I don’t want to distract from the hormone discussion but thought given the # of women here of varying ages, this might be a thread of continuing topics/discussion.
In GOOD women’s and based on science news….
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I was talking with my urogynecologist this week and was shocked to learn that only about 50 new urogyns are graduated each year.
That’s 50 new surgeons/year to treat the roughly 56,000,000 women who have pelvic floor disorders in the US. (Pelvic floor disorder are astonishingly common, affecting approx 1 in every 3 women during their lifetime.)
No wonder there’s often a 6 month or longer wait to get an appointment.
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I have an amazing urogynecologist but it took 6 months plus to get my first appointment with her. I totally agree that this is an underserved area of medicine.
Unlike other countries, pelvic floor physical therapy is not well known here and not routinely prescribed after childbirth. It should be.
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I think that the issues facing women have been and continue to be overlooked in our country. I don’t know how we fix it, unfortunately.
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And this study is just counting actual cervical cancer deaths. It is not even counting other deaths directly or indirectly due to HPV. For example, during my career as a primary care doctor I have had patients die of all the following: HPV-caused tongue cancer (a man), HPV-caused vulvar cancer, HPV-caused anal cancer, and a baby who died of complications of prematurity who was born early due to his mother having a cervix that had been weakened by surgical treatments to remove HPV-caused precancerous lesions. And then of course cervical cancer.
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This is absolutely true. But I would point out that it is actually worse in many other wealthy countries. My own pelvic floor surgeon is actually an immigrant from Sweden. He says it’s worse there, and that urinary and fecal incontinence due to pelvic floor injuries are just considered “natural” there and women are just sent to PT and told to do pelvic floor exercises. Unfortunately, all the kegals in the world cannot fix torn or avulsed muscles, ligaments or fascia. He came to the United States for training because training in advanced pelvic floor repair wasn’t even available there, and he had no future as a pelvic floor surgeon there.
ETA: randomized studies that look at postpartum pelvic floor PT are a mixed bag. Many show no objective improvement at all. Some show some objective improvement, but by 12 months postpartum there is no meaningful difference in the treatment vs. control groups. And pelvic floor therapy does not help fecal incontinence or pelvic organ prolapse. Here’s a typical study (shared by my own pelvic floor doctor.) https://journals.lww.com/greenjournal/abstract/2013/12000/postpartum_pelvic_floor_muscle_training_and.13.aspx
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Until last week I had not heard of this field of medicine. I saw that the hospital has opened a new clinic and there is a new physician whose specialty is urogynecology. Her bio says she is one of the few in the nation. I have a female urologist but I usually see the male PA unless it’s something more complex. I’m also needing to find a new gynecologist as mine doesn’t take Medicare. I think Monday I’ll call and see what her availability is. I’m in the middle of a flare up of IC. I’m trying all my conservative treatments and hope I can get it back under control.
My daughter and daughter in law both have had pelvic floor PT after pregnancy. It’s not something I’d heard of back when I had my children.
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A urogyn is unlikely to see patients for routine gynecology visits or menopause treatment (“benign gyn”). They typically work with patients with complex problems like pelvic organ prolapse, bowel or bladder incontinence, fecal leakage, overactive bladder, vaginal fistulas, pelvic floor hernias, etc
Not all urogyns were general gynecologists first before completing a urogyn fellowship. About 1/3 are urologists who then complete a 2 year fellowship in female pelvic reconstructive surgery.
Via either route, urogyn training takes 7+ years
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When the vaccine came out, my husband (who was researching head and neck cancers at the time), was the world’s greatest proselytizer for the vaccine and made sure everyone knew that boys should get it as well as girls. (Which required a bit of discussion with their pediatrician, though I believe the guidelines were changed.)
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I did notice that her website does reflect that she doesn’t do routine gynecology. It does say she treats menopause symptoms and hormones. I’m more interested in learning more about her options for my urology needs.
I recently had some symptoms that required a uterine biopsy. The PA that was available knew nothing about another condition I have and was not a believer of women in their 60’s taking hormones. They made me an appointment with a gynecologist to discuss my issues later this summer.
I hate that I have to find a new provider. I also find I’m having to use a large healthcare system. Many of the doctors in private practice have gone concierge.
Private practice is a dying breed. Venture capital is buying up private practices left, right and in between.
New physicians basically have 2 choices: W-4 salaried employee of a large healthcare organization or concierge medicine.
(However, it’s impossible to start out as a new, fresh-out-of-residency doctor doing concierge. You first need to develop a core of patients who are willing to pay the monthly or yearly fee for concierge service. And concierge physicians generally don’t have hospital admitting privileges so their patients get handed off to physicians who do if the patient develops a serious illness that requires hospitalization or in-patient surgery.)
This is a bit off topic for this discussion. I know of a solo practitioner who is in the process of selling his practice to the hospital after 30 years.
Covid shutdowns caused a lot of debt, lower payouts, never recovered despite being very busy. It’s a complicated situation, some of which was compounded by not being able to ever find an associate who wanted to be a partner.
I think it’s going to be a good thing. Debt is being paid, he’s going to sign a contract and going to get more vacation. When you are a solo practitioner, the practice doesn’t make money when you are gone. Yes you have NPs or PAs but you are the engine that drives the business
New physicians don’t want the hassle, they want to be an employee. Who can sign a 3 year contract and renegotiate or move to greener pastures. Lots of vacation and benefits. It’s also hard when you practice in a small rural area, your wife works or doesn’t want to live in the rural Midwest.
Solo practitioner is going to work 3 more years, retire. It’s the hospitals job to find his replacement.
Sorry, I know this is off topic.
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And regional/city based healthcare (health care systems) are not regional or city based anymore. Which CAN relate to women’s health and can be positive or negative. You can be with one health system and not be limited to traveling to that main hospital for care - they may have an entire branch - not just an office in your area.
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