Greater Boston Urology Blog

When to See a Urogynecologist: The 5 Top Reasons

What is a "urogynecologist?" A urologist? A gynecologist? Something else?

This blog post will clear up any confusion by answering the following questions:
●    What is a urogynecologist?
●    When should you see a urogynecologist?
●    Who are GBU's urogynecologists?

Let's get to it!

As with all content on the GBU blog, the following is meant to be educational only, not medical advice. Always consult a physician about your specific healthcare needs.

What is a urogynecologist?

As the American Urogynecological Society (AUGS) explains, "Doctors called urogynecologists, or urogyns, receive special training to diagnose and treat women with pelvic floor disorders."

The website goes on to say that although a person's primary care physician, gynecologist, or urologist may have knowledge about pelvic floor disorders, a urogyn offers additional expertise. 

Urogynecologists complete medical school and a residency in obstetrics and gynecology or urology. They then complete a two- to three-year fellowship in conditions that impact the pelvic floor. Urogynecology became a certified subspecialty in 2011, and the first physicians became board-certified in 2013.

Dr. Angel Marie Johnson, the Director of Women's Health at GBU, is a board-certified urogynecologist. She says that patients who see her sometimes think they're getting two doctors for the price of one, but the reality is much more nuanced. 

"I don't replace your gynecologist," she explains. "Your gynecologist has a critical role in your pelvic health. I specialize in conditions that impact your bladder, bowel, and vaginal health. My patients still see their general gynecologists for annual well-woman visits, pap smears, and breast exams." 

When should you see a urogynecologist?

While urogynecologists treat a wide variety of conditions, below you'll find the top five reasons why you should consider seeing one.

1. You're experiencing urinary incontinence—especially incontinence that isn't getting better despite treatment

Maybe you've seen your primary care physician or gynecologist and you've made lifestyle changes like cutting down on caffeine, seltzer, and other bladder irritants. Maybe you've tried medication prescribed by your PCP or gynecologist, but it's not enough, and you're wondering what other options are available. Maybe your urinary incontinence is so debilitating you're avoiding things you used to love, like traveling and social gatherings, because you're constantly worried about bladder leakage. If this sounds like you, then consider seeing a urogynecologist. 
Dr. Johnsons says that bladder leakage is one of the top reasons to see a urogynecologist since urogyns specialize in complex urinary leakage or voiding dysfunction. 

"We're able to look at the whole picture in a more comprehensive way because of our background and training," she explains. "So I won't just treat your bladder because I know that your vaginal and bowel health also impacts your bladder."

Read more about treatment options for things like stress urinary incontinence and overactive bladder.

2. You're experiencing frequent urinary tract infections.

When we say "frequent" urinary tract infections (UTIs), we mean more than two in six months or more than three in a year. Frequent or recurrent UTIs may indicate a larger health issue, and urogyns are trained to treat these complex cases.

"We commonly perform tests and evaluations to make sure the urinary system is healthy," Dr. Johnson says. "And we have a whole array of prevention strategies that we can employ—not just antibiotics—that can improve your overall health and urinary function."

Read about cranberry for recurrent UTIs.

3. You have pelvic organ prolapse (POP).

When the tissues and muscles supporting the pelvic organs weaken or loosen, the pelvic organs can descend or "prolapse." According to the International Urogynecological Association (IUGA), vaginal prolapse affects "up to half of adult women." 

Dr. Johnson says that urogyns are experts in prolapse repair. "We have the full gamut of treatments that range from pelvic floor physical therapy to advanced surgeries that often can be performed at a surgical center or without a hospital stay."

Dr. Johnson says if you have POP, it's in your best interest to have a urogynecologist perform the repair since they do prolapse surgery on a regular basis and are familiar with the latest techniques. This gives patients the most predictable and durable surgical outcome. 

Read more about treatment options for pelvic organ prolapse, including Lefort colpocleisis.

4. You're experiencing pelvic pain, vaginal dryness, or pain with intercourse—or you simply feel that something is "off" with that part of your body. 

It can be equally frustrating and frightening when something feels off in your pelvic region. A urogynecologist has expertise in pelvic floor disorders and can often diagnose your symptoms and offer effective treatments. 

And it's important to note that many minimally invasive treatments exist, depending on your condition and unique health factors. 

Read about trigger point injections for pelvic pain and chronic pelvic pain caused by myofascial pelvic pain syndrome.

5. You're experiencing difficulties during the transition to menopause.

Dr. Johnson jokingly refers to menopause as puberty in reverse. She also says that the medical world's understanding of menopause has changed dramatically in the last decade.

A woman officially enters menopause when she goes 12 consecutive months without a period. Dr. Johnson says, "It used to be taught that the transition lasted a year. But that's not what studies are showing now. The transition can take much longer, even 10 to 15 years for some women."

While the average age of menopause is 52, Dr. Johnson says that some women can start as early as their forties while other women could still have a monthly cycle up until their mid-fifties.

And the symptoms are just as vast—a whole "constellation" of symptoms, as Dr. Johnson calls them—that include hot flashes, sleep disturbances, vaginal dryness, decreased libido . . . and that's just the beginning.

Dr. Johnson says that like many conditions in healthcare, if patients understand what's going on it, it takes away some of the fear. It takes away the sense of being powerless. And the good news is effective treatments do exist for these symptoms.

"There is a whole host of things that a physician, especially a urogynecologist, can recommend or prescribe to help women navigate this transition. They don't have to simply put down their head and be in misery."

Read more about navigating perimenopause.

Who are GBU's urogynecologists?

Throughout this article, we've quoted Dr. Angel Marie Johnson, a board-certified urogynecologist who serves as the Director of Women's Health at GBU. Dr. Johnson currently sees patients in Dedham. 

Last fall, Dr. Dima Ezzedine—a  full-time urogynecologist who sees patients in our Plymouth Care Center—joined GBU. Dr. Ezzedine has contributed several articles to our blog, including a detailed one on prolapse surgery and another on robotic surgery for urogynecology.

Dr. Johnson and Dr. Ezzedine are accepting new patients. Request an appointment here.

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