Restoration of lost function – whether pathological, physiological, menopause or prolapse-related – is the goal of EVMS Urogynecology. Treatment options range from physical exercises to medications to laparoscopic, minimally invasive and reconstructive surgery.

Otherwise known as Urogynecology, Female Pelvic Medicine and Reconstructive Surgery has the distinction of being one of the rare certification processes that is approved by two separate Boards: the Board of Obstetrics & Gynecology and the Board of Urology. Rather than dealing with disease, urogynecologists treat conditions that result in abnormal function of the organs within the female pelvic floor.

Treatments

Incontinence, Non-Surgical Treatments

There are two types of urinary incontinence: stress (in which women experience leaking with coughing, sneezing or laughing) and urge (a sudden, urgent need to urinate).

Non-surgical treatments include:

  • Dietary modification instruction
  • Medications to prevent bladder spasm
  • Nerve electrical stimulation
  • Kegel exercises instruction
  • Vaginal cones or pessaries
  • Urethral occlusion
  • Collagen injections
Incontinence, Surgical Options

Our skilled physicians will discuss all treatment options to help alleviate incontinence, including minimally invasive procedures.

Surgical options include:

  • Anterior repair
  • Burch urethropexy
  • Pubovaginal slings
  • TVT, TOT slings
  • MiniSling
Prolapse

Prolapse is a highly complex anatomical issue and demands the high level of skill of our medical professionals to treat.

The most common forms of prolapse are:

Cystocele/urethrocele – the front wall of the vagina sags downward or outward, allowing the bladder to drop from its normal position. This may be referred to as a “dropped bladder.”

Rectocele – the back wall of the vagina sags outward, allowing the rectum to bulge into the vagina.

Uterine prolapse – the upper supports of the vagina and uterus/cervix are weakened, allowing the uterus and cervix to bulge downward and outward.

Vaginal vault prolapse – the vaginal cuff descends below a point that is 2cm less than the total vaginal length above the plane of the hymen. Seen when the upper vagina bulges into or outside the vagina, often in women who have undergone hysterectomy.

Enterocele – the support to the top of the vagina is weakened, allowing bulging of the small intestine. This type of prolapse is most often seen in women who have undergone a hysterectomy.

Surgical intervention, whenever possible, is done in the most minimally invasive procedure possible.

Procedures include:

Cystocele

  • Anterior repair
  • Laparoscopic paravaginal repair

Rectocele

  • Posterior repair

Uterine

  • Hysteropexy

Vaginal Vault

  • Laparoscopic sacral colpopexy
  • Laparoscopic uterosacral
  • Ligament suspension
  • Sacrospinous ligament
  • Suspension
  • Colpocleisis
Incontinence, Non-Surgical Treatments

There are two types of urinary incontinence: stress (in which women experience leaking with coughing, sneezing or laughing) and urge (a sudden, urgent need to urinate).

Incontinence, Surgical Options

Our skilled physicians will discuss all treatment options to help alleviate incontinence, including minimally invasive procedures.

Non-surgical treatments include:

  • Dietary modification instruction
  • Medications to prevent bladder spasm
  • Nerve electrical stimulation
  • Kegel exercises instruction
  • Vaginal cones or pessaries
  • Urethral occlusion
  • Collagen injections
Prolapse

Prolapse is a highly complex anatomical issue and demands the high level of skill of our medical professionals to treat.

Incontinence, Non-Surgical Treatments

There are two types of urinary incontinence: stress (in which women experience leaking with coughing, sneezing or laughing) and urge (a sudden, urgent need to urinate).

Incontinence, Surgical Options

Our skilled physicians will discuss all treatment options to help alleviate incontinence, including minimally invasive procedures.

Prolapse

Prolapse is a highly complex anatomical issue and demands the high level of skill of our medical professionals to treat.

Non-surgical treatments include:

  • Dietary modification instruction
  • Medications to prevent bladder spasm
  • Nerve electrical stimulation
  • Kegel exercises instruction
  • Vaginal cones or pessaries
  • Urethral occlusion
  • Collagen injections

Surgical options include:

  • Anterior repair
  • Burch urethropexy
  • Pubovaginal slings
  • TVT, TOT slings
  • MiniSling

The most common forms of prolapse are:

Cystocele/urethrocele – the front wall of the vagina sags downward or outward, allowing the bladder to drop from its normal position. This may be referred to as a “dropped bladder.”

Rectocele – the back wall of the vagina sags outward, allowing the rectum to bulge into the vagina.

Uterine prolapse – the upper supports of the vagina and uterus/cervix are weakened, allowing the uterus and cervix to bulge downward and outward.

Vaginal vault prolapse – the vaginal cuff descends below a point that is 2cm less than the total vaginal length above the plane of the hymen. Seen when the upper vagina bulges into or outside the vagina, often in women who have undergone hysterectomy.

Enterocele – the support to the top of the vagina is weakened, allowing bulging of the small intestine. This type of prolapse is most often seen in women who have undergone a hysterectomy.

Surgical intervention, whenever possible, is done in the most minimally invasive procedure possible.

Procedures include:

Cystocele

  • Anterior repair
  • Laparoscopic paravaginal repair

Rectocele

  • Posterior repair

Uterine

  • Hysteropexy

Vaginal Vault

  • Laparoscopic sacral colpopexy
  • Laparoscopic uterosacral
  • Ligament suspension
  • Sacrospinous ligament
  • Suspension
  • Colpocleisis

Start the conversation

One of the most difficult discussions a woman will ever have with a medical professional is describing the symptoms of female pelvic floor dysfunction.  The conversation can be just as embarrassing and uncomfortable as the symptoms themselves.

Symptoms generally begin gradually and the natural evolution is for them to progress with time. They vary among women and can include:

Bladder control problems:

  • Urine leakage
  • Overactive bladder
  • Difficulty emptying the bladder

Bowel control problems:

  • Infrequent bowel movement
  • Constipation or diarrhea
  • Hard bowel movements
  • Abnormal stool consistency

Pelvic organ prolapse:

  • A bulging, pressure or heavy sensation in the vagina that worsens by the end of the day or during bowel movements
  • Difficulty starting to urinate or a weak or spraying stream of urine
  • Urine leakage and/or pain with intercourse

These symptoms, and any subsequent loss of function, can be effectively diagnosed and treated by competent and skilled physicians who have the highly specialized training of Female Pelvic Medicine and Reconstructive Surgery. EVMS Urogynecologists Dr. Peter Takacs and Dr. Kindra Larson are fellowship trained and Board certified.

Patient education

Female pelvic disorders are complex conditions that affect women in several ways, at virtually almost every stage of their lives. Talking to physicians candidly when symptoms present is an important element in reducing the likelihood of permanent organ dysfunction.

In addition to providing EVMS materials, we recommend the Voices for PFD website, which provides reliable information and excellent resources to help prepare for a visit with your doctor – including a section on talking about symptoms.

EVMS Pulse: Pelvic Floor disorder is more common than you think