Picture this: You're out with your friends and someone says something so hilarious that you all burst out laughing. But your good mood plummets to embarrassment: You've started to leak urine. You dash to the nearest restroom, hoping you'll make it in time.
Over the next few months, you're plagued by more embarrassing leaks and close calls. Finally, you mention it to your primary care physician. She or he recommends you see a urogynecologist.
A what...? You heard right — urogynecologist.
No, it's not a European gynecologist. Urogynecology is a hybrid specialty: Urology plus gynecology.
"I see a lot of women who are postpartum — just had babies. I see women who are in or approaching menopause. I see women who are postmenopausal. I also see women at other times in their life who are simply bothered by their symptoms," explains Pamela Levin, MD, assistant professor of Clinical Obstetrics and Gynecology.
Here's what you should know about the specialty.
What does a urogynecologist do?
Urogynecologists help women who have pelvic floor conditions. They handle everything from evaluation and diagnosis to treatment and management.
"The beauty of urogynecology is that it is a collaboration between you and your doctor. It's all aimed at meeting your goals," says Dr. Levin. "The primary focus is on quality of life."
Treatment for pelvic floor conditions include:
- Behavioral therapy — relaxation techniques, muscle training, dietary changes can help manage symptoms
- Pessaries — after receiving doctor instruction on proper use, this device that fits into the vagina to support the bladder, uterus, etc. can be removed for cleaning and reinserted
- Medications — depending on the condition, this may be an option for treatment
- Surgery — options vary from minimally invasive and laparoscopic procedures to reconstructive surgery, depending on the condition
Some common pelvic floor conditions that urogynecologists treat
Urinary Incontinence
Urinary incontinence is the clinical term for urine leakage. The American Urogynecologic Society (AUGS) found that it's twice as common in women than in men. Risk factors include:
- Vaginal childbirth
- Genetics
- Diuretic medications
- Chronic constipation
- Obesity
- Smoking
Overactive Bladder
People with overactive bladder have urine leakage as well as a frequent, intense urges to urinate.
Some women have an obvious underlying medical condition — usually a neurological or inflammatory illness — that causes overactive bladder. But for most women, the cause is unknown.
Pelvic Organ Prolapse
Pelvic organ prolapse occurs when the pelvic organs — like the uterus or bladder — drop because of weakened vaginal muscles, says the AUGS.
Risk factors for pelvic organ prolapse include:
- Vaginal childbirth
- Genetics
- Smoking
- Pelvic floor injuries
- Chronic constipation
- Chronic coughing
- Obesity
Obese women are 40 to 75 percent more likely to have pelvic organ prolapse.
Is urogynecology a new field of medicine?
Yes and no. The health issues that urogynecologists deal with are not new.
But the American Board of Medical Specialties (ABMS) — the organization that oversees certification standards — added urogynecology as a subspecialty in 2011, according to AUGS.
Urogynecology is also known as Female Pelvic Medicine and Reconstructive Surgery. Doctors began receiving board certification for it in 2013.
What you should look for in a urogynecologist
Your primary care physician or gynecologist can refer you to a urogynecologist if you're dealing with pelvic floor issues.
If you're looking at prospective doctors on your own, keep in mind a few key factors: Experience and certification are important. But, so is the doctor's personality and how comfortable you feel with him or her.
"You have to make sure you feel like this person is someone you can share intimate details of your life with," says Dr. Levin "Someone that you feel comfortable with, that you trust and that you know is listening to you."