When I was in my late 20s and early 30s, our family had a tradition of hosting a family reunion each year. It was held at a local company-employee park complete with volley ball courts, baseball diamonds, putt-putt golf, and so forth. These were some of my favorite memories when our whole family was present; aunts and uncles, cousins and in-laws and kids everywhere! We had dinner in the shelter house and then off for a spirited game of baseball.

My cousin was a great ball player, playing on several leagues for his work and others for play. We would pick sides, whittling down the players until the “old people” (those over 40), were the ones left. Then it was grab a glove and head to the outfield.

My aunt is one of those ladies who makes everyone laugh. Whether she is...


Being a man in a woman’s world has provided me a perspective that not many men are privileged to experience. Yes, I said privileged. Every day in my practice, I meet with a variety of women of all ages, all careers, all phases of their lives and all sizes, shapes and colors.

I have noticed, however, that all of them have at least one thing in common (other than the fact that they are women). They all want to feel good about themselves.

Many of these women come to me lacking self-confidence because of the medical problems that they have kept secret from others in their life. For whatever reason, embarrassment, shame, or pride, they feel that they are not only alone with their issue, but somehow it is almost a disgrace. Urinary incontinence affects one in four women! You...


Pelvic floor dysfunction affects about 25% of the women ages 30-70 around the world. While many go undiagnosed and untreated, the symptoms can be frustrating, embarrassing, and lifestyle altering.

Who does it affect? The stage is set for dysfunction with a loss of pelvic support from injury to the pelvic floor tissues. The most common cause is childbirth but other factors can contribute. These include women who are overweight; Women who have asthma or chronic constipation, women who have physically strenuous jobs; women who have had abdominal surgery; women who do strenuous exercises (like weight lifting), and women who are aging. Pelvic pain from various sources can cause spasm of the pelvic floor muscles which can affect voiding and intercourse. If you are lucky enough to...


When I was doing a fellowship in Urogynecology and Pelvic surgery, I met a wonderful Physical Therapist named Kathleen Novicki. She was getting a Master’s Degree in Pelvic Floor Physical Therapy and was several years ahead of what traditional doctors and hospitals were offering patients with pelvic issues. And her results were impressive, to say the least. Some problems are treated well with surgery and others with medications. But some issues fall between the two mainstays of treatment and that’s where Physical Therapy fills the bill. Over the years we have worked together with many patients, resulting in great outcomes without surgery. I have seen women who have suffered for long periods of time and after their initial consultation and examination, we opted for physical therapy...


Many women complain of urine leakage with activity (stress incontinence) or with an uncontrollable urge (urge incontinence).

Some women feel there is a worsening of the urinary incontinence around the time of the menses. Still others notice a worsening of incontinence symptoms with menopause, when estrogen levels drop to very low levels.

That estrogen plays a role in these symptoms is pretty certain, but exactly how it affects urinary incontinence is not clearly understood. Estrogen has a enhancing effect on the vaginal and urethral mucosa, and the pelvic floor muscles, rejuvenating the tissues and making them more elastic.

The most noticeable effects of estrogen on urinary tract symptoms occur when it is applied locally. This provides high levels that produce...