Urogynecologist

What is a urogynecologist?

A urogynecologist is a doctor who specializes in pelvic floor disorders in women or people assigned female at birth (AFAB). Your pelvic floor consists of muscles and connective tissues that support the organs in your reproductive system, including your uterus and vagina. These muscles also support organs in your urinary system, like your bladder.

Weakened or injured pelvic floor muscles can cause problems with how these organs (and these systems) work. When this happens, it’s a good idea to see a urogynecologist.

What is the difference between a urologist, a gynecologist and a urogynecologist?

Like the name suggests, a “uro-gynecologist” diagnoses and treats conditions that overlap with those that urologists and gynecologists treat. Depending on your condition, these providers may work together to treat you:

• Urologists diagnose and treat conditions affecting your urinary system, which includes your bladder, kidneys, ureters and urethra. They treat urinary conditions in people regardless of sex. They also diagnose and treat conditions affecting the male reproductive system.
• Gynecologists diagnose and treat conditions affecting the female reproductive system. They also monitor breast health. They may diagnose and treat some conditions involving your urinary system.
• Urogynecologists specialize in diagnosing and treating conditions that arise from an injured or weak pelvic floor called pelvic floor disorders. Like a gynecologist, they treat pelvic floor disorders affecting the female reproductive system. Like a urologist, they may also treat problems affecting your bladder or urethra.

While urology and gynecology are specialties that have been around for years, urogynecology wasn’t officially recognized as a specialty area until 2011. Doctors started receiving certifications in urogynecology (officially “female pelvic medicine and reconstructive surgery”) in 2013.

What are the educational requirements to become a urogynecologist?

After medical school, urogynecologists-in-training complete a residency in either gynecology or urology. Some programs allow residents to receive training in both. Afterward, they complete a fellowship in Female Pelvic Medicine and Reconstructive Surgery (FPMRS).

After the fellowship, urogynecologists must pass an exam to become board-certified.

Becoming a urogynecologist can take up to seven additional years after graduating from medical school.

What does a urogynecologist do?

Urogynecologists diagnose and treat pelvic floor disorders. While pelvic floor disorders can affect anyone regardless of sex, most of the conditions urogynecologists treat reflect the unique experiences of women or people AFAB. For example, pregnancy, vaginal deliveries and menopause are all risk factors for developing a pelvic floor disorder.

Some of the common pelvic floor disorders urogynecologists treat include:

• Urinary incontinence: Urogynecologists treat bladder control issues, including stress incontinence (leakage with cough, sneeze or other activities), urge incontinence (leakage with the urge to pee) and overactive bladder (having to pee frequently or urgently).
• Pelvic organ prolapse (POP): With POP, one or more organs in your pelvis slip out of place because there’s not enough pelvic floor support. Organs that can slip include your bladder, uterus, rectum and vagina. POP can be related to bladder problems.
• Fecal (bowel) incontinence: Weakened pelvic floor muscles can cause fecal incontinence, or “bowel leakage,” when you can’t prevent stool (poop) from leaking.
• Pelvic floor dysfunction: This condition involves not being able to coordinate the pelvic floor muscles that control when you pee and poop. It can lead to trouble peeing or having bowel movements. It can also cause vaginal pain and pain with intercourse.
• Vaginal fistulas: With this condition, a passageway forms from an injury or certain medical conditions, allowing pee or stool to leak into your vagina.

To treat pelvic floor conditions, urogynecologists:

• Prescribe medications. These include medicines that help you control your bladder and keep your bowel movements regular.
• Fit you for devices. For example, you may need a vaginal pessary if you have POP. A pessary is a silicone, rubber or plastic device that goes inside your vagina and holds your pelvic organs in place.
• Perform surgeries. Surgeries include reconstructive surgery to place your pelvic organs back in their normal locations. Surgery can also help with bladder control problems. These surgeries may use your own tissue and ligaments or may involve inserting supportive materials (like mesh) that reinforce weakened or damaged pelvic floor muscles.
• Teach pelvic floor strengthening exercises. A urogynecologist can teach you to perform Kegel exercises correctly. Kegels strengthen your pelvic floor muscles. They may work with a physical therapist as well using a technique called biofeedback. Biofeedback trains you to become more mindful of when your pelvic floor muscles squeeze and relax. With this awareness, you can take more control over these actions (and muscles) that control peeing and bowel movements.
• Recommend helpful lifestyle changes. They can work with you to identify parts of your routine that may be contributing to symptoms and recommend changes that can help. This may include changing what you regularly eat and drink, incorporating relaxation techniques into your schedule or timing bathroom breaks to stretch out how long you can “hold it.”

Why would I need to see a urogynecologist?

You may want to see a urogynecologist if:

• You’re dribbling or leaking pee or stool.
• You find you need to pee more often.
• You’re having trouble making it to the bathroom in time.
• You feel fullness or pressure in your vagina or pelvis.
• You have a sensation (or have felt) that something is falling out of your vagina.

Seeing a urogynecologist is a good idea if you’d feel comfortable in a more gender-exclusive space. Incontinence issues and POP are private matters for most people. It can feel comforting to see a provider who exclusively treats people with anatomy like yours and understands your conditions. It can make the waiting room experience feel less intimidating — regardless of the reason you’ve scheduled the appointment.

What happens at your first visit with a urogynecologist?

Your experience depends on the reason for your visit. In most cases:

• You’ll review your medical history with the urogynecologist.
• They’ll ask about your symptoms, including when they started, how long they last and how they affect your life.
• They’ll perform a physical exam that’s similar to a pelvic exam. They’ll need to take a closer look at the organs and tissue in your pelvic floor.

Based on their findings, they’ll recommend treatments or additional tests needed for a diagnosis.

What questions should I ask my urogynecologist?

Questions to ask include:

• What likely caused my pelvic floor issues?
• How severe is the damage to my pelvic floor?
• What treatments would you recommend?
• How much pelvic floor strength will I regain after treatment?
• What changes can I make to my routine to preserve my pelvic floor function?

A note from Cleveland Clinic

It’s easy to take the muscle control that enables basic bodily functions like peeing and pooping for granted — until there’s an issue. It can be alarming and embarrassing to dribble pee when you weren’t before or to feel unfamiliar fullness in your vagina.

Urogynecologists understand the concern. They’re experts at pinpointing the problem in your pelvic floor and identifying the best treatments that can help you. They’ve likely worked with people with experiences very similar to yours. If you’re having issues, you can ask your primary care doctor for a referral to a urogynecologist, or you can schedule an appointment yourself.