What is Urogynecology?

Urogynecologists complete 4 years of medical school, a 4-year residency in Obstetrics and Gynecology and 3-year fellowship in Female Pelvic Medicine and Reconstructive Surgery aka Urogynecology (see below). These doctors are specialists with additional training and experience in the evaluation and treatment of conditions that affect the female pelvic organs, and the muscles and connective tissue that support the organs.

Many, though not all, complete formal fellowships (additional training after residency) that focus on the surgical and non-surgical treatment of non-cancerous gynecologic problems. Some of the common problems treated by a Urogynecologist include urinary incontinence or leakage, pelvic organ prolapse (dropping of the vagina, uterus, cystocele, rectocele), and overactive bladder.

The American Board of Medical Specialties approved Female Pelvic Medicine and Reconstructive Surgery, also known as urogynecology, as a certified subspecialty in 2011, and the first doctors were board-certified in 2013. Urogynecologists are physicians who complete medical school and a residency in Obstetrics and Gynecology. These physicians are specialists with additional years of fellowship training and certification in Female Pelvic Medicine and Reconstructive Surgery. The training provides expertise in the evaluation, diagnosis, and treatment of conditions that affect the muscles and connective tissue of the female pelvic organs.

Pelvic floor conditions that urogynecologists commonly treat include urinary incontinence, overactive bladder, and pelvic organ prolapse. These physicians are also knowledgeable on the latest research in the field pertaining to these conditions.

A physician who has passed an exam from the American Board of Obstetrics & Gynecology and American Board of Urology attesting that they possess exceptional expertise in Female Pelvic Medicine and Reconstructive Surgery. The first board certification exam was in 2013. Physicians who complete training after 2012, also participate in an accredited fellowship in order to be eligible for board certification.

As is always the case, feel free to ask about the training and expertise of any doctor caring for you.

Gynecologists specialize in the health of the female reproductive system. This includes the uterus, cervix, vagina, and ovaries.

Urologists specialize in diagnosing and treating urinary tract disorders for female and male patients, along with the male reproductive system. Urologists have specialty training in both conservative treatments and surgical management of the kidneys and urinary tract.

Urogynecologists specialize in treating women with complex benign pelvic conditions, including lower urinary tract disorders. They are trained in the comprehensive management of pelvic floor conditions.

The pelvic floor muscles are located between the tailbone and the pubic bone within the pelvis. They support the bowel and bladder.

In females, the pelvic floor muscles also support the uterus and the vagina. These muscular bands are called sphincters to encircle the urethra, vagina, and anus as they pass through the pelvic floor. If the pelvic floor muscles become weak, you may experience prolapse, where there is no longer enough support for the uterus. You may also experience incontinence or the loss of bladder control.

There may be a number of causes for weak pelvic floor muscles that may have you looking for a urogynecologist.

These may include:

  • Childbirth
  • Pregnancy
  • Overweight or obesity
  • Chronic constipation
  • Chronic straining to have a bowel movement
  • Heavy lifting
  • Chronic coughing from smoking
  • Health problems
  • Hereditary conditions
  • Constipation
  • Overactive bladder syndrome (OAB) – OAB includes the frequent feeling of needing to urinate or the need to urinate often. This urgency may also cause you to wake up at night.
  • Urinary incontinence – This is when urine leaks when pressure is on your bladder like coughing, sneezing, laughing, exercising, or lifting. This uncontrollable leakage may also occur during other activities.
  • Pelvic organ prolapse (POP) –This is a common pelvic floor disorder where one or more of the organs in the pelvis, such as the uterus and the cervix or the inner vaginal walls, become relaxed to the point of dropping close to or beyond the vaginal opening. These prolapses cause women to feel pressure, fullness, or a bulging sensation in the vagina.
  • Fecal incontinence – This is inadvertent loss of stool in liquid, solid, or gas bowel contents.
  • Pelvic pain – This type of pain arises from any of the organ systems housed within the female pelvis.

If you have had uncomfortable symptoms with your pelvic floor, seek help from a urogynecologist. Often, you can talk about your medical history and any concerns you may have.

What may have become normal to you may not be normal to others. It is possible to live a life free from pain, discomfort, or other setbacks that you may experience.