Hailing from the Bay Area, Dr. Angel Marie Johnson, FACOG earned her undergraduate degree in cognitive psychology from the University of California, Irvine. She moved to New York for graduate work and has been on the east coast ever since.
Dr. Johnson attended New York Medical College and completed her residency in Obstetrics and Gynecology at Albert Einstein College/Montefiore Medical Center in the Bronx. Following her residency, she came to Boston for a three-year fellowship program in Urogynecology (Female Pelvic Medicine and Reconstructive Surgery) at Mass General Hospital/ Harvard Medical School.
Dr. Johnson joined Greater Boston Urology in August 2017 as the director of our new Women's Health Center in Dedham. She and her husband (who is also a physician) have two children and currently live in Boston.
We invited Dr. Johnson to sit down for a Q&A so that our readers could learn more about her background, her fellowship, the ins and outs of urogynecology, and her approach to the management of pelvic floor disorders.
QUESTION: What inspired you to become a doctor? When did you know this was what you wanted to do with your life?
Dr. Johnson: I knew back in high school. Initially, I wanted to be an astronaut and be a NASA doctor, but that direction changed a little bit. I was always drawn to math and science as well as volunteering. My mom was big on giving back and understanding not everyone is born into privilege. Growing up, I could often be found working with children and volunteering with the underserved and underrepresented. I found medicine to be a great combination of all my interests: math, science, people, and advocacy. Medicine gives me a platform to make a difference and to advocate for those who can't advocate for themselves.
Advocacy is what brought me to the field of urogynecology in particular. I enjoy working with women at the local level and being able to help women from other countries who are plagued by birth trauma and can be ostracized from their community. As a urogynecologist, I can help improve the quality of life for people both nationally and internationally.
QUESTION: Tell our readers about some of the local advocacy work you've done. You’ve worked with a Girl's Group in Cambridge, right?
Dr. Johnson: With the Girl's Group in Cambridge, I met with a group of at-risk young women ranging in age from 10-14 years old. I provided them with accurate health-related information. Unfortunately, they encountered a lot of misinformation and hearsay about their bodies as well as women's health in general, including sexual health and sexually transmitted diseases. So I served as a reputable resource for them. I helped demystify things about their bodies and about what they were going through, how they were feeling. I met with them, they asked me questions, and I answered them.
QUESTION: Were they comfortable asking questions? Did it take them a while to warm up, or were they just full of questions since you're a doctor?
Dr. Johnson: In the beginning, it could take ten to fifteen minutes for them to ask me questions. Initially, they were bashful, shifting in their seats, looking nervous. But then they jumped in and started asking me questions.
To the best of my abilities, I'd answer their questions and provide accurate information, because that's one of the big things in my field—there's a lot of misinformation out there. Many people aren't aware of their own bodies, what structures they do and don't have, and how they are related to one another.
Much of what I do as a physician, as well as a mentor and volunteer, is to educate women. And that's kind of a big side of what I do. Whether that's a twelve-year-old girl or my patients, who are, on average, about seventy. It's all about education.
QUESTION: And that's the perfect segue into urogynecology. Let's pretend you're at a cocktail party and someone says, "What's urogynecology?" How do you explain it to non-medical people so they understand?
Dr. Johnson: Urogynecology is a marriage of gynecology and urology. The field spans anywhere from younger women who are suffering from birth trauma (think women who've had difficult deliveries—maybe they've had lacerations or maybe they're having bladder dysfunction following pregnancy) all the way to menopausal and post-menopausal women. The latter might be dealing with issues, such as pelvic organ prolapse, overactive bladder, stress urinary incontinence, UTIs, or defecatory dysfunction (e.g. constipation or fecal incontinence). It's not unusual for patients to experience multiple complaints.
Essentially, urogynecology is a field that improves quality of life. I'm not treating issues that are life threatening. But many patients come to me because their quality of life is suffering.
For example, many women will adjust what they do because of their overactive bladder. Meaning, they won't visit their family members anymore. They won't travel. Some won't even ride the bus because they worry about needing a bathroom. They don't want to have an accident in public and be humiliated. So my goal is to help my patients regain their quality of life. I do this through treatment, of course, but also education, as I mentioned before.
Another example: A common ailment I treat is pelvic organ prolapse. Many women fear this diagnosis, which is when the female organs start to descend. When we're younger, or even middle aged, your pelvic organs are well supported. But as you age, everything weakens a little. And when you reach menopause, this process can accelerate causing pelvic structures to descend outside the body. It's quite common. So part of what I do is reconstructive surgery to restore the pelvic structures to the way they once were. And this can bring about improved quality of life.
QUESTION: How does someone decide whether they should see a urogynecologist as opposed to a urologist or a gynecologist? Are most of your patients referred? Do they even know this sub-specialty exists?
Dr. Johnson: About 75% of the patients I see have been referred. And they can be referred from either gynecology or urology. The other 25% comes from people who've heard about urogynecology or maybe a friend of a friend who saw a urogynecologist. So it's kind of word of mouth how they hear that this specialty exists. It also can depend on the patient's comfort level.
