Female Pelvic Health: What’s Going on Down There?

This is an article on female pelvic health written by Dr. Karyn Eilber, Dr. Jennifer Anger, and Dr. Victoria Scott, the authors of the book – A Woman’s Guide to Her Pelvic Floor: What the F*@# Is Going On Down There?

There’s no standard information relayed to young women in regard to sexual activity or birth control options. In middle school or high school, some young women receive health or sex education class that provides a very cursory introduction to birth control and other basic sexual health issues.

However, the main message is that sex is only associated with disease and pregnancy—that’s it. Women are not taught that intimacy can be pleasurable, or about sexual satisfaction and masturbation. If a young woman engages in discussion about these topics in front of the wrong crowd, she might be branded as promiscuous or a modern-day Hester-Prynn-esq sexual deviant.

Addressing Post-Childbirth and Menopausal Concerns

There are a plethora of books and websites dedicated to pregnancy and childbirth, helping women and families through an understandably uncertain time. But what’s next? Women don’t have nearly enough access to accurate and concise information on what to expect in the years following childbirth, to menopause and after. Important questions such as:

Do I look normal down there?
Why is everything so different down there after childbirth?
What happened to my sex drive? And, how can I get it back?
I’m having pelvic pain and I feel like I need to pee all the time.
Basically, what the f*#k is going on down there?

Empowering Women Through Knowledge

Society already makes women feel insecure with aging; they don’t need to feel insecure because of what happens down there too. As three Urogynecologists, we felt compelled to write a book for women, by women, that shines a spotlight on their pelvic floor [A Woman’s Guide to Her Pelvic Floor: What the F*@# is Going On Down There, 2023]. With knowledge comes power, and the main purpose of our book is to empower women.

Addressing Health Inequality

While educating women about their pelvic floor seems like a much-needed public service announcement, it’s necessary for one clear reason: health equality. The three of us trained as urologists before specializing in urogynecology (Urogynecologists specialize in treating the pelvic floor and bladder).

We observed firsthand that, while there are parallels between male and female pelvic health conditions, the commonality ends there. The attention paid to and treatment options available to men greatly exceed those for women. Male erectile dysfunction is a commonly discussed condition with multiple prescription medications that are typically covered by insurance. The media is flooded with stories about erectile dysfunction, so much so that we are taught “what to do about an erection that lasts more than 4 hours” before learning how to treat our own symptoms.

Female sexual dysfunction is not often discussed and the few medications that are available are often not covered by insurance. Lastly, there is no FDA approved form of testosterone (the hormone associated with libido) for women. Not surprisingly, this lack of medical inequality is also apparent when diagnosing and treating pelvic floor disorders.

Understanding Pelvic Floor Disorders

Up to one-third of women will experience a pelvic floor disorder. [Kenne] Yes, that’s a lot of women. (For comparison, 18% of men suffer from erectile dysfunction. [Selvin]. But what is a pelvic floor disorder?

Pelvic floor disorders include urinary incontinence (involuntary loss of urine), pelvic organ prolapse (“falling” pelvic organs such as bladder or uterus), and bowel dysfunction (difficulty with bowel movements and anal incontinence). Risk factors for pelvic floor disorders include vaginal birth, increasing age, menopause, prior pelvic surgery such as hysterectomy, obesity, smoking, and connective tissue disorders.

With so many women affected by pelvic floor disorders, most women aren’t aware that:

Vaginal childbirth is the main risk factor for urinary or anal incontinence and pelvic organ prolapse.
Their uterus has nothing to do with their hormones.
Loss of libido and painful sex can be easily treated!

This lack of information means that women who have these issues are often too embarrassed to ask for help, or if they want to get help, they don’t know where to go!

We’ve listened and treated women’s most intimate and often embarrassing issues: lack of desire, painful intercourse, dislike of the appearance of her genitals, or the surprisingly common peeing in your pants. All of these issues are incredibly common. However a recurring theme is that women have no idea how or why these things happened, or what to do about them.

Confronting Medical Gaslighting

In general, young girls and women are simply not prepared for the changes that occur to their pelvic floor when they transition through the different stages of their lives. Before the onset of puberty, most girls receive minimal information about what they can expect when they have their first menstrual cycle and what is a “normal” period.

So many young women have near debilitating pain with their menstrual cycles, and when they say something about period pain they’re told “just deal with it” or “ it’s just part of being a woman.” In addition, most of us go through life believing that bleeding monthly is necessary for our health, when in fact, it is optional! Yes. It. Is. OPTIONAL. Continuous birth control pills, as well as intrauterine devices with progesterone, are both effective birth control methods that are not only safe, but they drastically reduce and even stop menses.

Why are these messages not being shared with women? Medical gaslighting. This medical gaslighting is endemic in our society and sends the message that pain, and every other unpleasant female-specific experience, is normal for women and there is nothing to be done about it.

Addressing Chronic Conditions and Research Needs

In our practices, we have seen many women reporting chronic pelvic pain that was attributed to their bladder, but in reality the cause of the pain was endometriosis: a condition that can cause painful periods and chronic pelvic pain but is treatable often with something as simple as birth control pills. The average time it takes women with this painful, often debilitating, pelvic floor condition to receive a diagnosis is seven to ten years [Nnoaham]. That’s almost a decade of suffering.

Unfortunately, we also see many women with pelvic floor disorders that we can diagnose but don’t have effective treatment options to offer them. One of those disorders is interstitial cystitis (also known as IC or bladder pain syndrome), which is a chronic condition that causes bladder pain and pressure and affects up to eight million women in the US. Oh, and up to four million men [Berry, Konkle]. We still don’t understand the exact cause of the condition, so there’s not a consistently effective treatment option for patients. Seeing so many women with debilitating symptoms inspired us to engage in research to help understand IC. Based on our research and observing what non-prescription products our patients have used to deal with their disease, we helped develop the IC supplement (Femetry) to help women with IC deal with their pain.

Bridging the Gender Health Gap

Women’s pelvic health clearly needs more attention and research, as does all of women’s health. Women’s health has historically been underfunded, understudied and underrepresented. The number one killer of women is cardiovascular disease, and yet heart disease was thought to be predominantly a man’s disease until the last few decades [Mosca]. Women were left out of many important clinical trials until relatively recently.

It wasn’t until 1999 that the American Heart Association published the first women-specific clinical recommendations for prevention of cardiovascular disease, and 2004 when they published the first evidence-based guidelines for preventing cardiovascular disease in women (Mosca et al. 1999, Mosca et al 2004). With the White House Initiative on Women’s Health Research, there’s finally hope for improving health inequality. We hope that what we and our pelvic floor health colleagues do for women has already started to close the gender gap between men’s and women’s health. And in the meantime, if you are suffering from a pelvic floor issue, follow the same advice we tell our patients with an erection lasting over four hours: call your doctor.

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