OHSU

female pelvic and reconstructive medicine

What is Female Pelvic Medicine and Reconstructive Surgery?

Female Pelvic Medicine, also known as Urogynecology or Female Urology, is the medical and surgical subspecialty dealing with pelvic floor disorders in women, including pelvic organ prolapse, incontinence and other problems affecting the pelvic organs in women.

Pelvic Organ Prolapse

Pelvic organ prolapse (POP) is when one of the pelvic organs – the bladder, small intestine, rectum, uterus, or any combination thereof – falls from its normal position and pushes against the vagina. This happens most commonly when the muscles and ligaments that normally hold these organs in place are weakened, such as after childbirth or surgery.
POP is relatively common. Overall, about 11 percent of women experience prolapse bothersome enough to undergo a surgical procedure. There are many different types and names for POP, depending on the organ or organs involved:

  • Uterine prolapse
  • Vaginal prolapse
  • Cystocele (bladder prolapse)
  • Rectocele (rectal prolapse)
  • Enterocele (prolapse of the small intestines)

The symptoms involved can vary, and may include any of the following:

  • Feeling a bulge, pressure or heaviness in the vaginal or pelvic area
  • Difficulty with urination or with bowel movements
  • Incontinence or the accidental leakage or urine
  • Low back pain

There are very effective treatments for POP available. One option is being fitted for a pessary, a small plastic or silicone device that is placed in the vagina in order to "hold up" the affected organs. There are a variety of pessaries available to fit almost any woman's needs.
There are many minimally-invasive surgeries available to treat POP, and can be done as outpatient / "day-surgery" or with a one-night stay in the hospital.

  • Robotic surgery (robotic sacrocolpopexy) involves a few very small abdominal incisions to suspend the vagina to the lower part of the back, and has excellent long-term results.
  • Vaginal surgery is done with incisions only in the vagina, and no scars on the abdomen.

Both options are minimally-invasive and involve a relatively short recovery time and quicker return to your normal active lifestyle.

Vesicovaginal Fistula, Urethrovaginal Fistula, Ureterovaginal Fistula, Rectovaginal Fistula

A fistula is an abnormal connection between two organs in the body. For example a vesico-vaginal fistula is an abnormal connection between the bladder and vagina, leading to continuous leakage of urine. Fistulas most commonly happen after surgery, for example a hysterectomy, or after receiving radiation therapy for certain cancers.
Vesicovaginal and urethrovaginal fistulae can usually be treated with a minimally-invasive, outpatient surgery done entirely through the vagina.

Incontinence

Incontinence, also known as "leakage," is the accidental loss of urine. Incontinence affects as many as 13 million women in the United States alone, and many feel this number is an underestimate. Only about 10percent of women with incontinence seek treatment from a doctor. Many others do not because they are too embarrassed to discuss it, feel it is a "normal" part of aging, or do not know there are treatments available.

  • Stress Incontinence is the leakage of urine with cough, laugh, sneeze, or physical activity, such as walking or running. In addition, many women notice the leakage of urine during sexual activity.
  • Urgency Incontinence is the leakage of urine associated with a strong urge to urinate. Many women may find the urge so strong they cannot make it to the bathroom on time.
  • Mixed Incontinence is when a women experiences both stress incontinence and urgency incontinence. Over a third of women with incontinence have mixed incontinence.
  • Other causes of incontinence can include a fistula, an abnormal connection between the vagina and the urinary tract, or overflow incontinence, where leakage occurs because the bladder does not empty well.

There are many treatments available for incontinence, and they often depend on the type of incontinence. Many women respond very well to some behavioral and dietary changes, pelvic floor exercises (especially when aided by a physical therapist specializing in women's health), and, in some cases, medication.
For women with severe incontinence, or when the above measures no longer work, there are a variety of surgical options available. Fortunately, most of them are minimally-invasive and can be done as outpatient / "day-surgery."

Overactive Bladder

Overactive Bladder (OAB) is a common, bothersome syndrome, characterized by sudden, bothersome urge to urinate. It can be associated with frequent urination, the need to urinate at night frequently (known as nocturia). Some patients with OAB have incontinence as well, although not all do.
There are a variety of treatments for OAB, including:

  • Diet and behavioral changes
  • Pelvic Floor Exercises
  • Biofeedback
  • Medications

When the above treatments are no longer effective, several minimally-invasive procedures are available and are highly effective.

Female Sexual Function

Female sexuality is complex, and problems with sexual activity can be fairly common for women. Women of all ages may experience one or more of the following problems:

  • Decreased desire for sex, often known as low libido.
  • Difficulty with sexual arousal
  • Problems with orgasm, such as painful orgasm or difficulty achieving orgasm
  • Pain with sexual activity, which is known as dyspareunia

We offer treatments for many of these conditions.

Urethral Diverticulum

A urethral diverticulum is a small "pouch" that develops next to the urethra, which is the channel by which urine leaves the bladder when you urinate. This pouch can lead to recurrent urinary tract infections (UTIs, or bladder infections), painful intercourse, dribbling, or vaginal discharge.
The diagnosis of urethral diverticulum is usually simple and involves just a physical exam. In some cases, a MRI – which does not involve any contrast or radiation – can be helpful in establishing the diagnosis.