More on Urogynecology

Urogynecologists are physicians trained in the evaluation and management of specific disorders that can affect the female bladder, reproductive organs, rectum and pelvic floor muscles. In simple terms urogynecologists are the experts in robotic pelvic surgery, and the repair of problems with pelvic floor relaxation, vaginal laxity, prolapse, urinary leakage or other bladder conditions, and fecal leakage.

Overactive Bladder

This is a bladder condition that can affect women of all ages and is hallmarked by symptoms of urinary urgency, urinary frequency, nocturia and sometimes urge-related urinary leakage. Urinary urgency is defined as a sudden and intense need to pass urine that cannot be put off. This can happen even when the bladder is not full. Urinary frequency is defined as going to the bathroom to empty the bladder many times during the day (typically more than 7). Nocturia is waking up more than once at night to go to the bathroom to empty the bladder. Urge urinary incontinence is when a feeling of urinary urgency is so strong that urine leaks out before making it to the bathroom in time. Click here to learn about the many different treatment options for overactive bladder.

Stress Urinary Incontinence

This is a bladder condition where leakage of urine occurs during activities such as coughing, laughing, sneezing, lifting or exercising. Risk factors that can lead to stress urinary incontinence include pregnancy and vaginal birth, obesity, chronic cough and genetically inherited factors. Click here to learn about the many different treatment options for stress urinary incontinence.

Pelvic Organ Prolapse

This is a condition where the pelvic organs bulge into the vagina or protrude out of the vaginal opening. The pelvic organs include the bladder, bowel and uterus. A fallen (or prolapsed) bladder is called a cystocele. A fallen uterus is called uterine prolapse. When the rectum falls into the vagina, this is called a rectocele. The vaginal apex can fall as well if a woman has had a hysterectomy previously. This is called vaginal vault prolapse. This happens when the supportive structures (pelvic ligaments and muscles) lose the strength to hold these organs in their normal anatomic position. Symptoms typically include feeling a bulge at the vaginal opening, vaginal pressure, and difficulty with urination and/or defecation. Prolapse does not typically cause pelvic or vaginal pain. Click here to learn about the many different treatment options for pelvic organ prolapse.

Fecal Incontinence

This is when a woman loses the ability to control bowel function, causing stool (feces) and/or gas to leak unexpectedly from the rectum. This is sometimes associated with a sudden feeling of urgency to have a bowel movement, with the inability to make it to the toilet in time. Or, it can occur spontaneously, without knowledge of the need to have a bowel movement. The loss of stool can occur with small or large amounts of feces, as well as with formed or loose stool.

Recurrent Urinary Tract Infections

This is defined by three culture-proven infections of the urinary tract (bladder and/or kidney) in a 12-month period of time; or two culture-proven infections in a 6-month period of time. “Culture-proven” means when a urine specimen collected from a patient with a suspected infection is placed in a lab in a special way to see if bacteria grow out of it. Ideally, these urine specimens would be collected via a catheter to rule out contamination by vaginal and/or rectal sources.

Interstitial Cystitis

This is a chronic bladder condition that can affect women of all ages and is characterized by recurrent UTI-like symptoms without evidence of an actual bladder or kidney infection. Women with this condition may feel urinary urgency, urinary frequency, pain with urination, incomplete bladder emptying, vaginal pain and/or pressure, and pelvic pain and/or pressure. These symptoms can worsen with ingestion of certain foods and/or beverages such as caffeinated drinks, chocolate, spicy foods, citrus fruits and tomato-based foods. There are many different treatment options for interstitial cystitis which include behavioral and dietary modifications, medications and surgery.

Pelvic Floor Muscle Spasm

The pelvic floor is comprised of a group of muscles that support the organs in the pelvis and wrap around the urethra, rectum, and vagina. Coordinated contracting and relaxing of these muscles controls bowel and bladder functions. The pelvic floor must relax to allow for urination, bowel movements, and, in women, sexual intercourse. When these muscles are in spasm, voiding, intercourse and defecation can be affected: patients may feel as if they have to strain to empty their bladder or to have a bowel movement, and intercourse may become painful. The goal of treatment for pelvic floor muscle spasm is to relax these muscles and avoid stressing them. Treatment usually combines strain avoidance, medications such as muscle relaxants, and physical therapy.


The definition of dyspareunia is painful intercourse. This can mean pain at the vaginal opening upon insertion, or pain inside the vagina, during deeper penetration. This can mean pain just at the initiation of intercourse, pain during intercourse or pain afterwards. There are many different causes of painful intercourse. A physical examination is often necessary to determine the cause. Vulvovaginal atrophy is a leading cause of painful intercourse in post-menopausal women. Atrophy is the condition caused by a lack of estrogen in the vaginal area, which can cause vaginal dryness, itching, burning, irritation, lack of elasticity and pliability, which can all lead to discomfort with intercourse. Typical treatments focus on the replenishment of vaginal estrogen by way of estrogen creams, tablets, etc. Women who are unable to take estrogen (i.e. breast cancer survivors) or women who are not interested in taking estrogen supplementation may be interested in vaginal laser therapy [link to vaginal laser therapy]. Pelvic floor muscle spasm is a relatively common cause of painful intercourse in both pre- and post-menopausal women – refer to the section of pelvic floor muscle spasm for more detail. Another, less common cause of dyspareunia is vaginal scar tissue. Vaginal scar tissue can be painful. There are many different treatment options available, including pelvic floor physical therapy, medications, trigger point injections or vaginal laser therapy. A physical examination by a urogynecologist can help determine which treatment is appropriate.