Q&A: Urogynecology with Adrianne Wesol, MD

Dr. Adrianne Wesol is an obstetrics and gynecology (OB/GYN) specialist who practices at the Kaiser Permanente Capitol Hill Medical Center.

What is urogynecology?

Urology and gynecology have always worked together, but this is even more of a collaboration between the two specialties. The urology system is very connected to the pelvic floor and vaginal area. This specialty helps solve medical dilemmas due to a combination of bladder, vaginal, and rectal issues. In short, we oversee that whole area of the body to ensure integration between the two specialties.

Is this a new subspecialty?

It became a subspecialty last summer. The official name is Female Pelvic Medicine and Reconstructive Surgery. I think of it as a focus on female urology.

What kind of training is needed?

It now includes a three-year fellowship after a residency. For those of us like me, who were practicing before the official designation as a sub-specialty, we did training during our residencies and continued gaining skills while in practice.

What are some common problems treated by urogynecology?

Two main problems are urinary incontinence and overactive bladder. That’s frequency of urination, getting up repeatedly at night, and feeling an urgent need to urinate. There is also stress urinary incontinence, which happens when women are active: coughing, laughing, jogging. An additional issue is pelvic organ prolapse. That’s when there is a hernia in the pelvic floor and organs drop down. It affects quality of life and the ability to stay active. Self-esteem and self-image are also issues, and these spill over into sexual satisfaction. Many women are embarrassed and back off a little bit from being sexually active when they have experienced a prolapse. Treatment options for all of these include exercises, medication, and surgery.

When should patients consider seeing an urogynecologist?

When the problem significantly affects their quality of life and they start looking for additional treatment options. Primary care doctors can help many women with basic medication for all of the problems I mentioned, along with Kegel exercises to strengthen the pelvic region. But if medication and exercises aren’t working, that’s when they should consider seeing a specialist.

Have you seen significant advancements in recent years?

I think robotic surgery has been a great advancement. There’s less blood loss and less post-operative pain. Vaginal slings, which are an outpatient procedure, have been very successful in controlling stress urinary incontinence symptoms.

What’s the most satisfying part of your job?

It’s how treatment changes women’s lives and allows them again to do the activities they love to do. I can help women to garden again, or to lift a 60-pound sea kayak off the roof of their car and go paddling in a lake. I treated a woman who loves to travel internationally. She had to bring pads wherever she went and look for bathrooms everywhere. She wants to be able to travel again without worrying.