The Evolution of Gynecology: Which Sub-Specialist is the Most Appropriate for Intimate Wellness Needs?

The vagina has typically been considered the vessel of life and love since the dawn of man and is as much a part of women’s daily navigation as is any other part of our bodies. There is no one-size-fits-all approach to vaginal and intimate health treatment, but there should be a one-size-fits-all objective – enabling women to feel comfortable and confident addressing their diverse feminine health needs.

I routinely communicate with patients, white coat, and white collar to engender evolution and revolution within the vaginal health and intimate wellness zones. On the patient side of this equation, because women often feel uncomfortable talking publicly about pelvic organ prolapse or related intimate health issues, they share experiences and concerns behind APOPS protective curtain. The vaginal "gap" related to introitus width. Vaginal wall laxity. Loss of intimate sensation. Vaginal or episiotomy surgical scar tissue or adhesions. The concerns that make women back away from the intimate activities they used to love to engage in.

Many women think a gynecologist is a gynecologist is a gynecologist, simply because that is the only women’s health physician they’ve ever seen. The reality is standard gynecologists (technically specialists), primary care physicians, and midwives can provide base-line diagnostic vaginal and pelvic examinations, referring patients to subspecialists when appropriate. Like most fields of medicine, standard gynecologists can extend their training to subspecialize in an even more distinct aspect of women’s gynecologic health.

When I was invited to participate in a global chat group of cosmetic gynecologists, I was excited to discover it was a mixture of multiple types of gynecologists who are additionally subspecialists in surgical treatments and procedures optimizing vaginal, vulvar, and intimate health. I have found this group of physicians to be refreshingly forward-thinking and extremely comfortable within the vaginal health and intimate wellness zone. These are the surgeons who recognize that sometimes women want “more,” and should have that choice without judgement. These are the surgeons who understand that a patient’s self-esteem is a pivotal aspect of the equation. These are the surgeons brave enough to ignore the stigma that still encompasses vaginal and vulvar aesthetic practice.

So exactly where do cosmetic gynecologists fit into the big picture of women’s vaginal health and intimate wellness needs? Gynecology can be as murky for women to navigate as a fog-filled morning. Time for a bit of clarification.

A specialist is a physician who has been trained in one of the major fields of medicine, such as gynecology. Each of the major fields of medical practice contains several additional distinct fields of that practice, called subspecialty fellowships. A gynecologist is a physician who specializes in women's reproductive health, providing pap tests, treatment for women’s reproductive disorders, and addresses sexually transmitted diseases. An obstetrician cares for women during pregnancy, delivers babies, and often continues care post childbirth. An ob/gyn does all these things.

Subspecialists continue additional medical training, typically spending one to three years focusing on a specific subspecialty field. There are four commonly recognized subspecialty fellowships in the ob/gyn sector:

1. Gynecologic oncologists (reproductive-organ cancer).
2. Reproductive endocrinologists (hormonal disorders, menopause, pregnancy loss, infertility and menstrual problems). 3.
3. Maternal fetal medicine (high risk pregnancy).
4. Female pelvic medicine and reconstructive surgeons (FPMRS), also known as urogynecologists (functional and anatomical pelvic floor disorders of the muscles, ligaments, nerves, and connective tissues that support the vagina, uterus, bladder, and rectum, particularly pelvic organ prolapse). Urologists can also subspecialize in FPMRS.

Some women struggling with vaginal health concerns experience changes in sexual function and/or genital appearance. To address these needs, there is an additional relatively new field of gynecologic practice evolving at a brisk pace: cosmetic gynecology. Cosmetic gynecologists frequently treat functional issues and include principles of regenerative medicine in their practices. This subspecialty practice includes internal and external surgical, energy-based, and additional alternate types of procedures related to the female vulvar-vaginal region. These treatments enhance or restore how the vagina or vulva look as well as address sexual dysfunction that may occur as a result of childbirth and/or aging.

So which subspecialty is best suited to address vaginal and vulvar appearance along with sexual function concerns of women, particularly when they overlap with pelvic organ prolapse? At this point in time there is no fellowship called cosmetic urogynecology, but it is clear that subspecialists who have studied and practice both urogynecology and cosmetic gynecology are playing a pivotal role in the transformation of women’s vaginal health and intimate wellness evolution.

Self-esteem is a significant aspect of health balance and quality of life that unfortunately at times is unrecognized or unacknowledged. There can be considerable difference between normal anatomy and what a patient feels is normal anatomy. Given that lack of medical imagery accessible in the female “private zone,” it’s not a shock that women don’t realize our female anatomy is as unique as our faces. Women’s feelings about the appearance of their genitalia are often overlooked or disregarded as legitimate. Both patients requesting and surgeons providing cosmetic gynecologic procedures must take into consideration the appropriateness of individual appeals for medical versus non-medical treatments. Body dysmorphic disorder and other psychological or trauma-based emotional concerns are undoubtedly a pivotal aspect of evaluations.

Medically critical surgical procedures such as vaginal and pelvic reconstructive surgery related to pelvic organ prolapse with simultaneous elective surgeries and/or procedures to address women’s self-image, are considerations that women are starting to and will continue to explore. Both function and appearance can be addressed at the same time by the appropriately trained surgeon who subspecializes in both urogynecology and cosmetic gynecology.

There is no doubt evolution is pivotal in vaginal health and intimate wellness within patient, white coat, and white-collar sectors. There is no doubt smart marketing is the secret sauce needed to eradicate the stigma that shadows this significant sector of women’s health. And there is no doubt physicians intersecting in cosmetic gynecology from within the urogynecologic sector are at the head of the curve, pivotal to evolution in these most significant female health sectors. The treatments provided, both surgical and nonsurgical, are a cornerstone in the next significant shift in women’s health evolution.

It is a brave new world in women’s vaginal and intimate healthcare. The gynecologists recognizing women’s diverse vaginal health and intimate wellness needs are agents of change. 

Every Voice Matters.

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SHERRIE PALM BIO

Sherrie Palm is the Founder/CEO of Association for Pelvic Organ Prolapse Support (APOPS), a pelvic organ prolapse KOL, a global women's pelvic health advocate, author of 3 editions of the award winning book Pelvic Organ Prolapse: The Silent Epidemic, and is a national and international speaker on multiple aspects of pelvic organ prolapse quality of life impact. 

Sherrie’s points of focus are generating global POP awareness, developing guidance and support structures for women navigating POP, and bridge building within POP healthcare, research, academic, industry, and policy sectors toward the evolution of POP directives.

Additional information about APOPS, pelvic organ prolapse, or Ms. Palm’s book or speaking presentations is available on the APOPS website.

https://www.pelvicorganprolapsesupport.org/sherrie-palm/