A non comprehensive list of challenges and missteps I see in managing/diagnosing female bladder problems that should be referred to Urogynecology, a🧵 1) Examine the patient! Even if it takes time. I have seen patient with fistulas/diverticula/stress incontinence/vulvar dermatoses and cancer who were being managed with OAB medication. Always do a pelvic/vaginal/vulvar exam on a female patient with bladder complaints!

A ( long but I think worth reading) thread on Gynecologic Surgical reimbursement and how it affects all of us: Gynecologic surgeons are the lowest paid surgeons in medicine, and the gap between us and other surgeons is widening. This disincentivizes the recruitment of clinical and research talent into our high-demand field, but in a profit-driven medical environment--

Ladies: your pelvic floor is one of your most precious commodities for healthy aging.

Please think very seriously about if childbirth is something YOU really want, or something society has taught you that you want. I won’t be entertaining any suggestion that arming women with more information about the risks and benefits of childbirth is anti-natalist. In doing so you show your sexist bias towards choice.

Having wanted and thoughtfully considered children is a beautiful thing.

Based on a text thread with a few of my Urogynecology colleagues across the country today, we are constantly inheriting poor Urologic management of female issues. Here are a few of them, and I know that modern #urologytwitter won't be doing any of these things! 😉 1) Not listening to the patient/medical gaslighting

I don't know if this is "old school" or ego-based care, or that female Urologic issues do not pay as well as male urology issues do. But please listen and refer them if your training isn't current on female Urology!

Baby boomers did a pretty good job teaching their millennial daughters that they could be anything they wanted to be and a pretty terrible job of preparing their sons for what that would mean for them as husbands and fathers Women are out here crushing it because they were raised to want the life their fathers have—but unfortunately the men were also raised to want the life their fathers have. We all know the traditional role women play is not a good time

If Twitter folds, I’d like to thank you all for allowing me to die on the following small mountain range of hills;

Women’s health is underfunded, undervalued, and underpaid relative to the immense skill involved

OB/GYN is too big and too complex to be contained into one field Patients deserve better.

Vaginal estrogen prevents most UTIs.

Bladder pain/worsening symptoms in a young woman without an infection should be assumed to be endometriosis until proven otherwise

Women deserve high-volume surgeons

🧵:For most male medical students, their OB/GYN rotation is one of the first times that they are not automatically perceived as trustworthy. This sends many for a loop. Having new boundaries can feel like exclusion! What is going on here? Who is to blame? doximity.com/newsfeed/937ec… Before I go further: we need and WANT patient-centered men in OB/GYN! But they must be trauma informed. And you are going to have to do that thing that women have done in every other field: work extra hard to prove yourself. Your tuition does not buy you access to womens bodies.

It can feel extremely lonely in OB/GYN fighting these fights day in and day out on top of your day job. The fate of a stable society can stand on our shoulders. To other medical providers who are speaking up and speaking out that they are also in this with us: thank you. 💙 We are a group of mostly female surgeons taking care of mostly female patients. We are constantly told that we aren’t surgeons, that there isn’t enough OR time for us, that our cases, despite the skill they take don’t bill enough. That the medicine we practice is soft.

We are so scared as a society about talking and educating openly about what really happens to women’s bodies after delivery and it is absolutely because we are afraid that with more information more women would forego motherhood. That is a concept people just can’t cope with. Women can do absolutely whatever they want with the facts. They are capable of risk-assessing their own lives and values. They are allowed to make the empowered choice to not become mothers. You can’t claim to value women’s body autonomy AND downplay maternal birth outcomes.

A thread 🧵 on some MATERNAL (not fetal, that’s another huge thread) consequences of forced birth from an OB/GYN and Urogynecologic surgeon who repairs postpartum maternal trauma: Hemorrhage from miscarriage or ectopic, sepsis, blood clots, strokes, heart attacks, hyperemesis and intractable vomiting, increased domestic violence, exacerbations of heart disease, lupus and rheumatologic disease, hypertension, seizures, and mental illness, diabetes

As promised, a tweetorial on pelvic organ and vaginal prolapse! So what is vaginal prolapse? Simply, it is when the vagina falls inside and sometimes outside of the body because the internal support structures can no longer hold it in place. These structures include pelvic ligaments and pelvic floor muscles.

To all of the women coming to my office understandably enraged that nobody told them their vaginas could fall out from having babies: I am so sorry that for so long the patriarchy was scared of what you would do with that information. We must ALWAYS always be on the side of trusting women with the full spectrum of information—good, bad, ugly—and allowing them to make informed choices. Life is messy with a lot of pros and cons to everything. But ignorance is not it.

This #MemorialDay as we honor our veterans, I would like to remember the appalling rates of Military Sexual Trauma (MST) that hover around 40% in our female veterans.

journals.sagepub.com/doi/abs/10.117… Women in the military are more likely to be raped by their peers than they are to be killed in combat. They have different physical and psychiatric rehabilitation needs than men do, many of which I see on an almost daily basis as a pelvic floor specialist.

With match day approaching, I have some reflections.

First, I will say that even though the match is in many ways an absolutely WILD system that assumes doctors are unattached people (read: historically men) with the enormous privilege of dropping everything for their job-- When it comes to "making a match", I do think it works.

It is important to remember that all matches in life are two way streets. When it comes to success, relationships are everything, and there is no substitution in the success formula for the concept of BEING WANTED.

Men, if you want to support women everyday, not just #InternationalWomensDay , start taking your paternity leave. It’s NOT radical. It normalizes the value of family, closes the motherhood wage gap/tax, and prioritizes your partners critical physical and mental recovery. This is an incredibly actionable thing you can do, on a personal level, in your own life, to make a difference in the status of women and to set a new standard of masculinity for the men around you. If you’re asking what you can do...this is it.

Ladies, let me reassure you--unless you are purposely wiping back to front, your hygiene isn't the problem.

A 🧵 on recurrent UTIs. 1/ Is it really a UTI? The best way to know if you have a UTI is to get a urine CULTURE. This is NOT the same thing as when your pee is dipped in the office or the ER! A culture actually tells you what kind of bacteria it is, and what antibiotics will kill it.

As we saw with the SCOTUS decision yesterday, not only do Obstetricians and Gynecologic Surgeons have to contend with practicing evidence-based medicine, we and our leading medical organizations (such as @acog) have to practice constant legal scholarship as well. Thread 1/ It is a great burden to have to divide your energy between science and law, science and prejudice. But that is why many of us chose it. In addition to constantly moving goalposts on how we can use female hormones to prevent pregnancy and treat disease--

In med school, I took an elective called "Stress", foolishly thinking I was going to learn about meditation and yoga. Instead the professor spent 6 weeks proving that being poor or a minority literally destroys your health on a molecular level, and I think about that every day. cc: @JWLuiza that class was really ahead of its time. Everyone should have to take it.