May 10, 2023 Urogynecology and Pelvic Health

 

The #gyncsm Community welcomed Jocelyn Fitzgerald, MD (@jfitzgeraldMD) and Theresa Feeley, PT, DPT, PRPC (@drtpelvichealth) as our guests to chat about Urogynecology and Pelvic Health. Eighteen participants, which included survivors, patients and physicians, joined us.

You may find the transcript and analytics for this chat on Symplur, part of Real Chemistry.

Here is summary of the topic questions and answers. 

T1: What is pelvic health and how can it be impacted by gynecologic cancer treatments?

• T1. Pelvic health involves the pelvic floor muscles. These are muscles that create a sling between the hip bones and lower spine. They assist in the stability of the hip girdle and support of the pelvic organs.
• T1: These muscles aide in bowel, bladder and sexual function. To do this, they need a balance of strength and flexibility. They lift up to hold things in (urine, stool, gas) and relax down to let things out (urine/stool) or to allow intercourse, tampon use, GYN exams.
• T1: Surgical and radiation interventions with gynecological cancer care can alter the muscle function, creating scar tissue and weakness. This sometimes leads to vaginal or pelvic pain, pain with intercourse, urinary/stool incontinence, to name a few.
• T1: "Pelvic Health is the best possible functioning and management of the bladder, bowel, and reproductive organs... not merely the absence of disease or weakness... Pelvic health plays an important role in ... physical, mental, social, and sexual well-being." @bcmhouston
• T1: Gyn cancer treatments, such as surgery, chemotherapy, and radiation, can all be used to cure cancer or reduce symptoms, and can also result in short & long term effects that can impact quality of life. Always important to talk to your doctor.

T2: What role does a urogynecologist play in the care of those diagnosed with a gyn cancer?

• Both Urologists and Gynecologists can do fellowship training in female specific pelvic floor issues and become a Urogynecologist. We specialize in bladder issues like incontinence, recurrent UTI, pain vaginal prolapse, sexual dysfunction, vulvar issues, fistula, birth trauma, vaginal stenosis, fecal incontinence, etc.
• T2 What on Earth Is Urogynecology https://pennmedicine.org/updates/blogs/womens-health/2015/june/what-on-earth-is-urogynecology via @PennMedicine
• "What Is the Difference Between a Urologist and a Urogynecologist? Urology is a more general field than Urogynecology. For example, urologists treat women, men, and children. Urogynecologists, on the other hand, deal only with matters of a woman's pelvic floor.

T3: What options are there for alleviating pelvic pain? What has been your experience with pelvic pain?

• Physical therapist use conservative options for alleviating pain. PT can do manual soft tissue massage throughout abdomen, incision sites, hip girdle and also in vaginal canal directly on pelvic floor muscles to relieve tension creating pain.
• We can do several things. We can do combined surgery with Gyn/Onc (for example, repair prolapse or treat incontinence at the same time as cancer surgery, and we can help manage symptoms like GenitoUrinary Syndrome of menopause, recurrent UTI, and sexual pain we can also help with fecal incontinence, radiation changes, urinary urgency, etc.

T4: How does pelvic health impact intimacy and sexual health? What are tips and resources to maintain intimacy and sexuality after gyn cancer?

• The muscles of the pelvic floor need to relax and stretch for intercourse. When there is increased tightness in these muscles, penetration can be painful. Soft tissue work (with a PT or done yourself) can reduce the tightness to allow for pain free intimacy.
• I recommend talking about this early and often. For men with prostate cancer, for example, sexual changes they can expect from treatment come up right away. The same is not done for women, so you should advocate for yourself. Ask what anatomic changes you can expect. Will you have a partial vaginectomy? Will your ovaries be removed? Will you have radiation or chemo? All of those things can affect sexual function in different ways.
• Tightness in the pelvic floor muscles can create a referred pain to the vagina, vulva and inner thighs. This also affects intimacy. I have heard it referred to as burning or cat’s nails. It's a similar effect to a knot in your neck that refers pain into your arm.
• Ask what can be done to protect the vaginal and vulvar tissues, ask about hormonal treatments like vaginal estrogen. Ask about hormone replacement
• Lubrication can be very helpful for pain free intimacy. Muscle tightness, medications, surgeries, stress, hormonal levels and many other things can result in dryness in the vaginal tissues increasing pain.
• Pelvic floor wands are tools made to use in the vaginal canal to address muscular tightness. This can be done at home to compliment pelvic floor therapy.
• T4: Dilators are a cylinder-shaped device that it used to help stretch the vaginal canal to work towards pain free intercourse. They are inserted similar to a tampon, in a comfortable position for 15-20 minutes. They progressively get larger to increase the stretch.

T5: What is pelvic floor physical therapy? How are patients evaluated for the need?

• Pelvic floor physical therapist evaluate the muscles of the pelvic floor. We can assess strength, endurance, tension and pain both externally and internally with a finger placed in the vaginal canal. We also assess the hip girdle, lower spine, abdomen and breathing. The pelvic floor works with your breath. Using your breath in specific stretches or yoga poses with help to release tension in muscles. This will allow the muscles to relax and decrease pain
• We combine many techniques based on the specific person. We can use massage externally and internally to loosen tissues. We sometimes focus on hip mobility, stretching, breathing and yoga poses. We also use a ton of education and home exercise programs.
• A wonderful form of physical therapy that rehabilitates the pelvic floor muscles and connective tissues so that they can perform their functions in a coordinated, pain-free fashion. It also involves breathing techniques and other maneuvers.

T6: What are some pelvic health resources for those impacted by cancer-related diagnoses? What have you found helpful?

• "Come As You Are" by Emily Nagoski is a great resource for intimacy and sexual health. It does not address pain with intercourse, but talks about your relationship with your body and women's sexual health
• Foundation for Women’s Cancer @GYNCancer publication Sexuality & Intimacy: Your Guide https://foundationforwomenscancer.org/wp-content/uploads/2019-FWC-Patient-Education-Handouts-Sexuality_FINAL.pdf
• I found this info helpful before I started PT at @AtlanticPT https://atlanticpelvichealth.com/pelvic-floor

Thank you Drs. Jocelyn Fitzgerald and Theresa Feeley for sharing your expertise with our community. We will not be holding a chat in June. Join us for our next chat on July 12th at 8pmET as we discuss GYN Cancer Research News from this year’s ASCO and SGO Annual Meetings.


Dee and Christina
#gyncsm Co-Founders