Female Pelvic Medicine and Reconstructive Surgery

In the field of Obstetrics and Gynecology, there are currently 3 recognized, (board-certified), sub-specialties. These are: Maternal-Fetal Medicine, Reproductive Endocrinology and Infertility, and Gynecologic Oncology.  This year however, the American Board of Obstetrics and Gynecology (ABOG), together with the American Board of Urology (ABU) are recognizing through a board certification process those physicians who devote the majority of their practice to the treatment of women with pelvic disorders.

In the past, physicians have divided the female pelvis loosely into three areas. The front part with the bladder was the urologist’s territory, the middle with the vagina and uterus was for the gynecologist and the back was for the gastroenterologists and colo-rectal surgeons. Sometimes you would have a gynecologist who also treated urinary incontinence, or a urologist who treated pelvic organ prolapse (ie, fallen bladder) and we would call these hybrid doctors “Urogynecologists”.

Fortunately, there has been recognition that there is quite a bit of inter-relation between all of these organ systems, plus the muscles that support them, the nerves and blood vessels that supply them and most importantly, the patient who is attached to all of these and is having an issue with one or more. For example, I see patient’s who have to strain or push down on the vagina to have a bowel movement because there is a weakness in the wall between the rectum and the vagina. Or a patient who has frequent bladder infections due to incomplete emptying caused a fallen bladder. Or, a patient who has bowel and bladder issues due to neurologic condition such as MS, or a stroke.

So where does Female Pelvic Medicine and Reconstructive Surgery (FPM/RS) come in?  For some physicians, they have completed a residency in either obgyn or urology and then had training in a fellowship, most commonly urogynecology.  For others, like myself, I completed my obgyn residency back in 1997. The few urogynecology fellowships that were available were not, “approved” that is, recognized by the American Board of Medical Specialties. I spent as much of my residency as I could with the urologists at the hospital learning about treating incontinence and other urinary/bladder conditions in women, so off I went into private obgyn practice. I was very fortunate to spend the next 13 years working with Dr. J. David Wollenman who was a great friend and mentor to me until his passing in 2011. He and I both shared an interest in treating female incontinence, pelvic organ prolapse and other conditions like Interstitial Cystitis. And over the years, we were able to grow our practice and spend more time helping patients with those issues. In 2011, I was again blessed to merge my practice with MacArthur OB/GYN and work with an equally stellar group of physicians and nurses who have supported me and encouraged me to continue my focus on treating women with pelvic disorders.

In September of 2012, ABOG and AUA announced that the first subspecialty exam in FPM/RS would be offered in June of 2013. There would initially be two categories, FPM/RS and FPM/RS-Senior. The first category would be for those who entered their fellowship program within the last 3 years. The latter category would be for those who completed their fellowship, or on the basis of their clinical experience and dedication of the majority of their practice to the field of FPM/RS, i.e., what I have been able to do over the last 15 years.

People have asked me why I am taking the exam and what will it mean for my practice? I think that it is an opportunity for me to validate what I have trying to do for my patients over the years as well as a chance to measure myself against my peers in the same field. Everyone in medicine has a story about why they chose the specialty they are in. For me, part of it was my exposure to urogynecology cases in both my obgyn and urology rotations in medical school. I found the surgeries to be interesting and challenging, and I appreciated how grateful many of the patients were when they got a good result. This interest and appreciation continued for me during my residency and into private practice. Most people probably don’t think much about how multi-functional their pelvis, and the organs within it are. As I type this, I’m sitting on mine. It also functions as an area of storage and elimination of solid and liquid waste. It is intimately involved in sexual intimacy and reproduction. And it provides something to hold up our pants. No one gives any of this a second thought, until something doesn’t work the way it is supposed to.  Unfortunately, as our population ages, the incidence of disorders affecting these normal bodily functions is increasing. So the creation of a sub-specialty called Female Pelvic Medicine and Reconstructive Surgery allows patients to seek out physicians with knowledge, training and interest in treating the many varied and interrelated conditions that may affect women and their bowel, bladder and reproductive organs. This can be done through various therapies such as behavior modification, biofeedback, physical therapy, medication, and surgery.