Ask the experts

How can I help my Pelvic Organ Prolapse?

Pelvic organ prolapse (POP) occurs when the pelvic floor muscles and ligaments that hold a woman’s pelvic organs in place become weak. The organs – including the bladder, uterus and rectum – can drop. For women, this can cause an uncomfortable bulge in the vagina that sometimes can be felt or seen.

Other symptoms of POP include:

  • A feeling of pressure, discomfort, aching or fullness in the pelvis
  • Pelvic pressure that gets worse when you stand or cough or as the day goes on
  • Leaking urine (incontinence) or problems passing urine or having a bowel movement
  • Problems putting in tampons
  • Feeling uncomfortable pressure during physical activity or sex

Some women’s symptoms are worse at certain times of the day, during physical activity or after standing for a long time. The symptoms of POP can get worse over time. The sooner a woman seeks treatment, the sooner she can feel better and improve her quality of life.

But many women are embarrassed or uncomfortable talking about their POP symptoms with their doctor. They may assume the symptoms are a normal part of aging, along with menopause. Often women begin to have symptoms at an age when they are busy taking care of children, their spouse and/or elderly parents. This leads them to ignore the symptoms until they get worse.

Many treatments are available for POP. Kegel exercises may help prevent progression of POP. A pelvic floor physical therapist can help teach you how to use and strengthen the correct pelvic floor muscles. If Kegels aren’t enough, the doctor can insert a silicone device called a pessary into the vagina. The pessary holds the pelvic organs in place. If other treatments do not work, surgery may be a good option. Talk to your doctor to find the best solution for you.

Dr. Ekene Enemchukwu, a urologist at Stanford University Medical Center, specializes in the management of male and female pelvic floor conditions, voiding dysfunction, refractory overactive bladder, urinary incontinence and addressing health inequities in pelvic floor disorders.

Why is the outlook different for men and women with bladder cancer?

In 2022, about 61,700 men and 19,480 women were told they had bladder cancer in the U.S. Smoking is the biggest risk factor for bladder cancer in men and women.

Men are more likely to get bladder cancer. But women with the disease usually have a worse outcome. There are many reasons for this, but one possibility is women are usually not diagnosed until after the cancer has gotten worse. The number one symptom of bladder cancer is blood in the urine, but this is also a main symptom of a urinary tract infection (UTI), which is also very common in women. This may lead women to ignore blood in the urine and not think bladder cancer could be the cause. Also, women may think the blood is caused by their period or another female issue.

If blood in the urine is ignored too long, bladder cancer may be found at a later stage, when it has started to grow and spread. Blood in the urine that’s linked to bladder cancer may be pinkish, bright red or the color of tea. It may be found consistently, or it may come and go. It could be painless. In some cases, patients may have burning when they pass urine or increased frequency or urgency to pass urine.

Sometimes when blood in the urine is thought to be a UTI, a women would be prescribed antibiotics before a urine culture is done. This can delay the referral to a urologist. Men with blood in their urine are more likely to be quickly referred to a urologist. If you take antibiotics for blood in your urine and symptoms don’t go away after you are done taking the medicine, follow up to find out whether you need testing for bladder cancer.

Dr. Sima Porten, a urologist at University of California, specializes in bladder cancer and upper tract urothelial cancer.

Gender Affirmation and Ways to Help a Family Member or Friend Transitioning to a Different Gender

Gender identity is the personal sense of one’s own gender, whether that is male, female, neither or a blend of both. Gender expression (how one expresses themselves) may take the form of vocal patterns, body shape and style of dress.

Transition is the process a person goes through as they begin to live and express their gender. Gender affirmation refers to the social, legal and medical steps a gender-diverse person takes to express their gender. Gender affirmation is unique to each person and varies between people who use the same words to describe their gender.

Gender affirmation may involve a person:

• changing their name and the pronouns they use,

• changing the way in which they dress,

• changing legal records to reflect their gender identity,

• getting medical care to help their body better reflect their gender identity.

Gender-affirming health care involves any medical, mental health care and/or self-care that helps a person express their gender identity. Based on a person’s sense of their own gender and how they would like to express that gender, this may include hormone treatment and/or surgical treatment.

Some adults may choose to do some, all or none of these things. The process of gender affirmation is typically personalized to fit the person’s identity. For most people, GAS occurs after gender affirming hormone care, pre-operative counseling and psychotherapy. There are many types of GAS, sometimes known as either “top surgery” or “bottom surgery.” People are unique, so remember that when supporting a family member or friend who is in the process of transitioning.

It is of great value for a person transitioning to talk with a counselor who is trained in gender affirmation and gender dysphoria (negative feelings linked to experiences a person lives through or body parts that conflict with their gender identity). Medical and mental health experts can give more details about gender diversity, gender affirmation and GAS.

Being transgender is not a phase and trying to dismiss it as such can be harmful during a time when your family member or friend needs support. Trying to change a person’s gender identity – either by denial, punishment, reparative therapy or any other tactic – is not helpful and can negatively affect a person’s mental health.

Here are some ways you can help a family member or friend who is transitioning:

  • Listen to them
  • Ask questions
  • Educate yourself
  • Accompany them to doctor’s appointments
  • Seek out your own support if needed
  • Call them by their preferred pronouns/name
  • Know that you will make mistakes and that is ok. Apologize and continue to give support

Learn more about adult sexuality and gender diversity, sexual orientation, gender dysphoria and medical choices for gender diverse adults with these adult gender health resources.

Dr. Ali A. Dabaja is the Vice-Chair of Clinical Affairs, Director of Male Reproductive & Sexual Medicine and Associate Director of Urology Residency at the Vattikuti Urology Institute at Henry Ford Hospital. He is also the Clinical Associate Professor at the Wayne State School of Medicine. His clinical focus includes male infertility and sexual medicine.  |  WINTER 2022-2023  |  UROLOGYHEALTH extra