What is Urogynaecology?

The branches of medicine that are most commonly associated by many when discussing women’s health issues are gynaecology and obstetrics. Urogynaecology may be unfamiliar to some, but this sub-specialty is just as important to women’s health. Having the knowledge about these different fields is important, so that women know which type of women’s health specialist they can consult with should any medical condition or concern arise.

The difference between gynaecology and urogynaecology

While these two branches of medicine have similar sounding names, their focus is different. Gynaecology deals with conditions, disorders, and treatment of the reproductive system. On the other hand, urogynaecology is a specialisation that involves the care and treatment of the pelvic floor and urinary tract.

A doctor specialising in urogynaecology is called a urogynaecologist. A urogynaecologist can treat various conditions and diseases affecting the pelvic region. Some of the common disorders are:

● Bladder discomfort or pain

● Dysfunctions in the bladder or urethra

● Frequent urinary tract infections (UTIs)

● Pelvic pain

● Pelvic organ prolapse

● Vulvovaginal concerns

When should you see a urogynaecologist?

Conditions influencing the pelvic region may not show any initial symptoms. However, you should see a urogynaecologist to get examined when the slightest sign of a disorder appears. Here are the usual symptoms that can indicate pelvic floor dysfunctions:

● A vagina that feels heavy or painful after a bowel movement or during the end of day

● Difficulty in peeing

● Frequent urination or overactive bladder

● Inability to completely empty the bladder when urinating

● Urinary leakage

● Vaginal bulge

Getting a consultation with a medical professional to address this kind of health problem is not a cause of embarrassment at all. Many people experience this and conditions like these are definitely not new or strange to a urogynaecologist. The earlier you get examined, the faster your health can be restored with the proper treatments.

What to expect during your first appointment with a urogynaecologist

A visit to the doctor can cause anxiety for some people. Knowing what happens during a consultation and being prepared for it can help alleviate those anxious thoughts and make your doctor’s appointment flow smoothly.

● Analysing your symptoms – Your doctor will ask you about the symptoms that you feel, when you usually feel them and what happens when they occur. This conversation may be awkward, but it is crucial. The correct diagnosis of your condition and treatment options will rely heavily on the information that you provide your doctor, so be as thorough as you can in explaining your symptoms.

● Discussion of your medical history – To be able to properly diagnose your symptoms, your doctor must know about your medical history, such as your medical conditions in your family, diet and lifestyle, any surgery done to the pelvic area and past births. Be prepared to share necessary information as these will greatly help in developing your treatment plan.

● Examination of the pelvic and/or rectal area – Once your doctor has the information about your symptoms and medical history, your doctor will do a physical exam of your pelvic and/or rectal area. Other tests may also be performed by your doctor based on your symptoms.

● Further testing – Your doctor may recommend further testing depending on the findings on the day of your appointment. The common urogynaecology tests include cystoscopy, defecography, pelvic ultrasound, urine testing, and urodynamic studies.

● Planning for treatment – After knowing about your symptoms, medical history and performing a physical assessment, your doctor will diagnose your condition and start to develop a treatment plan. In some cases, you might wait until the results of further tests are out before your doctor reaches a diagnosis and plans your course of treatment.

What to expect during a pelvic exam

A pelvic exam is a physical assessment performed by a medical professional to examine the condition of the pelvic organs, which includes:

● Vulva

● Vagina

● Cervix

● Uterus

● Fallopian tubes

● Ovaries

● Rectum

To begin the exam, your doctor will check the vulva and see any signs of discoloration, inflammation, soreness, or other irregularities. Next, a speculum is inserted into vagina, widening it so your doctor can check the condition of the vagina and cervix. Then using one of their hands, a doctor or nurse will insert one or two gloved, lubricated fingers into the vagina while their other hand will press on the lower abdomen. Your rectum may also be checked for abnormalities.

During the test, you may feel some discomfort as you feel the pressure on your abdomen and vagina. Remember to relax yourself and breathe normally. Let your doctor or nurse know in case you are feeling extreme pain while they are doing the physical exam as the sensations you should feel during this time should be mild.

How to prepare for a pelvic exam

Undergoing a pelvic exam does not require any tedious preparations. Here are some tips to consider:

● Avoid vaginal creams, douches, medicines and suppositories two days prior to your exam.

● Avoid sexual intercourse two days before your exam.

● Grooming is optional. Do whatever will make you feel more comfortable during the physical exam.

● Inform your doctor if you have experienced sexual violence or have posttraumatic stress disorder or are suffering from health anxiety, so they can help you feel safe and give proper support during the exam.

● Schedule your exam on a day when you do not have your period. While a pelvic exam can still be carried out even when a patient has their period, you will feel a lot comfortable if it is done on a day that you are not menstruating.

● Wear comfortable clothes. Use clothes that can be easily removed.

Some may be uncomfortable or hesitant in getting checked because they feel ashamed of the appearance of their body. Rest assured, your medical provider is not there to judge how your body looks like, but is more concerned about your health.

What treatments are given for pelvic floor conditions and disorders?

There are non-surgical and surgical treatment options that can be given tp treat pelvic floor conditions and disorders.

Non-surgical treatments include:

● Kegel exercises

● Injections

● Medications

● Physical therapy

● Vaginal pessary

Surgical treatments include:

● Enterocele repair

● Hysterectomy

● Mesh midurethral sling