Written by: Kristýna Volfová
Women's intimate health is often surrounded by myths and shame, but it is still extremely important to talk about it. Urogynecology, a specialized field on the border between gynecology and urology, focuses on problems that can significantly affect the quality of life. From postpartum injuries, through incontinence to the descent of the pelvic organs. We talked with Dr Erika Francová, urogynecologist and expert consultant at Whoop·de·doo.
Would you please introduce the field of urogynecology to our readers? How did you get into it?
Urogynecology, a specialized field that focuses on the diagnosis, treatment and prevention of pelvic floor disorders in women. It combines aspects of urology and gynecology and deals primarily with problems that affect the function of the bladder, genitals and rectum. In addition to the treatment itself, this field also strives to improve the quality of life of patients.
I got into this field already at university thanks to my participation in several studies, which motivated me to further develop. Even though I then joined another hospital, I continued to draw valuable experience and knowledge from previous projects and cooperated with experts in the field. This combination then led me to a deeper specialization and interest in this field.
What problems do women most often come to you with?
Most often women come to us with spontaneous leakage of urine, descent of the pelvic organs, frequent urinary tract infections or pelvic pain. We also care for patients with extensive birth injuries, including rectal injuries.
Are there any bad habits that women may unknowingly be doing to worsen their intimate health?
I commonly see women who have been incontinent for several years. They are afraid or ashamed to go to their doctor. They solve it with pads, which are not a cheap thing, they limit their drinking regime, they are ashamed to go out in society.
How well informed are Czech women about intimate health and the menstrual cycle? Are you seeing growing interest among your patients?
The degree of education of Czech women in the field of intimate health has been increasing in recent years, but there are still certain gaps in awareness and openness to certain topics. Spontaneous leakage of urine or descent of the pelvic organs is still considered by some women as a huge taboo and something that belongs to aging and can no longer be dealt with. While some women have a good understanding of the prevention and treatment of common gynaecological problems, there are still many women who do not know, for example, why they should go for regular gynaecological examinations.
Many women worry about the effect of pregnancy and childbirth on their bodies, including birth injuries. Is there anything they can do to prevent these problems?
There are several preventive measures that can reduce the risk of birth injury and promote a healthy course of pregnancy and childbirth.
It is very important to follow regular check-ups with your gynaecologist, who monitors the progress of your pregnancy and can detect early any problems that could affect the birth.
Strengthening the muscles of the pelvic floor can help improve their flexibility and strength. Prenatal massages of the perineum can improve the elasticity of the skin and tissues in the area and reduce the risk of injury. Massages are recommended a few weeks before the planned date of birth. Also, attending antenatal classes or consulting with a physiotherapist specializing in pregnancy and childbirth can help women better prepare for childbirth, learn proper breathing or relaxation techniques. A balanced diet and sufficient fluid intake are also important. A correctly chosen birth position can also reduce the risk of injury.
What actually happens to the pelvic floor area during pregnancy and birth?
The pelvic floor undergoes significant changes during pregnancy. As the uterus grows, the weight of the fetus increases, causing the body's center of gravity to shift forward. This leads to a necessary adjustment in posture to keep the woman in balance. The spine curves backwards (a so-called lumbar hyperlordosis is created), which can lead to lower back pain. As the center of gravity changes, the woman can also adjust the way she walks. We often encounter the so-called "swing step", where the width of the foot increases to increase stability. This altered posture puts more pressure on the pelvic floor, which can make it harder for it to effectively contract and support the internal organs. This increased pressure can overload some muscles of the pelvic floor and thereby further weaken their function.
Under the influence of hormones, especially relaxin, ligaments and joints loosen. It is a physiological preparation of the pelvic floor for childbirth, but at the same time it can negatively affect stability and coordination.
During childbirth there is a significant stretching and relaxation of the muscles pelvic floor area. The placenta, passing through the birth canal, exerts extreme pressure on the pelvic floor. These mechanisms can lead to damage to the muscles or nerves of the pelvic floor, which can be permanent. The consequences of these damages can be different - leakage of urine or faeces, painful sexual intercourse, pain in the lower abdomen or in the hips, descent of the pelvic organs - typically a woman feels a "bump" on the external genitalia, which does not hurt, but can be a problem, for example, during sports.
What would you recommend to women for faster recovery after childbirth?
I don't think we can speed up the regeneration. Each of us heals at a different speed, and we should definitely not rush this.
How can Venus balls help after childbirth?
Venus balls they have a significant effect on strengthening the muscles of the pelvic floor. I see very good results from patients who used Venus balls simultaneously with pelvic floor exercises.
It is advisable to start with balls after childbirth, best after an examination with your gynaecologist after six months. The balls should then be used at least three times a week. The use of Venus balls is also suitable for women after caesarean section. We also recommend it for light urinary incontinence.
Strengthening of the pelvic floor muscles after childbirth and the associated strengthening of the back and abdominal muscles has a very positive effect on the woman after childbirth. It relieves back pain, strengthens the abdominal wall, helps with diastasis, can help with light leakage of urine and certainly has a very positive effect on a woman's sex life.
Are there any cases when a woman should first consult a doctor about using Venus balls?
There are groups of women to whom I recommend pelvic floor physiotherapy after childbirth. These are women with severe birth injuries, including rectal injuries. Women who gave birth vaginally after a previous caesarean section. Women who have had a forceps delivery or those who have given birth to a baby with a birth weight of over 4000g.
Can the perception of sex change after childbirth?
Sexual life after childbirth is taboo for many women. A woman's body can change significantly after giving birth, and not every woman feels good about her body after giving birth, whether it's possible extra pounds, stretch marks, mood swings, pain or fatigue. So when to resume your sex life after giving birth? Doctors recommend waiting for the period after six months. However, it depends a lot on how the woman herself feels. Pain during intercourse may be caused by vaginal thinning or pelvic floor dysfunction.
Is there any way to work with it?
Longer foreplay is recommended, suitable lubricant, try more positions that will be more comfortable. If the pain persists, it is advisable to visit a gynaecologist, who will rule out more serious causes of pain, possibly will recommend specialized pelvic floor rehabilitation.
Another important milestone in a woman's life is menopause. What advice would you give women at this stage of life to feel their best?
I would recommend regular activity (e.g. regular longer walks, swimming, hiking, cross-country skiing, cycling), for example yoga or pilates, regular sleep, balanced diet are also great. It is certainly advisable to limit alcohol and smoking. Hormonal therapy can also be used, which can be recommended by the registering gynaecologist.
During the menopause, women often struggle with incontinence. It can also occur after childbirth. Are there any differences in the causes and treatment of incontinence in younger and older women?
If a woman would still like to have another child, then the treatment will be more conservative. We also know that targeted pelvic floor rehabilitation is very effective in younger women. Otherwise, the therapy is the same.
What remains taboo in your field, despite deserving more attention?
Urinary incontinence is still considered a taboo for some women. But I think that we are also trying to raise awareness within the Urogynecology Society so that women no longer consider it taboo.