IT ISN’T easy to start a conversation about the things that can go wrong with a woman’s pelvic floor. Overactive bladder, stress incontinence, vaginal looseness and loss of sensation in the genitals can be awkward to discuss, even with a urologist, the kind of doctor who specialises in these conditions. It is even more difficult when the doctor is a man – which most urologists are.
Dr Sarah St Louis is a urogynaecologist, a specialty that focuses on women’s pelvic floor problems. St Louis, who is starting a practice in Trinidad this month, talked about some of these rarely discussed but common issues at the J&C Re-Creation Centre in Petit Valley on November 10. Her audience was made up of members of the Diego Martin West Lions Club, whose health committee hosted the surgeon and physician in a talk with other presenters.
Many women in the audience were over 50 and one club speaker noted that “certain things are happening” with their bodies. St Louis’ frank talk about the issues helped shed light on treatment options, she said.
St Louis has been a physician for ten years. A slender woman whose patients tease her about her baby face, she will turn 37 in a month. Her Orlando, Florida practice treats women who face pelvic floor and gynaecological surgical problems, but she’s not one to go straight for the knife as a treatment option.
She said, in an interview at J&C after her talk, “It is an interesting field and it depends on the patient. I tailor my practice towards what each individual patient requires.” She noted that some want surgery immediately, while some want to look at more natural health interventions. “This isn’t your appendix: it’s inflamed and it has to come out no matter what. This is whatever makes you comfortable. I don’t have to tell them what to do; I can do what works best for each patient.”
Patients come to her for many concerns. Incontinence is one of the big ones. She said it’s not unusual to hear of women who had been fond of exercise suddenly stopping because they had begun to leak urine while being active.
“If you have what used to be an active 65-year-old who has stopped being active because she is worried about her bladder leaking, that’s detrimental to her overall health because once we stop being active our health takes a turn.
“I can’t explain how common that is. One of the big reasons for older adults being admitted to nursing homes is incontinence, they can’t control their bladder and their bowels. To act like the female pelvic floor is not an important issue for the society is turning your head to the subject matter.”
Overactive bladder is a common cause of incontinence, and it’s treatable. The condition, characterised by urgency and frequency of urination, does not have to come with ageing, the doctor emphasised.
Another common patient concern is the condition of the vagina.
“As we age, we lose our oestrogen, we lose our collagen, we lose our elastin,” St Louis explained. “Tissue changes all over your body, you notice it from your head to your toes. We don’t talk about it but we have changes in the vagina as well. The skin on the outer part of the vagina and the inner part of the vagina changes. The skin becomes loose and wrinkly; it’s not firm, smooth and plump as it used to be. It has a totally different appearance and feel; same thing in the vagina.
“You might notice a loss of support; what a lot of people say is, it’s not as tight as it used to be. That’s because the lining of the vagina has changed and it’s lost its compliance and elasticity.”
The cluster of conditions is treated by vaginal rejuvenation. Surgical treatment, like a lift, or a prolapse repair, is a choice for some of her patients.
Non-surgical therapy may include applying radio frequency energy or a laser to the area to cause the formation of new collagen, she said. “What this does is it plumps things up again, causes smoothening of the skin, causes the tissue to change in the lining of the vagina and become firmer, tightening and giving a lift to the vagina. By increasing the collagen, it can create more blood flow to the area. We basically get that natural lubrication again, which makes intercourse more comfortable. And with more blood flow we get more sensation.”
St Louis is an experienced ob-gyn but now focuses only on urogynaecology. “I enjoyed delivering babies. That was an extreme amount of fun and warmth. But I really enjoyed the gynaecological aspect and doing GYN-based surgeries. And then another big thing: I really enjoyed seeing older patients. I felt I connected with them, and felt a huge interest in helping them. And I knew that urogynaecology was a field where I could help them, interact with them, provide a better quality of life and still be a surgeon.”
She has practised in urogynaecology since 2016 when she completed a fellowship in urogynaecology at Atlantic Health System in New Jersey, following her Howard University medical education and a first degree in chemistry from Spellman College. St Louis is months away from her board certification in the specialty technically called female pelvic medicine and reconstructive surgery.
She chided medical insurance providers who would pay for Viagra, a pill to boost men’s erections, but not surgery to repair sagging or elongated labia, which may chafe painfully and lead to a woman being less active. It is unfair that patients should pay out of pocket for a procedure that can so profoundly affect their quality of life and their relationship with their spouse or partner, she said.
The daughter of Trinidadian neurosurgeon Phillip, the urogynaecologist planned on seeing her first TT patients over the next few days at her Caribbean Urogynaecology Specialist clinic at St Clair Medical Centre. She will return to Trinidad every eight to ten weeks for clinics, she said; her next visit is planned for early January.
For more info: Facebook page: Caribbean Urogynecology Specialist Ltd.