Cancer Society, approximately 19,710 women will receive new diagnoses of ovarian cancer, while around 13,270 women will die due to this disease. Ovarian cancer ranks fifth in cancer-related fatalities among women, surpassing other cancers of the female reproductive system in terms of mortality. A woman's risk of developing ovarian cancer stands at about 1 in 78, with the likelihood of dying from the disease at approximately 1 in 108, excluding low malignant potential ovarian tumors.
This cancer predominantly affects older women, with around half of those diagnosed being 63 years or older. Over the past two decades, ovarian cancer diagnoses have exhibited a gradual decline. From 1990 to the mid-2010s, the incidence rate experienced a 1-2% annual decrease, followed by an almost 3% yearly reduction from 2015 to 2019. This decline is attributed to increased usage of oral contraceptives and decreased use of menopausal hormone therapy.
Moreover, there has been a notable improvement in survival rates, shifting from a 2% annual decrease in ovarian cancer deaths during the early 2000s to a more than 3% yearly decrease from 2016 to 2020. This positive trend is likely a result of fewer diagnoses and treatment advancements.
Sources
WebMD
Healthline
American Cancer Society
Mayo Clinic
Cleveland Clinic[1]
Cleveland Clinic[2]
Cleveland Clinic[3]
Cleveland Clinic[4]
