Philly Doctors Explain the Latest Advancements in Gynecology That Patients Need to Be Asking About
It can be difficult to have a frank conversation with your gynecologist. Sharing details that can feel particularly personal or embarrassing isn’t easy, especially when you’re not sure if your symptoms are just an inevitable matter of aging, something your doctor can’t help with, or require more inventive treatment.
But it’s important to remember that, while physical and hormonal changes are a natural part of aging, new gynecologic and urologic symptoms may not be. While you might feel the impulse to simply adapt to these new symptoms—anything from new vaginal bleeding to urinary incontinence, an overactive bladder, or abdominal pain—these new discomforts might be signs of more serious conditions that require treatment.
When it comes to health, knowledge is power. And while doctors can provide you insights into your condition, you also want to make sure you’re equipped to be honest with your physicians and ask the right questions during your appointments.
We talked to gynecological specialists Drs. Aaron Shafer and Yarini Quezada at Jefferson Health to help you recognize when to talk to a professional about your gynecological and urinary health, and how to inspire conversations that will optimize your screening and treatment options. Here’s what they said about preventing life-threatening conditions, and about making sure that your symptoms don’t stop you from achieving your best quality of life.
What Gynecological Screenings Do You Need?
For Dr. Shafer, Director of Gynecologic Oncology at Thomas Jefferson University Hospital, screenings are the primary step in ensuring that patients stay healthy—and for patients, open communication with your doctor is key to ensuring that you receive all the gynecologic cancer screenings that are critical to your health.
Your risk profile—a portrait of your health shaped by genetics, family history and lifestyle—determines what types of screenings you need and at what frequency you need them. Cervical, endometrial and ovarian cancers are the most common types of gynecologic cancers, and each have unique criteria for screenings.
“Generally, the screening that most adult women, if not all adult women, should be undergoing is some form of cervical cancer screening,” says Dr. Shafer. But whether that screening occurs annually or every three years depends on a patient’s screening history, age, and risk factors such as prior abnormal pap smears or treatment for cervical pre-cancers.
Your genetics also determine how you should be screened for endometrial cancer; most women do not need to be screened, however a certain high-risk population does require annual screenings. The determining factor is a predisposition called Lynch syndrome, which increases the risk of developing endometrial and colon cancers. If you have Lynch syndrome, annual endometrial biopsies are recommended to help you mediate your risk and to catch the cancer early should it appear.
But women who don’t have this genetic syndrome can still develop endometrial cancer, and that’s why Dr. Shafer encourages patients to tell their doctors about any changes in their gynecological symptoms. “Most endometrial cancers are caught early because there are early symptoms,” he explains. “That’s why it’s so important for women to present any abnormal, persistent or irregular bleeding—whether before, during, or close to menopause—to their doctors.”
Keeping an eye on your symptoms is also important for ovarian cancer, a particularly dangerous disease. For people who don’t present with symptoms or genetic predispositions, researchers have yet to develop a reliable, effective screening for ovarian cancer—which is why the cancer is often not found until later stages. Women may want to consider asking for genetic testing, which allows doctors to locate any high-risk mutations you might have and therefore monitor you closely.
But genetic testing is not the only thing you can do, and people with high-risk mutations are not the only ones who suffer from ovarian cancer. Communicating any new symptoms to your doctor as soon as they develop gives you the strongest chance of figuring out your risk level and detecting the cancer early if it arrives—so that you can be scheduled for comprehensive exams and take preventative measures. “Any woman who is experiencing new or different abdominal pain, bloating, or any changes in their bowel that are consistent, those are things to present to your doctor,” says Dr. Shafer.
New Treatment and Prevention Strategies for Gynecological Cancers
Investigating your risk level for cancer can feel like opening up Pandora’s box, but knowing your risk is critical—and with new and innovative treatments, you can get proactive about managing it.
Leading a healthier life can decrease your cancer risk, along with specific lifestyle decisions. Taking oral contraceptives has proven influential in warding off ovarian cancer—even in women with high-risk mutations, long-term continuous usage of birth control pills can reduce the risk by 50 percent. For endometrial and cervical cancers, controlling your weight, eating healthy and being active are effective precautions—and these choices protect against other cancers, too.
But no lifestyle decisions can guarantee that cancer won’t impact your life—and for those who have genetic predispositions, taking more direct preventative options can be the right choice.
Often, surgery is the most beneficial preventative option. At Jefferson, doctors choose minimally invasive techniques, like laparoscopic, where doctors create a very small incision, and robotic, which allows doctors to use very small instruments in a series of very small incisions, to make surgery safer and more comfortable for patients. “For patients who have been identified as having high-risk genetic mutations for ovarian or endometrial cancer, we absolutely discuss prophylactic surgery,” Dr. Shafer says. “Usually that involves minimally invasive removal of the uterus or the ovaries and fallopian tubes, or both. It depends on the indication, patient, and what mutation they have.”
