[music playing] Speaker 1: Production of Being Well is made possible in part by, Sarah Bush Lincoln Health System, supporting healthy lifestyles, eating a heart healthy diet, staying active, managing stress, and regular checkups, are ways of reducing your health risks.

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Ke'an: Thank you for tuning in for this episode of being well.

I'm your host, Ke'an Armstrong.

Today we're going to be talking about something that affects females in all different ages.

Joining me today, is Dr. Arturo Menchaca, with Paris Community Hospital, and you are a Euro-Gynecologist.

Arturo: That's correct.

Ke'an: This is a sub-specialty of gynecology.

Am I correct?

Arturo: You're correct.

It's a sub-specialty of both gynecology and urology.

After you do a residency in each one of those, then you do additional training to become a Urogynecologist, or a female Urologist.

Ke'an: Okay, so ... Go in a little bit deeper.

What parts of the female do you treat?

Arturo: The gynecologist usually deal with the female reproductive organs.

That's the uterus, the ovaries, the female pelvic floor, the vagina, the external area in the vulva.

Urogynecology involves also, the interior part of the pelvis, which involves the bladder, the urethra, and the posterior part of the pelvis, which involves the intestines.

Ke'an: Okay.

Arturo: We're involved with the whole pelvic floor.

Ke'an: All right, so that's a lot more than what a gynecologist ... That's where it comes in, where you need the extra training and so forth.

Arturo: Correct.

Yes, so it's an additional three years of training on top of the four years of gynecology.

Ke'an: Okay.

All right.

Well, I'm sure that there's lots of different things that you treat then, so let's talk about some of the different ages that you treat, and some of the different things, the different conditions that come along with that.

Arturo: I usually start treating females, because that's most of what I treat, starting probably from around 10 years of age.

I've done surgery in young girls that are about 10 years of age, up to 90, in the 90's, 95 range.

I see all the women, between those ages.

Ke'an: Right.

A wide range of ages.

Arturo: A wide range.

Ke'an: Okay.

If we start at age 10, is this surgeries?

Have they started their periods yet?

I mean, what is ... Arturo: Well, there's girls that start their periods, when they're eight.

Eight or nine.

Ke'an: Goodness.

Arturo: Depending on their weight ... You know, the heavier girls start periods even as early as eight.

If you have certain problems, of course you start your periods ...

The ovaries wake up and they start producing eggs.

You may have problems with cysts.

You may have problems with pelvic pain, problems with bleeding, so even young girls have issues of that type of problem.

And of course, you go through the teens, the 20's, 30's, and then you go through menopause in your 50's, and then you end up with other problems.

And then, as we get older ... You know, men and females, we start coming up with the problem of cancer.

I also deal with that issue, with cancer.

Women in their 20's, and their 30's, they may have problems with bleeding, problems with fibroid tumors, problems with infertility.

All of that I see in the clinic.

Ke'an: Okay.

Well, let's go back to ... Let's talk about the 10 year old.

You said a surgery.

What type of surgery would you do on a 10 year old, who's having some difficulties?

Arturo: Well, you may have cysts.

They may be in the ovaries that are not going away.

Whenever you have a cyst in the ovary, if it's large enough, and the girl is very active, you may have what we call a torsion, that it twists on itself, and then you have an emergency type of situation, where you have to go in, and do laparoscopy, and untwist it, before it dies.

A lack of oxygen to any part of the body can kill the organ.

You can have that.

You can have internal bleeding from a ruptured cyst.

You can have infections.

That type of thing.

You don't see 'em as much in that age group.

You see it more in a little bit older group.

Ke'an: Okay.

More the teenage years.

Arturo: The teenagers then, yes.

I have seen young girls that I've done surgery on ... Ke'an: Okay.

Arturo: that are very young.

Ke'an: All right.

And then speaking of the teenage years, what are some of the difficulties that females can interact with, or ... What are some of the different things that bother females in the teenage years?

Arturo: The usual things that I just mentioned.

Problems with ovulation.

Problems with pelvic pain.

It's a common thing.

There is and acceptable amount of pain that you can have with periods.

And then you get into the non-acceptable pain.

Those pains, they can cause girl to not be able to go to school.

Ke'an: Yes.

Arturo: Incapacitating type of pain.

