As women in the 21st century, there are so many ways our lives are different from those of our mothers, grandmothers and great grandmothers. It seems inconceivable now, but it wasn’t until 1920 that American women were given the right to vote with the ratification of the 19th Amendment. Our ‘foremothers’ would hardly recognize the multifaceted lives of today’s women. But despite all the changes, advances, and seriously damaged glass ceilings, many women still suffer with age-old ‘female’ problems that range from irritating, to painful, to incapacitating and life-threatening. Fortunately, advances in medicine and technology are providing groundbreaking improvements in women’s health.
To shed some light on new treatment options for a number of common gynecological problems, Well-Being turned to Robert Harris, M.D., Urogynecologist, at Southeast UROGYN, with clinics in Jackson, Meridian and Indianola, and Kay Kay Brantley, M.D., OB/GYN of Southern Women’s Health in Jackson.
Our conversation with Dr. Harris began with a basic question…What is urogynecology?
“It is a subspecialty of obstetrics and gynecology that focuses on disorders of the female pelvic floor such as vaginal prolapse (support loss), urinary incontinence, fecal incontinence and other bladder problems,” explains Dr. Harris. “After finishing an OB/GYN residency, a urogynecologist spends additional years of fellowship training focusing only on these disorders. In our practice we treat women with urogynecological conditions and other surgical GYN problems as well.”
According to Dr. Harris some of the most common problems he sees are bladder control issues, overactive bladder, pain and excessive bleeding associated with periods, painful intercourse, concerns about pelvic mesh implants and bladder slings, and symptoms of menopause.
“Overactive bladder and uncontrollable urges with leakage often are nerve issues,” says Dr. Harris. “Controlling the bladder is actually a function of the brain. The brain tells the nerves to suppress the urge to go, you might call it ‘mind over bladder.’ There are a number of treatments that can be successful to help with the problem of leakage or urgency, including oral medications, Botox injections into the bladder wall, and neurostimulation of the nerves to the bladder.”
“With so much publicity about vaginal mesh and bladder sling problems, women who have had these procedures are concerned,” notes Dr. Harris. “Most of the time a direct issue with mesh is not the problem, but it does cause anxiety for many women.”
“For younger, premenopausal women who are finished childbearing, endometrial ablation can be a solution for heavy periods due to benign causes,” notes Dr. Brantley. “It is a minimally invasive surgery that uses electrical energy, heat, or freezing to destroy the endometrium, or uterine lining.”
Success rates of endometrial ablation vary depending on the specific procedure used and the patient, but for the following three to five years after the procedure the percentage of successful outcomes is generally quite high (up to 80 to 90 percent). The goal is to shorten periods to 2 days or less or no period at all.
“Endometrial ablation is not for those patients who have or suspect uterine cancer or pre-cancer, have an active genital or pelvic infection, or an IUD or metal uterine implant in place,” Dr. Brantley adds. “Also patients who have had myomectomies (surgery to remove fibroids) or classical Cesarean sections or patients who want to have more children are not candidates for ablation. Alternative treatments would be hormone therapy like birth control pills or IUDS, Dilation and Curettage, or Hysterectomy.
With so many women working and having such hectic lives, stopping to have a traditional open hysterectomy with 6 to 8 weeks of recovery time is a very difficult option. According to Dr. Harris one potential solution for the busy woman is a vaginal hysterectomy. It requires no incision because the uterus and other reproductive organs are removed through the vagina. It can be performed on an outpatient basis ususally in under 30 minutes, and pain is very minimal and even less with a nerve block at the mouth of the uterus.
In robotic-assisted laparoscopic hysterectomy, the surgeon uses a computer to control the surgical instruments. There are usually three to four small incisions through which the instruments work. The computer station is in the operating room, and the surgeon is able to control the robot’s movements steadily and precisely. This lets him or her get into tiny spaces more easily, and have a better view of the operation than with conventional laparoscopic surgery.
“Robotic hysterectomy has been the most helpful new technology in my career in my opinion,” adds Dr. Brantley. “Patients stay less than 24 hours in the hospital with a shortened recovery period in comparison to traditional hysterectomies.”
Fractional Laser for Painful Intercourse
As a woman goes into menopause, whether naturally, surgically, or after breast cancer treatment, the lining of the vagina can become thin and less moist resulting in irritation, burning, pain and discomfort during intercourse. There is a new laser treatment option, called MonaLisa TouchTM that Dr. Harris says is getting very good results since his practice started using it last spring. It uses a fractional CO2 laser to stimulate the growth of new tissue and collagen and subsequently improve moisture in the vagina. Initially, three treatments are recommended six weeks apart and these are done in the office in about 2-3 minutes with no anesthesia or pain. Annual treatments are required thereafter to maintain your result.
The Take-away “You know when something doesn’t feel right, there is unexplained pain or your body is not functioning as it once did,” continues Dr. Harris. “The most important advice I can give is that you get help. There are new treatments and procedures for women that can help restore you to a normal life, often without having to miss work. Don’t wait and allow the problem to get worse. And, if surgery is indicated, do your homework. Find out how many procedures a surgeon has done and check out his or her credentials. Be your own advocate for a healthier, happier you.”
Robert Harris, M.D. Urogynecologist, received his Doctor of Medicine degree from the University of Mississippi School of Medicine and served his Obstetrics and Gynecology residency at the University of Mississippi Medical Center. His fellowship in Urogynecology and Reconstructive Pelvic Surgery was completed at Duke University Medical Center. Dr. Harris is double board-certified by the American Board of Obstetrics and Gynecology in OBGYN and Female Pelvic Medicine and Reconstructive Surgery.
Kay Kay Brantley, M.D., OB/GYN, received her Doctor of Medicine degree from the University of Mississippi School of Medicine, and served her internship and residency in Obstetrics and Gynecology at the University of MS Medical Center. Dr. Brantley is board-certified by the American College of Obstetricians and Gynecologists.