We all know we need a primary care provider for annual wellness exams; likewise, we know the benefit of seeing our OB/GYN or Midwife on a regular basis to talk about breast, vulvar, vaginal health, cervical screenings and family planning. However, comprehensive women’s healthcare should address so many more areas! One often overlooked area of healthcare is urogynecology.
A urogynecologist is a doctor who completes their medical study and a residency in obstetrics and gynecology or urology. They also have extra training in female issues related to your bladder and pelvic floor, specializing in female anatomy.
Ascension has two urogynecologists who practice in both the Milwaukee and Racine area, Nicolette Deveneau, MD and Dennis Miller, MD.
These physicians provide compassionate care to help women achieve their full potential and an improved quality of life. They are also passionate about addressing concerns that may feel embarrassing to discuss (eek! – leaky bladder, painful intercourse, etc.). They are skilled at creating a safe space for conversation, empowerment and personalized care.
Let’s review a few questions with Drs. Deveneau and Miller to better understand when it may be time to seek the support of this type of specialist.
Urogynecology Care at Ascension Wisconsin
What are some signs of sexual health issues that can be addressed by a urogynecologist?
Dr. Deveneau: “This is a great question. I love to help women feel comfortable asking these types of questions in my office. It is important to me that women feel safe to talk about issues that concern their well being. Women come to me with concerns of uncomfortable or unsatisfying intercourse. While many things can contribute to uncomfortable intercourse, something we often see is the vaginal and pelvic floor muscles are too tight. In the case of muscle tightness, we could discuss pelvic floor muscle relaxation, which can be achieved through a number of therapies. One example involves inserting Valium into the vagina to relax the muscle walls. Another option may include working in close partnership with one of our pelvic floor physical therapists, who has special training and experience in releasing tension in the pelvic muscles. Other sexual concerns may include vaginal pain, pelvic floor pain, dryness, lack of sexual desire, vulvar discomfort and intercourse without orgasm. Some suggestions I may offer include different types of lubricants, vaginal estrogen creams, and various tools, such as phone apps which can really offer great resources to help empower a woman with her sexuality.”
We have a question from a woman asking: “By the end of the day my underwear is damp, I know my bladder is leaking…I have had two kids, I am in my late 30’s…not sure if we are done having kids. Do I have any options? Also, I am scared that fixing my bladder leaks will put me out for days and I am concerned about the mesh, but I don’t know much about it.”
Dr. Devenueau: “For starters there are two types of urine leakage that we see most commonly. The first is stress leakage which may be triggered from physical activity or a strong cough or sneeze. The second is an overactive bladder, which I describe as a miscommunication of brain and bladder causing urinary frequency and urgency, and subsequently urine leakage.
For both types, options may include medicine and/or pelvic floor therapy, and in some cases surgery. My goal is always to provide personalized care to each patient I see.
A sling is a piece of material, sometimes mesh, that is placed beneath the urethra to support and compress the urethra during activity. Mesh has gotten a really bad reputation. A lot of research has been done on the mesh sling showing its effectiveness and safety. It is a highly successful treatment. Let’s not forget there are non-mesh options, too.”
Urogynecologists provide surgery, too. What are the most common issues addressed with minimally invasive surgery?
Dr. Miller: “There are two main conditions for which minimally invasive surgery may be an option:
- Stress urinary incontinence can be treated with a short outpatient procedure. One of the remedies is a sling. In my practice I have seen excellent results. The recovery time is short. This means women can get back to the things they love without fear of leaking.
- Pelvic organ prolapse (sometimes referred to as dropped bladder) can be treated with pelvic reconstructive surgery or prolapse repair. This is done at the hospital and does not involve an abdominal incision; it is done through the vagina.”
I understand bladder Botox is important to urogynecology care, can you describe what that means and how that is significant?
Dr. Miller: “Many women are impacted by feelings of urgency and the inability to get to the bathroom without leaking. They are also often bothered by needing to get to the bathroom throughout the night. While meds are helpful for some women, Botox is an exciting option for other women. The injection takes minutes, occurs in the office and does not require sedation. The effect can last between 6-9 months before another injection is needed. The best treatment for a woman’s incontinence starts with a visit to a UroGyn office. I want to emphasize evaluation — discomfort does not need to be part of aging. As physicians, we will offer options and our patients are involved in the decision making process.”
So there you have it — from sexual health to leaking bladder, frequent or urgent peeing, vaginal bulging to pelvic pain — the UroGyn providers at Ascension are here for you.
Meet the Providers
- Dr. Nicolette Deveneau: “Pelvic floor disorders can dramatically affect awomen’s quality of life but can be difficult for women to talk about. I strive to provide patients with compassionate care and a comfortable environment to discuss their problems and develop a care plan that is tailored to their specific needs.” Dr. Deveneau is board certified and a Fellow in the American College of Obstetricians and Gynecologists. Her professional memberships include the American Urogynecologic Society, the Society of Gynecologic Surgeons, and AAGL minimally invasive surgical society. Her patient-focus care includes urinary and fecal incontinence, overactive bladder, prolapse, vaginal and bladder pain, vaginal reconstruction, and minimally invasive surgery.
- Dr. Dennis Miller: Dennis Miller, MD, is a urogynecologic physician with Ascension Medical Group. Dr. Miller is board-certified in urogynecology and obstetrics & gynecology. He provides personalized and empathetic care to women in every stage of their life. He uses state-of-the-art minimally invasive vaginal surgical approaches. He practices based on the most up-to-date knowledge and treatment options, including simple office-based treatments like botox.