Ke'an: Right.

Arturo: And then you have to start thinking of problems.

One of the most common problems where you get chronic pelvic pain, especially during the time of periods, is something called endometriosis.

That's when you have the endometrium, which comes out as the period, is growing in the wrong place.

Ke'an: Okay.

Arturo: It can be growing in the walls of the uterus, or it can be growing in the pelvis, most commonly, but it can be growing any place in the body.

It's an unusual disease.

We don't know why some women get it.

Ke'an: Yeah.

That's what I was going to ask.

What causes endometriosis?

We don't know yet.

Arturo: We don't know yet.

It's most likely a genetic thing.

It's most likely an immune problem, because it is associated with other immune problems, autoimmune problems.

People, they have rheumatoid arthritis, [inaudible 00:07:08], thyroid, and autoimmune problems.

It's most likely related to that.

Ke'an: Okay.

What kind of treatment is available for teenage girls, who have this sort of problem?

Arturo: The main thing that we worry about, is the girl's fertility, maintenance of fertility.

If you ignore a girl that's having pain, and it is secondary to endometriosis, and you don't do anything, by the time they're in their 20's, or 30's, they become infertile.

Ke'an: Okay.

Arturo: We do have to take that into account.

We're more aggressive in treating a young girl with pains, pelvic pains, than we are with somebody that has already has their children, and doesn't desire anymore children, because then we don't have to worry about fertility.

In a young girl that still hasn't made up their mind, whether they want to have babies, we do have to take that into account.

Ke'an: I understand.

Is there a way to remove the endometriosis, without harming the fertility?

Arturo: Yes.

The main thing, we initially have the girl come in.

We talk to her, and just by the history and the symptoms, we suspect that she may have endometriosis.

And then we do an ultrasound, which also gives us some signs that may be pointing towards endometriosis.

The only way that we can diagnose endometriosis, is by doing a procedure called, a laparoscopy.

You make a small incision, about a fourth of an inch.

You put an instrument called a leptoscope, and you put a camera in that.

Then, we can see inside the pelvis.

And then, if we need to excise any of that, then we put an additional tool, they're little incisions, and we put instruments through there, and we excise things.

Ke'an: Okay.

Arturo: Yeah.

Ke'an: Is this an outpatient type of treatment?

Arturo: It's an outpatient treatment.

Once, we have diagnosed the problem ... Once the patient comes back, then we give her options.

They're mostly medical options, to try and control the endometriosis.

We cannot get rid of endometriosis, but we most certainly can control most of it ... Ke'an: Okay.

Arturo: most of the time.

Ke'an: All right.

Now, some signs or symptoms of a female who may have endometriosis.

What's some things that can look out for?

Arturo: Chronic pelvic pain, especially when they have the period.

Pain with intercourse.

Excessive bleeding with clots.

Cysts.

Masses in the pelvis.

Those are the most common complaints that they give.

Also, gastrointestinal symptoms, like nausea, vomiting, and diarrhea.

Ke'an: Okay.

Arturo: There are certain chemicals, called prostaglandins, that endometriosis makes, and those affect the gastrointestinal tract.

Ke'an: Okay.

All right.

That's interesting to know.

I'm sure there's a lot of girls out there that are wanting to know this information, and are tired of dealing with that pain.

Arturo: Definitely.

You know, the main thing is to come in as early as possible, because then it allows us to help 'em, and to avoid all these problems.

Not only do you have the pain, but you can't sleep the right way, you're constantly walking around with pain the whole day, so you're grouchy, because you haven't slept, and you're grouchy because you have pain.

Ke'an: You just don't feel good.

Arturo: You don't feel good.

I mean, if I don't sleep right, I'm gonna be grouchy.

Ke'an: Right.

Arturo: I'm not feeling right.

Constant pain ...

I mean, you're just not relaxing.

Ke'an: No.

Arturo: You can't relax.

Ke'an: No.

So, what's the difference between endometriosis and fibroids?

Arturo: Endometriosis is abnormally placed endometrium, which is what comes out as the period.

Fibroids are tumors of the muscle, of the uterus.

Ke'an: Okay.

Arturo: Those are solid tumors.

At the age of 40, 40% of women have fibroids.

They're very common.

