Combining practices of urology and gynecology, this sub-specialty involves diagnosing and treating urinary incontinence and pelvic floor disorders in females.
These remarkably common conditions include loss of bladder control, bowel symptoms, and uncomfortable pelvic symptoms. Some urogynecology conditions are:
A cystocele—also sometimes called an anterior prolapse or a prolapsed bladder—happens when the wall between your bladder and vagina weakens, letting the bladder protrude into the vagina. Cystoceles may result from the strain of vaginal childbirth, heavy lifting, or straining during bowel movements. Women who have gone through menopause or have had a hysterectomy are also at higher risk. Mild cystocele cases may require no treatment. In more serious cases, a doctor may advise you to wear a pessary, a small removable device that can be placed in the vagina to hold the bladder in place. The most serious cases can require surgery to repair.
An enterocele—also sometimes called a small bowel prolapse—happens when the small intestine drops into the lower pelvic cavity, pushing on the top part of the vagina.
An enterocele can result from vaginal childbirth, repeated heavy lifting, straining with bowel movements, or a chronic cough. Women who are older and are overweight are also at higher risk. Symptoms can include a feeling of pain, pressure, or fullness in the pelvic region; a bulge of soft tissue in the vagina; pain during intercourse; and low back pain that feels better if you lie down.
A mild enterocele may require no treatment other than a recommendation to do Kegel exercises and avoid heavy lifting. In more bothersome cases, you may be advised to use a pessary, a small removable device made of silicone, plastic, or rubber that can be placed in the vagina to hold the bowel in place. Other cases may require surgery to repair.
Genital prolapse occurs when an organ such as the bladder, uterus, or bowels descends into the vagina. It can result from pregnancy and childbirth. Other factors that increase your risk are obesity, smoking, suffering from a chronic cough or constipation, or having had a hysterectomy.
Genital prolapse symptoms may include vaginal irritation, feeling a mass or pressure in the vagina, a feeling that your bladder or rectum hasn’t completely emptied, or feeling lower back pain.
Depending on the severity of the prolapse, it may be treated with Kegel exercises or by inserting a removable device called a pessary in the vagina. Surgery may be required in some cases.
Lichen sclerosus and lichen planus are skin disorders that cause itchy, sore or fragile skin around the vulva, the outer area of a woman’s genitals. The skin may change color, and you may find having sex or urinating uncomfortable.
If you’re diagnosed with lichen sclerosus or lichen planus, your doctor will first try treatment with medicines such as steroid ointments. If various medical treatments don’t succeed in controlling the condition, your doctor may recommend surgery.
In rare cases, lichen sclerosus or lichen planus can lead to cancer, so you should have regular follow-up appointments.
Pelvic Organ Prolapse
Pelvic organ prolapse is a condition where one or more of your pelvic organs—for instance, bladder, bowels, uterus, or rectum—drops out of its normal place and pushes into the wall of your vagina.
The strain of childbirth causes pelvic organ prolapse in some women. Other conditions that increase the risk of prolapse include having a hysterectomy, being overweight, frequent constipation, or a long-lasting cough.
Kegel exercises may help prevent or treat a mild prolapse problem. Your doctor may also fit you with a pessary, a removable device inserted into the vagina, to help hold the pelvic organs in place. More serious cases may require surgery.
Vaginal agenesis is a rare birth defect in which the vagina, and sometimes the uterus, are missing or not fully developed. If the condition isn’t noticed earlier, it will probably be discovered at puberty when a girl fails to begin menstruation.
To treat the condition, your doctor may first recommend trying self-dilation using a small round rod daily over a period of weeks or months to stretch the skin to create a vagina. Surgery, using a skin graft, a traction device, or a portion of your colon to create a vagina, is also an option.
Women with the condition can go on to have a normal sex life, although if the uterus is missing, they will not be able to carry a child.
A vesicovaginal fistula is an abnormal opening between your vagina and bladder. It’s also sometimes called a bladder fistula. It can cause incontinence because it lets urine to pass through your vagina. Possible causes of fistulas can include surgery, infection, radiation treatment, or some type of injury.
If the fistula is small, your doctor may see if it heals on its own. Often, though, surgery is needed to repair the problem. Some cases can be treated with minimally invasive surgery.