#177 – Urology for Women – Dr. Lamia Gabal

#177 – Urology for Women – Dr. Lamia Gabal

Listen to “177: Urology for Women – Dr. Lamia Gabal”

Urology for Women 

Dr Lamia Gabal is a Urologist with a sub-specialty in Female Pelvic Medicine and Reconstructive Surgery. She talks about all kinds of concerns women bring to a Urologist, information about the treatment options, and how to go about it.  

Sexual issues that bring women to urologists 

Women come to urologists for various kinds of sexual concerns. While traditionally urologists were thought to be “Male gynecologists”, Dr Lamia says urologists deal with much more than that. Women come with issues of Urinary Incontinence, Urinary Tract Infection, orgasmic dysfunction, female sexual dysfunction, libido issues, and more. Many women who come with these concerns back away from having sex with their partners because of the embarrassment they feel around it. Sometimes fixing their medical problems also helps them with their sex lives. While male concerns around this subject are already well understood and treated, female sexual dysfunction has only received a “trash can diagnosis”, says Dr Lamia. There are several types of female sexual dysfunctions and each needs to be treated accordingly. 

Urologists also deal with hormonal changes and core dysfunction. Thinning of vaginal tissue as women age can also lead to sexual dysfunction. Pelvic organs prolapse after childbirth can also lead to sexual dysfunction and can be painful. 

Medical concerns that drive women away from having sex 

There’s an overlap of urologists and gynecologists in the sub-specialty of female pelvic medicine and reconstructive surgery, with each performing their roles. However, not all urologists or gynecologists specialize in the field Dr Lamia does. She categorizes the kinds of concerns patients come in by their age. While most of her patients are post-childbirth age, she also treats young women who come in with issues of painful sex which could be pelvic floor dysfunction or dyspareunia and is usually associated with sexual trauma or PTSD. Women who are of child-bearing age often come in with recurring Urinary Tract infections. Women who are getting older and are past having kids struggle with pelvic organ prolapse, urinary incontinence, and fecal incontinence. All the concerns Dr Lamia mentioned can drive women away from having sex or from having a satisfying sex life. 

According to Dr Lamia’s advice, women who experience Urinary Tract Infections that have constipation, pelvic prolapse, and vaginal atrophy (thinning of vaginal tissues) should consult a urologist.  

Where does sex intersect in terms of conversations with patients?  

As a doctor, there’s no training you get in medical school that prepares you to have these conversations about sex with your patients. It’s often one’s interest to seek out more information and awareness that leads to these conversations with patients. Dr Lamia says it’s important to talk about sex with their patients to provide better health care, it aids in understanding how it affects their body and to make important decisions. However, most doctors don’t have these conversations for reasons of not having enough time or not being comfortable enough. Sometimes because of the assumption that an older patient might not be sexually active, which should not be done. 

Pelvic Organ Prolapse – treatment options 

Pelvic Organ Prolapse commonly occurs after childbirth and is more common with vaginal deliveries. All of these factors put pressure on organs making them lean into the vaginal wall. It increases the risk of urinary incontinence, fecal incontinence, and UTIs, and the most severe case can cause kidney dysfunction. It can be treated by “Pessary” which delays or prevents the need for surgery. Surgeries like cystocele repair, rectocele repair, and slings for incontinence are also an option, but patients can expect them to be redone after 15-20 years. It can impede sexual intercourse when the patient is constipated or something else. The surgery fixes vaginal laxity caused by this which can benefit sexual intercourse for both partners. 

Treatment options for Urinary Tract Infections 

To treat Urinary Tract Infection, all the other causes of the infection has to be ruled out through either a physical exam, an ultrasound of the kidneys, or a cystoscopy. Dr Gabal explains some treatments that could help such as maintaining good sexual hygiene, treating constipation, emptying bowels regularly, consuming fiber and a lot of water, peeing before and after sex, using plenty of lubrication that isn’t “warmed or flavored” can help to reduce the infection. Using antibiotics after intercourse and using probiotics to normalize vaginal bacteria can also help. She suggests supplements like cranberry and D-mannose prevent certain types of UTIs. 

Conditions That Can Cause Sexual Pain  

Dr Lamia talks about pelvic floor dysfunction as the most common cause of dyspareunia or painful sex. It causes mild pelvic floor muscle spasm to vaginismus where the vagina doesn’t open and causes pain. To treat this, she suggests soaking in a tub, putting heat on the area, or taking muscle relaxant drugs prescribed by the doctor. Pelvic floor physical therapy is the most effective of all and is done by specially trained pelvic floor physical therapists. Post-menopausal vaginal atrophy could also be the cause. She talks about birth control as an understated cause that causes thinning of vaginal tissue and a change in PH levels causing painful sex. She recommends putting topical testosterone mixed with estrogen to treat it. 