Most of 'em are benign, if they're small, and they're not bothering you, just ignore them.

If they're growing very quickly, then you have to rule out something, that may be malignant, something called sarcoma.

They are misbehaving, you know, for whatever they're doing, either causing pain, or causing infertility, or causing a problem, then we have to also take 'em out.

Ke'an: Okay.

And how invasive is that?

Arturo: Well, it depends how big they are.

We can also, most of the time, take care of them with the laparoscope.

Ke'an: Oh.

Okay.

Arturo: If they're very large, then we have to make an opening, larger incision.

There's a problem with very fast growing tumors, that they may be cancer ...

If we're gonna use the laparoscope, we have to put a plastic bag through a small opening, put the specimen in there, and then try to take it out in small pieces, but within the bag ... Ke'an: Okay.

Arturo: because we don't want to break it up inside.

If it's cancer, it will go all over the abdomen.

Ke'an: Okay.

Arturo: We have to recognize there may be a possibility with it ... Ke'an: All right.

Arturo: so that we avoid further problems.

Ke'an: And, so what's the difference between cysts and Fibroids?

Arturo: Cysts are collections of fluid, like a balloon filled with water ... Ke'an: Okay.

Arturo: That would be a cyst.

Ke'an: All right.

Arturo: A fibroid is solid tumor.

Usually cysts you get 'em in the ovaries, or you get 'em in the tubes, in areas ...

In Fibroids, they usually come from the uterus itself.

Ke'an: Okay.

All right, so these are some things that may be happening in younger years, and maybe going in through your teenage years, your young female years.

What's some things that some females may struggle with, maybe like, in their 20's to 40's?

Arturo: It depends on whether the female has babies or not.

Ke'an: Okay.

Arturo: Because once you put in the pregnancy factor into it, you add on whole bunch of other things that come into play.

If the female does not have a baby, well she's just an extension of the teenage years, dealing with abnormal bleeding, and endometriosis, fibroids, cysts, that type of thing.

Once you get pregnant, then you add another big factor into the equation.

Once you get pregnant, of course, tissues, you have tissues that expand, tissues that lose their tension.

Then you start having the pelvic organs dropping ... Ke'an: Okay.

Arturo: Stretching of the ligaments.

Stretching of the organs, the uterus, the bladder.

If you deliver by vaginal delivery, then you can have torn the pelvic floor will tear, and then you start having hernias.

Ke'an: Okay.

Arturo: And then you start having what we call prolapses, or dropping of the bladder, dropping of the uterus, or dropping of the rectum.

And then you have additional problems, which can be incontinence, because the bladder has dropped, and you lose pressure in the Urethra, which is the little tube that comes from the bladder to the outside.

When your bladder is full, you empty your bladder through the urethra, and if you lose pressure there, or if it becomes hyper mobile, then you will start having loss of urine, otherwise known as urinary incontinence.

Ke'an: Which is no fun for anybody.

Arturo: Which is no fun for anybody at all.

Ke'an: No.

No.

So, getting pregnant and having a baby is great and wonderful, and it's a full joy, but it could also lead to some problems within [crosstalk 00:14:43] the body.

Talk to me about some different things that will help treat some of these conditions, that you just mentioned.

Arturo: If it's a minor thing with incontinence, we usually teach the patient to do what we call Kegel exercises.

Kegel exercises are exercises of the pelvic floor, not the buttocks, not the thigh, not the abdomen, but the pelvic floor itself.

That will kind of strengthen the pelvic floor, and prevent some of the incontinence.

If that does not work, then we have to think about some additional surgery to put pressure and stability to the urethra.

The way that we do that is, by putting ribbon underneath the urethra, to increase the pressure, or to stabilize it.

It's made out of a portion of mesh.

It's a thin ribbon, probably, no more than half an inch in size.

If the pelvic floor is torn, then we also have to repair the pelvic floor, push the pelvic organs up where they should be, and then repair the pelvic floor.

If it's a large defect, then we have to start thinking of using additional products to help [inaudible 00:15:58] the repair.

It could be made out of animal tissue, or in my case, because I'm a specialist, they usually send me large defects, I use mesh.

Ke'an: All right.

Arturo: I'm sure that you've seen commercials on TV, regarding mesh, and that's what I use.

