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Female Urology

Bladder Prolapse (Cystocele)

Are you a woman experiencing discomfort in the vaginal area, problems with urination and/or painful intercourse? Then perhaps your bladder has shifted out of its normal position.

Symptoms associated with prolapse include: frequent urination or urge to urinate; stress incontinence; not feeling bladder relief immediately after urinating; frequent urinary tract infections; discomfort or pain in the vagina, pelvis, lower abdomen, groin or lower back; heaviness or pressure in the vaginal area; painful intercourse; or tissue protruding from the vagina that may be tender and/or bleeding. Mild cases of prolapse may not cause any symptoms.

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To learn more about this condition we recommend you visit the following website:

Female Sexual Medicine

Female Sexual Dysfunction is a newly recognized medical condition in which women experience sexual complaints that cause significant personal bother. FSD is common, as 43% of American women or about 40 million women complain that they have lost interest in sex or it just is not as enjoyable as it used be. Many report diminished sexual sensation or say they've lost their ability to achieve an orgasm. Some have pain with intercourse.

FSD is divided into four categories:

  1. Desire Disorder: the woman doesn't feel "in the mood" for sexual activity.
  2. Arousal Disorder: the woman has trouble becoming vaginally lubricated or "wet" and/or her sexual sensations are diminished.
  3. Orgasmic Disorder: the woman has difficulty achieving orgasms or doesn't have them at all.
  4. Pain Disorder: means that the woman experiences pain during intercourse.

Causes of FSD include:

  • Decreased estrogen and/or testosterone levels, which may be associated with changes during and after menopause.
  • Decreased blood supply to the clitoris — symptoms associated with this condition include lack of sensation and pelvic pain, both chronically and during intercourse.
  • Complications from nerve or spinal cord injuries and/or medical conditions such as multiple sclerosis.
  • Musculogenic insufficiencies relating to childbirth or pelvic trauma that result in a lack of sensation.

The number and quality of treatments is growing but lags far behind male sexual dysfunction. Clinical research is ongoing as well as pharmacological research to address the problem. Some of the treatments for FSD today include:

  • Hormonal therapy
  • Vaginal creams to stimulate blood flow
  • EROS™ a clitoral pump that helps stimulate blood flow
  • Trans-vaginal electrical stimulation to stimulate nerves and help strengthen pelvic floor muscles
  • Peripheral nerve stimulation

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Female Incontinence

Bladder control is a common yet complex problem that can seriously affect a person's life. Fortunately, with today's high-tech procedures and powerful drugs, a diagnosis may simply mean the road to bladder control is challenging, rather than impossible. Incontinence in women is often categorized as overflow incontinence, stress incontinence, urge incontinence, or mixed incontinence. Treatment is dependent on the type of incontinence.

A new therapy is called Percutaneous Tibial Nerve Stimulation. It is a weekly procedure where a tiny acupuncture type needle is placed near the ankle in proximity to the tibial nerve, which then sends messages to the spinal cord to modulate the bladder tone over various sessions.

A more advanced but invasive approach is Sacral Nerve Stimulation. A small lead is placed in the small of the back and attached to a modulating device which is implanted under the skin. This is usually a two step procedure, with the second step performed under anesthesia. It is a relatively simple procedure and is usually reserved for those people who fail more conservative means.

Medical therapy for Urinary Urge Incontinence (UUI) and Overactive Bladder (OAB) is common and consists of a class of drugs called anticholinergic or drugs with bladder relaxant abilities. These drugs can be very effective in certain people, but can also have side effects such as dry mouth, dry eyes, constipation and blurred vision. Some of the newer approved drugs act more specifically on the bladder and have fewer side effects.

Please contact us to schedule an appointment.

To learn more about this condition we recommend you visit the following website:

In-Office Treatment for Incontinence

Biofeedback and Incontinence

Biofeedback takes information about something happening in the body and presents it in a way that you can see or hear and understand. Getting on a scale to check your weight or having your blood pressure taken are very simple examples of biofeedback, which can be used to measure any body response such as heart rate or muscle contraction and relaxation. The measurement can be displayed on a computer screen or heard as a tone and used to learn about a subtle body function.

Two small sensors are placed with a sticky pad on either side of your anus, where the pelvic floor muscles are close to the skin. These can be placed under your loose clothing. Another set of sensors is placed across the abdomen. The sensors around the anus are connected to a computer screen and display a graph of your muscles as they are being exercised. Since many women incorrectly use their stomach muscles when doing pelvic floor exercises, the sensors on the abdomen display a computerized graph to show you when you are using these muscles instead of those on the pelvic floor. The graphs also are helpful in measuring your growth in strength between biofeedback visits.

Biofeedback sessions are generally 30 minutes. The average number of sessions is four, but a few more or less may be needed to achieve the best results. Visits are scheduled every two to three weeks. Since biofeedback is a learning tool, it is important to practice pelvic floor exercises every day at home as well.

Tibial Nerve Neuromodulation--Urgent® PC

The Urgent PC Neuromodulation System is designed to treat urinary urgency, urinary frequency and urge incontinence. You may have one or more of these symptoms if you have an Overactive Bladder, Mixed Incontinence, Interstitial Cystitis or have recently undergone a radical prostatectomy.

The Urgent PC Neuromodulation System is a combination of a stimulator and a lead set. The stimulator generates a specific kind of electrical impulse that is delivered to the patient through the lead set. Using a needle electrode placed near the ankle as an entry point, the stimulator’s impulses travel along the tibial nerve to the nerves in the spine that control pelvic floor function.

A small, slim needle electrode is inserted near your ankle. The needle electrode is then connected to the battery-powered stimulator. After turning on the stimulator, your physician will observe your body’s response to determine the ideal strength of the impulses.

Each of your treatments will last approximately 30 minutes. You will receive an initial series of 12 treatments, typically scheduled a week apart. After the initial 12 treatments, your physician will discuss your response to the treatments and determine how often you will need future treatments to maintain your results.

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