I recently saw a patient who originally saw a urologist for a complaint, and she felt uncomfortable being in the waiting room with all these elderly men. The doctor was male, and her nurse was male. She didn't feel like they could really understand her symptoms. So instead, she went to see me where she was much more comfortable.
QUESTION: So let's consider an issue that could be treated by either a urologist or urogynecologist, such as incontinence. What's the best decision for a woman?
Dr. Johnson: In this example, it would depend on the type of incontinence and the patient. I'd refer the patient to a urologist if the patient had a complex neurologic picture, meaning they had a stroke, or they had a spinal cord injury, or maybe they even had multiple sclerosis (MS). That would be better for urology because it has a strong neural component. That's less my area of specialty. But if the patient has a very overactive bladder—that's the "I gotta go, I gotta go, I gotta go right now" urge or they're leaking urine when they cough or sneeze—that's definitely more my side of things.
QUESTION: What attracted you to Greater Boston Urology?
Dr. Johnson: They have over 15 urologists, so they have the urology side very well covered, but they were referring out the majority of their women's health conditions. I suggested they consider a multidisciplinary approach that included urogynecology as opposed to urology alone. As a urogynecologist, I'm a gynecologist trained in female urology, so I bring a slightly different perspective. And, together, it ends up being one of those perfect marriages.
QUESTION: You're going to head up the Women's Health Center at the new Dedham location. What are some of your goals and hopes?
Dr. Johnson: My biggest hope is to serve the community around the center. Right now, there's a dearth of urogynecologists in the Dedham area. So my goal is to address local people's needs while also addressing people who come in from the surrounding areas or even out of state.
We're hoping Dedham will become a regional referral center for women with pelvic floor disorders. With that in mind, we're designing this practice to be an optimal care center for women. In other words, a space where they feel comfortable, and a place that women of all ages know, from the time they enter the front door, that we'll be addressing their specific pelvic health needs.
In addition to providing world class patient care, it is also critical to track patient and surgical outcomes. Part of what we are putting in place is a solid way to closely track our outcomes. Medicine has become much more outcome driven and value based. I think our practice is going to be cutting edge and ground breaking in those regards.
QUESTION: You wrapped up your fellowship in June. Tell us more about that experience.
Dr. Johnson: I completed a three-year fellowship in Female Pelvic Medicine and Reconstructive Surgery the official name for urogynecology. After four years of residency, you can be an attending physician and practice independently, but I wanted to sub-specialize in urogynecology to become an expert in pelvic floor dysfunction. And so I devoted the last three years of my life to getting expertise in this area. I spent two of the three years in the operating room where I operated three days a week. I did about 300 cases a year, on average.
My goal was to gain that extra level of expertise and to learn how to be a consultant. There’s an art to the ability of a specialist to enter an operating room during a crisis, quickly take the pulse of the room, deescalate the stress, and save the day. Fellowship training provides the opportunity to gain that extra level of surgical expertise.
In addition to my surgical training, I also spent a year doing basic science work. One of my interests is looking at recurrent urinary tract infections. My initial goal was to create a model of the bladder using bladder cells and to make those bladder cells menopausal (the majority of women I see are post-menopausal). I then studied the immune system of those cells to see if that's what's leading to recurrent bladder infections.
I also looked at probiotics, because it's one of the hottest topics in both medicine as well as the media. I wanted to see if there's real science behind it. Using the model with the menopausal bladder cells, I was able to culture them with probiotic bacteria to see if that would help them prevent bladder infections.
QUESTION: And what did your research reveal? Or are you still figuring that piece out?
Dr. Johnson: A truism of science is that you'll answer one question and two more will come up. We were able to see that there is something unique about probiotics, specifically Lactobacilli, which is the one you'll see on TV. Lactobacilli interact directly with known bladder pathogens such as E. coli and inhibit its growth. And by inhibiting the growth of this pathogenic or bad bacteria, it allows the body to better fight off the bacteria and to remain healthy.
The vagina has multiple different bacterial organisms in it, many that are good for a woman's health. As long as you maintain that bacterial community of good bacteria, that then can protect the bladder as well. However, if the good bacteria die off, which commonly happens in post-menopausal women, then it leaves women susceptible to recurrent bladder infections. So the question becomes how do you maintain that healthy environment? We still don't know the magic bullet, so the ending is still unfolding, but probiotics like Lactobacilli could very well play a role.
QUESTION: Before we wrap up, let's talk about life outside the lab and office. What do you do for fun?
Dr. Johnson: So outside the office, I spend a lot of time with my kids. You can usually find me at my daughter's swim or ballet classes. My family tends to spend a lot of time outdoors as well. So we'll go hiking, kayaking, or bike riding. In the winter, I'm a big snowboarder.
Thank you so much for your time Dr. Johnson, and welcome aboard!
Do you think you could benefit from seeing our urogynecologist, Dr. Johnson? Schedule a consultation.