Biography 

Dr Lamia Gabal, MD, FPMRS, is a board-certified physician who specializes in several areas of medicine, including urology and restorative surgeries. Dr Gabal has more than 20 years of experience in the field of general medicine and urology. The doctor and her staff take great pride in offering many of the newest, cutting-edge treatment options and strive to continually provide the latest in technological advancements. 

She graduated from the University of California at San Diego Medical School in 1995 and performed two separate residencies at the UCSD Medical Center. She was the recipient of the “Patient’s Choice Award” from 2011 to 2013. Currently, Dr Gabal serves residents of Southern California at Prestige Medical Group in Santa Ana, CA. 

Resources and Links:  

Website: https://www.drgabal.com/ 

Services: https://www.drgabal.com/services/ 

More info and resources:
 
How Big a Problem is Your Sex Life? Quiz – https://www.sexlifequiz.com
Access the Free webinar: How to make sex easy and fun for both of you: https://intimacywithease.com/masterclass
Secret Podcast for the Higher Desire Partner: https://www.intimacywithease.com/hdppodcast
Secret Podcast for the Lower Desire Partner: https://www.intimacywithease.com/ldppodcast
#138 – [Personal Story] Pelvic Organ Prolapse – Erin

#138 – [Personal Story] Pelvic Organ Prolapse – Erin

Listen to “138: [Personal Story] Pelvic Organ Prolapse – Erin”

Personal Story: Erin Underwood 

Once a casualty of prolapse, Erin is completely asymptomatic today. Having encountered this long before support groups and information was easily available, Erin was forced to learn how to help herself.  After the birth of her fourth child, her body had surrendered. 

Symptoms
In addition to incontinence, Erin explains the symptoms of prolapse as the feeling of a tampon falling out or sitting on a tennis ball. After being advised to live with her condition, Erin did some searching of her own. 

Working Solutions
Her search led her to a biomechanist, marking the beginning of her recovery. One of the methods she discovered was the belly release. She notes the role of the ribcage and how important it is to select non-underwire bras to allow movement in the ribcage. Erin credits a book by Katy Bowman (available on Amazon). 

Erin advocates walking and tackles the superficial elements of kegels, explaining how critical control is for this exercise. With unnecessary shame around pelvic floor prolapse, Erin encourages women to take look at recovery as very achievable.  

Background
Erin Underwood is a functional movement therapist from Oregon that specializes in prenatal and postnatal health. She is passionate about education around pelvic floor and core strength and function.  

She has studied biomechanics extensively and in addition to her in-depth yoga training has continued her education by certifying and training with the top minds in the country connected to pelvic floor and core wellness.  

She currently is focusing on her local community by serving through workshops to the prenatal and postnatal community as well as local health care providers, providing them with the most up to date science broken down into practical and helpful tools.  

Erin has four beautiful boys and, post deliveries has personally healed from a grade 2 uterine and grade 2 rectocele prolapses and a four-finger Diastasis Recti using all the tools she teaches in her movement therapy, which further fuels her passion for seeing women fully functional and getting all the information necessary to heal. 

Resources and Links 

Website: https://www.erinunderwoodmovement.com/ 

https://www.facebook.com/erinunderwoodmovement/ 

https://www.instagram.com/erinunderwoodmovement/ 

Book by Katy Bowman: https://www.amazon.com/gp/product/B01A00CZIE/ref=dbs_a_def_rwt_hsch_vapi_tkin_p1_i1 

More info and resources:
 
How Big a Problem is Your Sex Life? Quiz – https://www.sexlifequiz.com
Access the Free webinar: How to make sex easy and fun for both of you: https://intimacywithease.com/masterclass
Secret Podcast for the Higher Desire Partner: https://www.intimacywithease.com/hdppodcast
Secret Podcast for the Lower Desire Partner: https://www.intimacywithease.com/ldppodcast
#95 – Sherrie Palm – Pelvic Organ Prolapse

#95 – Sherrie Palm – Pelvic Organ Prolapse

Listen to “95: Sherrie Palm – Pelvic Organ Prolapse”

Pelvic Organ Prolapse 

My guest is Sherrie Palm, who is the founder and CEO of the Association for Pelvic Organ Prolapse Support. In addition, Sherrie wrote a great book called Pelvic Organ Prolapse: The Silent Epidemic that delves deeper into the subject of this episode: Pelvic Organ Prolapse or POP for short. 

Driven by Sherrie’s expertise and research on the subject, this talk demystifies the condition and shines a light on treatment options, causes, challenges, and ultimately the ways to manage the condition and live freely with it. Such an important episode that I am glad I have the opportunity to share with you. Enjoy! 

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