Leaking urine and feces. Organs protruding from our bodies. Painful intercourse. Chronic discomfort. Pelvic floor disorders are medical problems resulting in diminished quality of life for one in three women around the world.

Though pelvic floor disorders are common, they should not be dismissed as “normal.” There are a variety of medical treatment options, from surgery to nerve stimulation to physical therapy, that can alleviate or cure each disorder. There are also many ways to reduce your daily discomfort without ever seeing a doctor. I hope you will find this book a useful guide to care for your pelvic health and overall wellbeing.

I wrote this book for my sisters in suffering. I do not know your pain, but I know my own. To my horror, I discovered that my cervix and an unsightly bulge of vaginal tissue were protruding outside of my body following the birth of my first child. The lack of support or information from doctors added an extra level of stress and uncertainty that I could have done without.

For years, my doctors responded to my concerns as though they were temporary and not particularly significant. They were wrong. What I have aimed to do in this book is give you the information I wish I had from the beginning.

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In addition to sharing lessons learned from my own experiences, I studied medical research literature to fill each chapter of this book with essential information every woman should know. Every woman benefits from becoming informed about her pelvic health and what symptoms to watch for.

The primary causes of pelvic floor disorders are giving birth and aging. I imagine a future where women are assessed for pelvic floor health during pre- and post-natal gynecological appointments and during each annual gynecological exam once they reach 50 years old. Those with symptoms would be referred to a urogynecologist for further assessment and treatment. Until then, this book is my attempt to fill the knowledge gap.

Chapter 1 provides an overview of the prevalence, risk factors, and anatomy of pelvic floor disorders. Chapter 2 takes an unflinching look at vaginal delivery as a physical trauma that can cause lasting damage. Chapter 3 unveils an underdiscussed reality of sexual dysfunction after vaginal delivery. Chapter 4 looks at the impact of pelvic floor disorders on quality of life. Chapter 5 investigates the efficacy of physical therapy for the treatment of pelvic floor disorders. Chapter 6 discusses the impact of additional pregnancies on pelvic floor disorders and explores the historical use of pessaries to provide relief for pelvic organ prolapse. Chapter 7 covers what is known about exercising with leaky or protruding pelvic organs. Chapter 8 is about the surgical treatment of pelvic floor disorders. Chapter 9 suggests new standard medical protocols that would provide comprehensive, holistic health care for women.

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Though women around the world have been coping with pelvic floor disorders since at least the earliest medical records and probably long before then, research related to pelvic floor disorders did not start in earnest until the 1980s. This change is largely due to the efforts of a small but persistent group of doctors who believed that the quality of care for women with pelvic floor disorders needed improvement.

In 1979, five doctors, a mix of gynecologists and urologists, founded what would become the American Urogynecologic Society, with annual meetings and their own research journal. Membership now exceeds 1,900, and there is also a thriving International Urogynecological Association. Leadership within the American Urogynecologic Society advocated for research funding and succeeded in convincing the U.S. National Institutes of Health (NIH) to fund research on pelvic floor disorders. The first dedicated NIH request for applications on pelvic floor disorders was in 1999. As a result, the number of published research papers on pelvic floor disorders has been steadily increasing over the last twenty years. There is finally evidence to drive needed changes in standard protocols for women’s pelvic health.

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As I was writing, I realized that I also want medical professionals to hear my story. If you are a gynecologist, urogynecologist, obstetrician, or pelvic floor physical therapist, this book is also for you. I think it is important for you to understand what these problems are like from the patient’s perspective, which is something we rarely get a chance to share during our short appointments.

More than that, I want to encourage future doctors to enter these specialties. Women’s health has a lot of room for improvement. If you want to be a leader or innovator, women’s health provides a good opportunity to do so. If you want to dramatically change the quality of people’s lives for the better, specializing in Female Pelvic Medicine would give you that chance daily. If you are interested in performing challenging surgeries that restore a woman’s core bodily functions, consider reconstructive surgery for pelvic floor repair.

For a rallying cry from one of your own, consider this statement from M.D. and University of Michigan Professor John O.L. DeLancey.

“Why should we care about this? For millennia, women have paid a lifelong price for their unique role in vaginal delivery, and we as obstetricians and gynecologists are responsible for their care. Given the remarkable scientific tools at our disposal, what is our generation doing to create a safer way for women to give birth?”