So, we see our gynecologists once a year, right? You might be thinking: “Got that covered. What else is there to talk about?” But what you might not realize is that an annual GYN exam is not the only way to deal with issues in the “down there” region.

Virtua female pelvic medicine specialist Joseph Maccarone, MD, says there are three primary issues that women most commonly bring to his practice. He’s been helping women solve these issues since 1993, and it turns out there have been significant recent advances in the treatment of pelvic problems. This is “not your mother’s pelvic medicine” – today’s women have access to all sorts of promising new procedures for pelvic organ prolapse, incontinence, and pelvic pain.

There’s so much great info, we’ll cover it in a 3-part series, starting with pelvic organ prolapse.

Pelvic Organ Prolapse

Prolapse means, “to fall out of place,” and for a variety of reasons the pelvic organs (vagina, uterus, bladder, and rectum) can shift out of their normal position. A certain amount of pelvic organ prolapse is normal and almost ubiquitous among women who’ve had children, Dr. Maccarone points out. “Prolapse is only a problem if it is causing symptoms. You may have a sense of fullness or heaviness in the pelvis, experience pain during intercourse, or you may feel a bulge or unusual sensation when you wipe after using the bathroom. If it’s bothersome enough to change what you do or how you function, it’s time to talk to a doctor about it.”

Wherever and however prolapse occurs, it’s due to a weakening or tearing of the muscles or tissues that hold those organs in place. To treat pelvic organ prolapse is to strengthen the muscles in the pelvis or reinforce or rebuild the supportive tissues, and ways to do this include:

• Physical therapy, which can include biofeedback, electrical stimulation, and even vaginal weights. (Yes, you read that right – your vagina can weight train just like the rest of you!) Sure, you can do Kegel exercises in the privacy of your own home, but think of this type of therapy as having a personal trainer for your nether regions. Physical therapists can help you push past your comfort zone, past your plateaus, and into the realm of real (pelvic) muscle-building exercise.
• A pessary, which is a flexible, removable device that is inserted into the vagina to hold the vaginal walls and neighboring organs in place. Pessaries come in a variety of shapes and sizes, and with new technology they’ve become increasingly comfortable. “Though they’ve been in use for generations, pessaries are still our go-to nonsurgical treatment option for prolapse in those patients for whom physical therapy is unsuccessful, or as an adjunct to physical therapy,” says Dr. Maccarone. “There are pessaries that you can insert and remove at home, and others that can only be inserted and removed in the doctor’s office.” Pessaries are custom-fitted during an office appointment, and the type of pessary selected will be based on your diagnosis and lifestyle considerations.
• Reconstructive pelvic surgery may be required for the most severe cases of pelvic organ prolapse. However, don’t assume the worst, says Dr. Maccarone. “Many of my patients, when I mention reconstructive surgery, think they’re going to need to have a hysterectomy. While that’s sometimes true, it’s more the exception rather than the rule.” What’s more, a minimally invasive approach through the vagina is almost always possible, and this will induce less pain and a shorter recovery period as compared to the major abdominal surgeries of the past.

Coming in Part 2: Incontinence

“Incontinence is a very common condition that affects up to 40% of women,” says Dr. Maccarone, “and the treatments now are better than they’ve ever been.”