There’s a movement towards minimally invasive surgery throughout the medical field, and in endometrial cancer, it doesn’t stop at prevention. For patients with this disease, new strides have been made in reducing surgical risks by targeting cancer with increased precision—removing the select few lymph nodes that are cancerous, rather than a larger number of nodes that will leave patients with a longer road to recovery. In some patients, this technique is applicable for cervical cancers, too.
Not every patient’s cancer qualifies for these minimally invasive operations, but Dr. Shafer encourages every patient to at least bring the option up to their oncologists. “It’s always worth asking,” he says.
What Urological Symptoms Should You Look Out For?
Though urological symptoms are very common, those who suffer from them sometimes do so in silence, even to their physicians. “Most patients are embarrassed to talk about them, so they never bring it up, and some providers don’t ask about it,” explains Dr. Quezada, Division Director of Female Pelvic Medicine and Reconstructive Surgery at Jefferson Einstein Hospital, who works on restoring quality of life for female patients afflicted with urologic and pelvic problems. Because these problems often manifest with symptoms like incontinence, patients can feel stigmatized and ashamed about talking about them, even though talking is key to receiving help. But, as Dr. Quezada emphasizes, no one should feel as if they need to live with any level of incontinence.
“These are common ailments that do occur, and there are treatment options available that are non-invasive,” Dr. Quezada says. “That’s something I want to bring awareness to.”
What’s important is that patients notice when their urinary or bowel conditions stray from their normal baseline—even if these changes occur within the larger context of menopause or aging. More frequent urination that interrupts your comfort, more urgent arrival of the need to urinate, incontinence, or the sensation of a vaginal bulge or mass—that Dr. Quezada’s patients often tell her feels like “sitting on a balloon”—are all concerns that warrant visiting a specialist. From there, a doctor can conduct exams to diagnose patients with a condition and a stage.
Symptoms can be caused by a variety of conditions. Urinary and fecal symptoms might indicate overactive bladder syndrome, stress-induced incontinence, or fistulas; vaginal pain and bulging can indicate a pelvic organ prolapse, which can impact the kidneys if left untreated. But none of these are untreatable, and knowing your stage is an asset for choosing the right care plan.
Innovative Treatment Options for Urologic and Pelvic Conditions
Urologic and pelvic conditions range in intensity, and so do treatment options. Aligning treatment to a specific patient is key to unlocking improvements in quality of life, according to what the patient’s priorities are.
“There is an association between therapy and what type of improvement you’re looking for,” Dr. Quezada says. For example, lifestyle changes like avoiding bladder irritants in your diet and losing weight can improve bladder function significantly—which can alleviate symptoms like consistent urinary tract infections and an inconvenient need to urinate too frequently. In turn, a patient’s quality of life improves not just physically, but socially and mentally.
“Overactive bladder symptoms have been associated with anxiety symptoms, depression symptoms, and isolation,” explains Dr. Quezada. “Some patients tend to abstain from intimate relationships if they’ve had an episode of incontinence, and so, it has been associated with a lot of these quality of life metrics.”
To improve quality of life for all patients, medical intervention might be a necessary supplement to, or alternative to, lifestyle changes. These treatment options are not uniform across conditions, but they each strive to be as minimally invasive as possible.
With a variety of treatment options available, doctors cater treatments to each patient’s specific condition and needs. For issues like incontinence, there are different theories of its origins, and different approaches to managing it: myogenic theories, which are related to the muscles, and neurogenic theories, which are related to the nerves. Some myogenic options include physical therapy for the involved muscles or botox injected into the muscle of the bladder. Doctors also offer oral options, where a daily medication can help strengthen the bladder or the pelvic floor.
While these choices are the perfect solution for some patients, they aren’t suitable for others: Older patients might not have the muscle control to achieve significant relief from physical therapy, and people with diabetes face increased risks of side effects from botox. Luckily, more options are available. To restore comfort, a pessary—a small, soluble device that’s fitted to a patient’s anatomy—can be vaginally inserted to physically hold up a patient’s prolapsed pelvis, or surgery can be considered to restore function. Even when surgery is the best resort, there are new ways to minimize side effects and risk. Whenever possible, reconstructive surgery is done through a minimally invasive approach that maximizes comfort and decreases recovery time.
“We have some really innovative treatment options that weren’t available many years ago,” Dr. Quezada says. And by monitoring your symptoms, knowing your risk, and advocating for yourself to receive the best care possible, you can take advantage of these medical advances.This is a paid partnership between Jefferson Health and Philadelphia Magazine