It isn’t easy to talk about what’s going on “down there.” But speaking up can help break the silence about important health issues affecting women.
In the second of a four-part women’s health webinar series titled “The Women’s Wellness Tour,” The Christ Hospital Health Network physicians Dena Costa, MD, Obstetrics and Gynecology, and Anne Stachowicz, MD, Urogynecology, along with Lauren Hill, a pelvic floor occupational therapist, got candid about some topics often viewed as embarrassing.
The three experts discussed gynecological health at every age and stage and shared what women should know about frequently overlooked pelvic floor concerns.
Here are a few facts to help women get comfortable talking about pelvic and gynecological health.
1. Gynecological needs change throughout your life
Taking control of your gynecological and pelvic health starts by understanding key milestones and challenges at every life stage.
Adolescence: Your first period and early gynecological care
Your first period generally marks the start of adolescence. For many in the U.S., this begins around age 12.
It’s not uncommon or even concerning for periods to be irregular for the first one to two years.
“Only about 50 percent of girls are going to have regular cycles even at the end of those two years,” Dr. Costa says, adding that some girls can reach their late teens and early 20s before they have consistently regular periods.
That’s why she encourages patients to track their menstrual cycles.
“There are a lot of different apps out there now that are great at helping you take control and be a little more aware of what’s going on with your periods,” Dr. Costa says.
Patients often ask her when their child should begin seeing a gynecologist.
While the first period alone isn’t a reason to visit the gynecologist, Dr. Costa says no age is too young for that first appointment—especially if periods are heavy, painful or bothersome. Because those feelings can be different for everyone, Dr. Costa recommends considering the following:
Are periods impacting daily functions?
Are periods causing school absences?
Are periods causing missed extracurricular or social activities?
Women can use hormonal treatments to manage disruptive periods.
“The other thing we want to see people for is when they need birth control or sexually transmitted disease (STD) screening,” Dr. Costa says. “For my younger patients, that doesn’t necessarily mean they need a pelvic exam when they come in.
“For the majority of people, if they’re just there to talk about birth control, they don’t need any form of a pelvic exam unless they want birth control methods like an intrauterine device (IUD) or something similar.”
Reproductive years: Preventive care and common concerns
Your reproductive years are a time for health screenings and essential preventive care.
Pap smears, which are different from complete pelvic exams, are essential for detecting abnormal cervical cells. During a Pap smear, your doctor uses a small brush to collect cells from your cervix. You only need a Pap smear every three years if your results are normal. Health professionals still recommend annual visits for pelvic and breast exams, STD screenings (if needed), and discussions about birth control or other concerns.
Your menstrual health remains an important issue during your reproductive years. Knowing what’s normal can help you determine when to see a doctor. Watch out for:
Irregular cycles (shorter than 24 days or longer than 38 days)
Periods lasting more than 7 to10 days
Severe pain that doesn’t improve with over-the-counter medication
Very heavy bleeding (soaking a super tampon or overnight pad every hour for several hours)
Birth control is another major consideration during your reproductive years. Options range from IUDs and implants to less effective choices like condoms or withdrawal. Understanding these options empowers you to make the best health and family planning decisions.
Breast cancer screenings, including yearly mammograms starting at age 40, are also important throughout and during your later reproductive years.
Menopause and perimenopause: Understanding the transition
Menopause and perimenopause have become hot topics, but many women still feel uncertain about what’s normal during this transition.
Doctors can officially diagnose menopause after one full year without a period. But the journey leading up to it—perimenopause—can last an average of four years, sometimes longer.
Hot flashes and night sweats affect about 80 percent of women, but other common symptoms include:
While these changes can feel overwhelming, understanding what’s happening in your body is the first step toward managing symptoms.
A common misconception is that checking hormone levels can provide clarity, but hormone fluctuations make lab tests unreliable.
“Those lab tests are not going to tell us a lot that we can’t already know from getting a good menstrual history, talking to you about symptoms or just looking at your age.”
Hormone therapy can be highly effective for treating hot flashes, night sweats and vaginal dryness, but it’s not a cure-all. Issues like weight gain, mood changes and sleep disturbances may require other approaches like lifestyle changes, medications or support from other members of your healthcare team.
