Jasmine – Final Thoughts

For the past 8 weeks, we have been working in the Urogynecology department at
Mass General Hospital. More specifically, we worked with urogynecologists who are part of the Female Pelvic Medicine and Reconstructive Surgery Program. Shadowing in both the clinic and the operating room, I have learned that this department addresses urinary urgency and/or incontinence, prolapse, and any problems involving pelvic pain. The main method of treatment I found that the doctors use is pelvic floor physical therapy to build strength and support in the pelvic muscles around the organs in the pelvic area. The clinic actually keeps a record of all the pelvic floor therapists all over Massachusetts and even New Hampshire for the convenience of all their patients. The majority of patients are around 60 years old and post-menopausal. At this age, it is common for the muscles in the pelvic area to have weakened, often resulting in vaginal prolapse. Especially after vaginal childbirth, these symptoms are common in many women.

I was surprised to find that a lot of the women that came into the clinic had never known
that a specialty like Urogynecology had even existed. The fact that so many women were not aware of an entire specialty geared specifically towards their pelvic health reinforced the fact that society expects women to accept any problems in that area and deal with it themselves. However, for men it is widely known that should they encounter any medical problems in the same area, they should see a urologist. Furthermore, it made me wonder whether the widely known obstetrics/gynecology department is only widely known because gynecologists help women through the childbearing process. It seems that society has accepted the field that helps women bear children, a strong societal expectation of women, but neglects the field that caters to the medical needs of women due to childbirth. Many women live with symptoms of urinary incontinence, fecal incontinence, vaginal prolapse, etc. because they are too embarrassed to seek help. It was heartbreaking to see that many patients that came into the clinic would lie on the table and continuously apologize to the doctors about the leaking during a routine exam even though these doctors had been trained to see and treat these symptoms.

During these past 8 weeks, we have completed the Perineal Database created by Dr.
Burkowitz and Dr. Hudson to find trends in the occurrences of third and fourth degree vaginal lacerations and breakdowns of those lacerations after vaginal deliveries. We have logged over 440 patients’ childbirth experiences by reading through their patient history into a database. The data will now be sent to a statistician at MassGeneral who will look for these trends and hopefully a paper will be able to be published about the findings. I am excited that I will be continuing to work in the FPMRS program and the Urogynecology department in future projects throughout this fall semester. Currently there are several projects that are under the IRB review process and once they are approved I can start helping with the project.

I was also very intrigued in a new project that is just being started. Recently, the Urogyencology department held a meeting with a group of cognitive behavior therapists to create a protocol that caters towards patients that have a history of trauma, whether that is verbal, physical, or sexual abuse. It has been found that having a history of trauma and chronic pelvic pain are connected. Therefore, FPMRS is trying to create a protocol starting from bringing up the conversation of trauma with the patient to making pelvic floor physical therapy a viable option without triggering the patient. I am excited to continue to work with this department and witness its growth.

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