From a Physician’s Perspective*

Let me begin with an introduction… I am a gynecologist who finished residency in 1993 and just completed a fellowship in urogynecology (Female urology). In addition to my many referrals of women with urinary incontinence and other chronic urinary symptoms, I immediately noticed a large number of referrals for patients with diverse entities such as chronic vaginitis, chronic pelvic pain, dyspareunia (pain with intercourse), and chronic vulvar pain.

My first response was “why are all these difficult patients getting dumped on me? I wasn’t trained to diagnose and treat such patients!” But the fact is that it is a rare gynecologist that is trained to treat such patients. That is one reason why women with these problems are medicated with various and multiple creams and antibiotics and are then “referred out” to other physicians. And that is why doctors are often frustrated and impatient with these women. Sure, you can always do a diagnostic laparoscopy to rule out endometriosis as a cause for chronic pelvic pain, but what if you find no obvious pathology? What then? And when pathology is found, treated, and “cured”, what do you do when symptoms persist?

So I immediately went to the library to find out all I could. I pulled articles on vaginitis, vestibulitis, urethritis, and trigonitis. (“itis” simply means inflammation and whenever something ends in “itis” it usually means that it is poorly understood.) It became apparent that there are very few “experts” in the area, and that standard medical therapies are generally inadequate. Based on my reading and my experience, I can say that what seems to happen in these chronic painful conditions is that there is an initial inciting event, such as an infection, which triggers symptoms, a normal and protective response from the body. Then, even after adequate treatment of the inciting agent, the body’s response continues, which understandably troubles the patient physically and emotionally and leaves physicians in a quandary.

Two months ago, I was discussing a particularly troubling patient with one of my partners, who after hearing her story, recommended referral to the Women’s Therapy Center. Susan’s (not her real name) symptoms had been going on for so long with minimal improvement to any treatment that she was at her wit’s end. She couldn’t sleep because of pain and urinary urgency. Usually a highly motivated and successful woman, she was having trouble functioning at work. Her marriage was suffering. Who wouldn’t be depressed and irritable and even possibly suicidal? I was treating her overactive bladder, but I was having trouble managing her resultant pelvic spasm and sexual difficulties and was in no position, either professionally or in terms of time, to manage her emotional issues. This is where the Women’s Therapy Center is an absolute godsend. These patients rarely get significant improvement with biofeedback/pelvic floor exercises or psychosocial counseling alone. With their joint training as sex therapists and expertise respectively in social work and urogynecology physical therapy, Ross Tabisel and Ditza Katz are in a unique position to effectively treat the entire individual.

I have spoken to Tabisel and Katz many times over the last few months, about particular patients and particular symptom complexes. I have consulted with them about various “non-traditional” or “alternative” therapies such as herbal remedies that my patients were using (another topic about which physicians are not educated). I also recently attended their support group for women with vaginismus. I was impressed with the openness and humor with which these sensitive and private problems were discussed. And now that a few short months have passed and I have witnessed a significant improvement in my patients’ symptoms and their lives, I am convinced that this approach is the correct approach for many women.

I am by no means an expert on vaginismus, chronic pelvic or vulvar pain, or even chronic urinary symptoms such as urethritis, which have no well-defined pathology. However, after reading much about such entities, it is clear to me that there are perhaps no medical experts. Standard prescribed medical therapies fall far short of being adequate treatment. I am thankful I found the Women’s Therapy Center because now I can offer these “difficult” patients some relief*.

Respectfully,
Dr. C.H., North Shore University Hospital
Long Island, New York

* Results may vary from person to person