Ke'an: Okay.

Arturo: The only people using mesh right now, are mostly Urogynecologist.

Most general gynecologists and urologists are no longer using mesh, because of the problems that you can have with mesh.

Ke'an: Okay.

All right.

That's to help hold up organs.

Talk to me about pelvic floor reconstruction.

Arturo: Pelvic floor reconstruction is ...

I'll just mention a little bit.

What happen is, that when you have babies, or even when you go through mesopause, you lose estrogen, you have weakening of the tissue.

If you are overweight, or you have any type of disease that will make you chronically increase your abdominal pressure.

If you have asthma, or coughing, or allergies, and you're coughing and putting pressure in the abdomen, they will transfer to the pelvic floor, and that will weaken the pelvic floor.

Even paratroopers, female paratroopers have been known ...

There was an article written on how, just because they're jumping out of planes and landing hard, they weaken the pelvic floor, and they end up with incontinence.

Ke'an: Okay.

Arturo: What we do is ... Again, reconstruct the pelvic floor, push the pelvic organs up where they should be, and reconstruct the pelvic floor.

If needed, put additional products that will help the reconstruction.

Ke'an: Okay.

All right.

That's fascinating.

Lots of different ways to help somebody out.

Arturo: Yes.

Ke'an: Let's talk about some things that might affect a woman later in life, as well.

We've talked about young, moving into getting pregnant, having the pregnant, some things that can happen.

What about when you're in menopause, and then further?

Arturo: Well, when you're in menopause, and you're getting to menopause, and by definition, is a year after your last period.

Then, you're no longer producing estrogen and progesterone.

Estrogen and progesterone is very helpful, because it keeps the tissue young, and strong.

Once you no longer have it, that's when women start having weakening of the pelvic floor tissues.

Also, side effects in the bladder.

Frequency, urgency, the bladder becoming spastic, and then you lose urine.

The main big thing that happens in the females, once they go through menopause.

The things that happen when you were young, become more severe, or aggravated when you go through menopause.

Ke'an: Okay.

Arturo: And then of course, the factor as we age, we start getting into the problem with cancer.

That's just a fact of life.

You know, some of the carcinogens that are in our environment ... if you smoke, you're going to increase your factors by, I don't know, by 100's, of getting any type of cancer.

Ke'an: Right.

Arturo: And then you start dealing with cancer of the uterus, cancer of the cervix, cancer of the ovaries.

That's another big thing that comes with age.

Ke'an: Okay.

Now, if a female has all of the organs removed, as far as a hysterectomy, do we still need to worry about cancer in that area of the body?

Arturo: Well, if you remove the uterus, and the ovaries, most of the time, you don't.

There's also a few times, when there are, what we call ovarian remnants that remain, and you can still get cancer.

Even if you remove the uterus and the ovaries, and the tubes, and you have endometriosis, and then you start taking hormone replacement therapy, you may wake up the endometriosis again.

Ke'an: Oh.

Okay.

Arturo: So ... Ke'an: It can come back.

Arturo: Yeah, so you have to take these things into account.

Just because you had a hysterectomy, and you had the ovaries taken out, doesn't mean that you cannot have female problems.

Ke'an: Okay.

Arturo: You can still have 'em.

Ke'an: All right.

Now, I have heard of something called, a Mona Lisa procedure.

Arturo: Yes.

The Mona Lisa procedure is a name specifically put there by a company to name a procedure.

Other different companies have like, V-Lase, which comes from vaginal lasering.

Different names are given by each company that makes a laser.

What it is, is laser treatment of the vaginas, specifically carbon dioxide, CO2 laser treatment to the vagina.

I started using the laser in 1983.

It was mostly used for destruction of lesions.

As time came on, like in the 90's, they combined the laser with the computer.

And now they were able to fire the laser very quickly and in different densities.

And slowly, slowly it came into the aesthetic market, the cosmetics market.

They started using the laser in the face for facial rejuvenation.

If you have wrinkles, if you have lesions, those can be treated with lasers.

What happens is that when you treat the skin with the laser, you heat the collagen and you get new collagen, and you can get rid of wrinkles.

The same thing happened a couple of years ago.

They started treating the vaginal tissue and lo and behold, we get the same type of effect.