Don’t let menopause symptoms be an afterthought at your routine visit.
“This should be a dedicated visit—sometimes multiple visits—to see how things are going and try different things,” Dr. Costa says.
Reliable resources like the Menopause Society can also help you confidently navigate this stage.
2. Your pelvic floor health is critical
Your pelvic floor includes the muscles, ligaments, nerves and connective tissues that support your pelvic organs, including your bladder, uterus and rectum.
“It’s like a bowl of muscles and connective tissues, nerves, ligaments—many different components that compose the base of our core,” Dr. Stachowicz says.
Pelvic floor disorders happen when these components weaken or become damaged. Some common pelvic floor disorders include:
Pelvic organ prolapse: When pelvic organs shift downward, causing pelvic pressure and a sensation that something is protruding from the vagina. Symptoms often worsen with increased activity throughout the day.
Urinary incontinence: This umbrella term includes stress incontinence (urine leakage from coughing or exercising) and urge incontinence (sudden, uncontrollable urges to urinate).
Accidental bowel leakage: Involuntary loss of stool or gas, often linked to low fiber intake.
Painful intercourse: A condition caused by multiple factors, including hormonal changes, muscle tightness or nerve issues.
Chronic pelvic pain: A complex condition that may involve multiple organs, requiring a multidisciplinary approach for diagnosis and management. Interstitial cystitis, which mimics recurrent bladder infections, is one potential cause.
Who’s at risk for pelvic floor disorders?
One in three to four women will experience a pelvic floor disorder in their lifetime.
“If you’re not having symptoms, odds are someone very close to you—your mom or your grandmother or your best friend—might be having symptoms worth discussing,” Dr. Stachowicz says.
Risk factors for pelvic floor disorders include:
Childbirth
Chronic cough
Chronic heavy lifting
Chronic straining
Genetics
Menopause
Obesity
Race or ethnicity
Smoking
Why you should seek care from a urogynecologist
“One of the most common things I hear when a patient comes into my office is, ‘I just assumed this was a normal part of aging.’ Pelvic floor concerns are very common, but that does not mean this is something you just have to deal with. Common does not equal normal,” Dr. Stachowicz says.
She encourages women to visit a urogynecologist for pelvic floor issues because:
Your health is as important as the health of those you care for.
You deserve a better quality of life.
Education can be empowering.
Prevention of further progression is possible.
Coping with symptoms can be expensive.
What to expect at your appointment
At your first visit, your urogynecologist will review your detailed medical history, discuss your symptoms, and recommend any necessary diagnostic exams, including bladder tests or imaging.
When your doctor knows enough about your condition, they will discuss all available treatment options. These can vary from noninvasive options like behavior changes, supplements and medications to office-based procedures and surgery.
3. Common pelvic floor concerns are treatable
Pelvic floor dysfunction is common, yet many people don’t realize their symptoms are treatable. Pelvic floor therapy can provide relief and restore normal function for people experiencing urinary or fecal incontinence, pelvic pain, painful intercourse, frequent urination and constipation.
“There’s so much that can be done, and we understand these symptoms so much better now because of recent research efforts,” pelvic floor therapist Hill says.
Therapists like Hill use tools and techniques to:
Build confidence
Decrease tissue sensitivity and improve muscle tone
Eliminate incontinence and reduce urgency and frequency
Improve movement
Improve posture and pelvic alignment
Manage pain
Optimize intimacy
Retrain the bladder and bowel to function
Hill says breathing is integral to pelvic health.
“Our diaphragm and pelvic floor communicate all day long,” Hill says. “When we breathe well, which we refer to as 360 breathing, it helps the pelvic floor muscles.” Hill says this type of breathing also:
You can practice 360 breathing by expanding the belly and ribs on your inhale as if opening an umbrella at its base.
4. Break the silence about pelvic and gynecological health
Women should get comfortable talking about pelvic and gynecological health. Make it a priority to discuss at every stage.
Ready to talk? Our ezCare Concierge nurse navigator can help you find the right provider. Call 513-596-6973 to schedule an appointment with a women’s health expert at The Christ Hospital Health Network. Or fill out this form to receive a call back.