Adolescents & Athletes

Expert Commentary - Samantha Pulliam, MD

In her own words: We sat down to chat with Samantha Pulliam, MD, a urogynecologist at Massachusetts General Hospital in Boston, MA.

I provided the talking points and she provided these fantastic quotes and insights.

Samantha Pulliam

SMF: Tell me about the typical women that make up your practice:

Dr. Pulliam (DP):

  • With a few exceptions, they typically range in age from 30 to 80 years old.
  • So many similar complaints which they often trace back to the birth of their children or onset of menopause. Their complaints, of urinary frequency or incontinence, for example, have typically been present for quite some time - 5,10, or even 20 years!

SMF: Talk to me about your thoughts on these delays in seeking care:

DP:

  • Delays in seeking help for such long periods of times are for many reasons, one primary one being that they don’t know who to talk to. For example, by the onset of menopause many women no longer have a relationship with an obstetrician (all done having babies!) and elderly women may no longer require pap smears, so they are without a relationship with a gynecologist.
  • Having a conversation about very sensitive topics with a health care provider is a necessary part of finding help, and this is often not an easy task for women. I encourage women to speak to the other women in their lives about these things. Often women come in and aren’t even comfortable using the word “incontinence” or “leaking” or “prolapse” because they are embarrassed about it and I am frequently asked: “Do you think any one else has this problem”?

SMF: And...

DP:

  • My schedule, and the schedules of many other related health care practitioners, are booked full of women who have decided to seek care for these very same problems. Women are anything but alone - these issues are sadly quite ubiquitous in women’s lives.

SMF: I would love to hear more about your inclination to encourage women to talk more - to healthcare providers, to each other - particularly because this is so much of what we are promoting via our Share MayFlowers initiative...

DP:

  • Of course! The women who do speak to other women, such as their daughters, mothers, or friends, realize a lot of other women suffer from things like urinary frequency, urinary urgency, and pelvic organ prolapse. As women, talking to each other (about our pelvic health and pelvic health issues) is something we don’t do nearly enough of.
  • Most women are proud of having their children, but yet are embarrassed about the effects that childbirth has had on their bodies. They also may feel pressure not to talk about these topics - that they are socially unacceptable or are “part of the price” of having those beautiful children that fill them with pride - and may feel guilty admitting they have these problems. One classic example is immediately postpartum: they have a beautiful new baby and should (rightly!) feel lucky, but there is a parallel reality where they also don’t have the tools to deal with what has happened to their bodies after having the baby. Women also may not know what to expect (with regard to physical changes and recovery in their own bodies) after giving birth or what is “normal”.

SMF: I could hug you now. I couldn’t agree more! What’s something you do specifically to address this?

DP:

  • One huge thing I do regularly is spending time with the patient and a mirror, describing what has happened to their anatomy after giving birth and why things may feel different “down there” now compared to before having a baby.

SMF: I’m on an idealistic journey to change the dialogue and standard of care for female pelvic and perinatal health. What is one wish you have in this arena?

DP:

  • Just one?? (smile!) I wish that women would seek help for their problems sooner, rather than waiting until it is unbearable, can’t be ignored and has already wreaked havoc on their quality of life. Clinical experience teaches you that problems that are dealt with early on are a lot easier to take care of than those who have been going on for quite some time.
  • One suggestion I have is for women to insist upon a postpartum visit to a physical therapist and/or a follow up with their obstetrician or midwife gynecologist longer than 6 months after giving birth to their baby, specifically to talk about the changes that have happened to their bodies that may persist after a delivery. Typical follow-up with these professionals ends at 6-8 weeks postpartum (when the acute healing process may still be going on) and it can be unclear how much of the physical symptoms a woman is experiencing will resolve over time and which are problematic.

SMF: Such great suggestions! How about changes in women’s health in the next 5-10 years...thoughts?

DP:

  • Its no secret that the female population is aging, the baby boomers are getting older. That places more and more women at a time in their life when these sorts of problems may happen to them - which I hope also means they will be more willing to speak up about women’s health topics such as these, and this will ultimately lead to more comfort in pursuing care. There is no reason to suffer from (pelvic health) problems that keep you from exercising and having intimate relations with their partners when treatment is available. As care providers, we hope to help patients remain active or return to their favorite activities.
  • For the younger set, ladies in their 20s and 30s, this is likely the most active time of your life, so if you are having problems that keep you from doing things you want to do, this is the time to fix them. Be proactive, even if they are small problems - they won’t get better on their own!!