Urogynecology and Women’s Pelvic Health at Novo Clinic

Women's Pelvic Health encompasses treating conditions related to the pelvic organs and surrounding muscles, tissues and nerves.

Novo Clinic Gynecology

Introduction to Urogynecology and Women’s Pelvic Health

Women’s pelvic health is a broad field encompassing a range of conditions related to the pelvic organs and the surrounding muscles, tissues, and nerves. Surgical interventions often play a crucial role in treating pelvic health issues that cannot be managed effectively through conservative or non-surgical means. Below is a detailed exploration of the role of surgical interventions in women’s pelvic health.

Dr. Richter can help. He has been performing advanced laparoscopic surgery for some of these problems for almost 25 years and was trained as a subspecialist in urogynecology. He currently performs high level minimally invasive (“keyhole”) surgeries to help women with prolapse. Many of the cases he does are problem cases with failed previous repairs. He was also trained in the full spectrum of vaginal surgeries to help incontinence, prolapse and certain bowel related problems like constipation and previous delivery-related complications.

In conclusion, surgical interventions in women’s pelvic health are diverse and tailored to the specific condition and needs of the patient. Advances in minimally invasive techniques have significantly improved outcomes, but it remains essential for women to work closely with their healthcare providers to choose the most appropriate treatment option.

Focus of our Treatment

What is urogynecology? It is a subspecialty of gynecology also known as “pelvic reconstructive surgery”.  It deals with problems related to female pelvic organ prolapse, urinary problems, like incontinence, and also some bowel related problems.

The female pelvic floor refers to the (complex) muscles, ligaments, connective tissue and nerves that comprise the pelvic organ support. Support and function are intertwined and these supports play a very important role in the function of the bladder, vagina, uterus and bowels.

Loss of support may lead to multiple problems. Some of these are incontinence, difficulty emptying the bladder, vaginal and pelvic pressure and prolapse, as well as difficulty emptying the bowel and constipation.

The impact on women’s daily functioning and QOL (quality of life) can vary from minimal to debilitating. Some women are not able to function due to these kinds of problems.

Aesthetic (cosmetic) gynecology has become mainstream over the past 10 years. Many women undergo aesthetic procedures to improve body parts. Gynecologic cosmetic surgery has been shown to enhance the well-being and function of women who are not satisfied with the appearance or function of their intimate body parts. Sometimes there are functional problems, like large labia that may interfere with spinning, or cycling, or cause unappealing appearance (e.g. “camel toe”).

Some women have other problems, like vaginal laxity (“looseness”), especially after vaginal deliveries. This is also a condition that can be surgically corrected with good success.

For women seeking aesthetic gynecology treatment it is important to have this done by a doctor who is appropriately trained. Dr. Richter is certified by ESAG (the European Society of Aesthetic Gynecology). He is also a urogynecologist and reconstructive pelvic surgeon, which makes him very well-qualified as an aesthetic gynecology surgeon.

He offers labiaplasty (minora and majora), clitoral hood reduction, vaginal rejuvenation and more.

Treatments Offered

Pelvic Organ Prolapse (POP) Surgery

Condition Overview: Pelvic organ prolapse occurs when the muscles and tissues supporting the pelvic organs (such as the bladder, uterus, or rectum) weaken, causing one or more of these organs to drop (prolapse) into or out of the vaginal canal. Surgical Treatments: Hysterectomy: Often performed if the uterus is prolapsed. The uterus is removed through the abdomen or vagina. Colporrhaphy: This is the repair of the vaginal wall to correct a prolapsed bladder (cystocele) or rectum (rectocele). Sacral Colpopexy: This procedure uses mesh to hold the vagina in its correct anatomical position, typically performed after a hysterectomy. Sacrospinous Fixation: Used to attach the top of the vagina to the sacrospinous ligament in cases of vaginal vault prolapse.

Urinary Incontinence Surgery

Condition Overview: Urinary incontinence involves the involuntary leakage of urine, which can significantly impact the quality of life. The two most common types are stress urinary incontinence (SUI) and urge incontinence. Surgical Treatments: Midurethral Sling: A common procedure for SUI where a sling (usually made of synthetic mesh) is placed under the urethra to provide support and prevent urine leakage during activities that increase abdominal pressure. Bladder Neck Suspension: Another technique to lift and secure the bladder neck and urethra to prevent leakage. Artificial Urinary Sphincter: For severe cases of incontinence, this device is implanted to keep the urethra closed until urination is desired.