We get increased collagen.

We get more elasticity.

We get more moisture, because now you have new vessels, getting built.

Women that are having problems with intercourse are now able to have intercourse, because before it was so tight, there was no elasticity, there was no moisture.

Now with the treatment of the CO2 laser, they now can enjoy having sex again.

Ke'an: Okay.

Well, that's something that I'm sure a lot of people are looking to find out right there.

Arturo: Yeah.

Especially women that have had breast cancer, or have had clots, they cannot use estrogen.

If you're ... After menopause, the most common thing is to use estrogen, so that you can have vaginal rejuvenation.

Those women specifically, they cannot use estrogen, then we have the option of using the CO2 laser.

Ke'an: Okay.

Well, we've talked about a lot of different things that you treat, the conditions ...

Does somebody need a referral to see a Urogynecologist?

Arturo: No.

If you have a problem with incontinence, or you have a problem with prolapses, you can self refer yourself.

You say, "Okay, well ..." There's not that many of us.

I'm the only Urogynecologist in the whole central state of Illinois.

Ke'an: Oh.

Okay.

Arturo: There's not even a Urogynecologist in Champaign-Urbana, or Terre Haute.

I'm the only one in western Indiana, and Central Illinois, that has been trained in this subspecialty.

Ke'an: All right.

That's good to know as well.

We just have a couple of minutes left.

You mentioned earlier, that you treat the whole entire pelvic floor.

If someone is having some intestinal issues, what would make them think about coming to a Urogynecologist, such as yourself, instead of a gastroen ... Arturo: Usually they go to a gastroenterologist.

Ke'an: Okay.

Arturo: If they cannot find anything, they usually are referred to me, because if it's a gastrointestinal thing, they usually think, "Well, gastroenterology first of all."

If they have a colonoscopy, they can't find anything, they still have nausea, vomiting, around the time of the period, then they should start thinking that the patient may have endometriosis.

If it's a cyclical type of symptom that they get, then you start thinking about a hormonal issue.

Ke'an: Okay.

Arturo: That's when they start referring me patients.

Ke'an: Okay.

At the beginning when we started talking you said, "I see girls ages 10 to 12, all the way up to their 90's."

And you said, "That's what I see for the most part."

Do you treat men?

Arturo: No.

I don't treat men.

I do other cosmetic things, so I could treat liposuction, that type of thing.

Ke'an: Oh.

Okay.

Arturo: That's an added thing that I do.

Ke'an: Right.

Arturo: Usually I don't treat men.

You know, if it's the husband of one of my patients, it's an emergency, and they say, "Well, you know my husband has this ..." I said, "Okay.

Fine.

I'll bring him in."

I also do some dermatology.

You know, so I get referrals for excision of facial things, tumors, and that type of thing, so I do treatment.

Ke'an: You do treatment for other things, but ... Arturo: For other things, but not for Urogynecology.

Ke'an: That's another topic for another day.

Arturo: That's another topic for another thing.

Yes.

Ke'an: Okay.

Well, this has been very interesting, and I'm sure very educational for a lot of women out there, and young girls.

Thank you so much for coming in today.

Arturo: Well, thank you for inviting me.

Ke'an: It's been a pleasure talking about this with you.

Arturo: And, if anybody has any questions, please call the office, and I'll be happy to talk to anybody.

Ke'an: All right.

And we thank you for watching this episode of Being Well, and we'll see you next time.

Speaker 6: Production of Being Well is made possible in part by ... Speaker 3: HSHS St. Anthony's Memorial Hospital, Delivering compassionate care, close to home.

From advanced surgical techniques, and testing, to convenient care for your family.

We promise to make a healthy difference each and every day.

St. Anthony's.

Together, we are better.

Speaker 1: Sarah Bush Lincoln Health System, supporting healthy lifestyles.

Eating a heart healthy diet, staying active, managing stress, and regular checkups are ways of reducing your health risks.

Proper health is important to all at Sarah Bush Lincoln Health System.

Information available at sarahbush.org.

Speaker 7: Rediscover Paris.

Speaker 2: Our Patient care and investments in medical technology, show our ongoing commitment to the communities of East Central Illinois.

Paris Community Hospital Family Medical Center.

[music playing]