Fibroids and Endometriosis Surgery

Condition Overview: Uterine fibroids are noncancerous growths in the uterus, while endometriosis involves the growth of endometrial tissue outside the uterus. Both conditions can cause significant pain, heavy menstrual bleeding, and infertility. Surgical Treatments: Myomectomy: The removal of fibroids while preserving the uterus, which is particularly important for women who wish to maintain fertility. Hysterectomy: The removal of the uterus, which may be necessary for severe cases of fibroids or endometriosis when other treatments have failed. Laparoscopic Surgery for Endometriosis: Minimally invasive surgery to remove or destroy endometrial tissue outside the uterus, which can alleviate pain and improve fertility.

Pelvic Pain and Adhesions Surgery

Condition Overview: Chronic pelvic pain can result from various conditions, including endometriosis, pelvic inflammatory disease (PID), or post-surgical adhesions (scar tissue). Surgical Treatments: Laparoscopic Adhesiolysis: A minimally invasive procedure to remove adhesions that cause pain or fertility issues. Laparoscopic Nerve Ablation: A surgical option for chronic pelvic pain where nerves transmitting pain signals are severed or blocked.

Pelvic Floor Dysfunction Surgery

Condition Overview: Pelvic floor dysfunction involves the inability to correctly relax and coordinate the muscles in the pelvic floor, leading to issues like constipation, pain, or urinary problems. Surgical Treatments: Pelvic Floor Reconstruction: Reconstructive surgery can correct various pelvic floor disorders, often using a combination of techniques such as prolapse repair, incontinence surgery, and mesh implantation. Rectocele Repair: A specific repair for a rectocele, which is a type of pelvic organ prolapse involving the rectum bulging into the vagina.

Minimally Invasive Surgery

Laparoscopy: Many of the surgeries mentioned above can be performed using laparoscopy, which involves small incisions and the use of a camera and specialized instruments. This approach offers benefits such as reduced pain, shorter hospital stays, and quicker recovery times.

Labiaplasty minora (inner lips)

Problem: Prominent inner vaginal lips, leading to undesirable appearance that causes women to feel unhappy about their appearance and physical discomfort due to chafing. Goal: Reshaping and making the labia smaller, removing the dark edges of the vaginal labia. A common problem is enlargement of the inner lips. Often women feel very uncomfortable due to chafing from the enlarged labia, when just walking, or during sports activities like spinning. Women also feel embarrassed and aware of the prominent lips when in bathing costumes and sometimes suffer from comments by their partners of friends. This can have a psychological effect that may lead to problems with women’s sexual functioning and well-being. And it may cause a woman to view herself negatively in terms of her sexuality. This technique focuses on reducing the size and/or the shape of the labia minora. It can also address the dark skin colouration on the labial edges, something that bothers a lot of women.

Labiaplasty Majora (outer lips)

Problem: The outer lips are unattractive because they are saggy, or too prominent. Goal: To reshape and decrease the size of the outer lips, to tighten the skin to remove the sagginess. The size and the appearance of the labia larger (outer lips) is changed with labia majora plasty, by removing excess tissue and skin with a “hidden scar” technique. There is removal of excess fat and tightening or lifting of relaxed skin. The labia majora can be enlarged, or appear saggy, due to genetic predisposition, weight loss, aging or side-effects of childbirth. Let Dr. Richter help you to discuss possibilities to relieve your anxiety and discomfort and to help you decide what is right for you.

Vaginoplasty

Problem: Vaginal gaping and looseness of vaginal opening and muscles. Goal: To decrease vaginal diameter and tighten lax muscles and tissues, leading to dramatic increase of your and your partner’s quality of sexual pleasure. Vaginoplasty is a delicate surgical procedure with the goal of tightening stretched out muscles and tissues. It removes stretched out vaginal skin and reconstructs a tighter vaginal opening and vaginal canal. In cases, especially in case of delivery related tears or episiotomy, perineoplasty may be necessary too; either on its own or in combination with vaginoplasty. With perineoplasty the outer vaginal opening is reshaped and usually tightened.

Meet our
Urogynecology and Women’s Pelvic Health Providers

A multi-diciplinary team of board certified professionals from around the globe. All with one aim: to improve your quality of life.

Dr. Barry Richter

Board Certified Gynecologist & Obstetrician & Urogynecologist , Certified Menopause Practitioner, European Society of Aesthetic Gynecology Certified

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Novo Clinic Gynecology

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