Urogynecology and Minimally Invasive Surgery

For more information about our urogynecology services and procedures, please click on the topic of your choice below or from the navigation on the left.


Minimally Invasive Surgery:




Pelvic Pain and Female Sexual Dysfunction

Pelvic pain and female sexual dysfunction are not typically discussed among women; however both are very common problems . Many women will experience pelvic pain and/or sexual dysfunction at some point in their life. Some women may experience pain that resolves quickly, however others will experience more persistent pain or chronic pelvic pain. Pelvic pain may occur with menstrual cycles, bowel movements, urination, exercise, or simple movements such as sitting or standing.

Common types of female sexual dysfunction include:

Hypoactive Sexual Desire Disorder: the persistent or recurrent deficiency (or absence) of sexual fantasies/thoughts, and/or desire for, or receptivity to, sexual activity which causes personal distress.

Sexual Aversion Disorder: the persistent or recurrent phobic aversion to and avoidance of sexual contact with a sexual partner, which causes personal distress.

Sexual Arousal Disorder: the persistent or recurrent inability to attain or maintain sufficient sexual excitement, causing personal distress. It may be express as a lack of subjective excitement or a lack of genital (lubrication/swelling) or other somatic responses.

Orgasmic Disorder: the persistent or recurrent difficulty, delay in, or absence or attaining orgasm following sufficient sexual stimulation and arousal, which causes personal distress.

Dyspareunia: recurrent or persistent genital pain associated with sexual intercourse.

Vaginismus: recurrent or persistent involuntary spasm of the musculature of the outer third of the vagina that interferes with vaginal penetration, which causes personal distress.

NonCoital Sexual Pain Disorder: recurrent or persistent genital pain induced by noncoital sexual stimulation.


Pelvic Organ Prolapse

Have you felt pressure in your pelvic area that won't go away? Pain or discomfort with intercourse? Does it constantly feel like you are wearing a tampon that’s falling out? Have you noticed lately that you're having some loss of bladder control? Perhaps you have difficulty passing stool? If you said yes to any of these questions, it's time schedule a visit to determine if you have pelvic organ prolapse.

The organs in your pelvic cavity—uterus, vagina, bladder and rectum—are held in place by a web of muscles and connective tissues that act like a hammock. When these muscles and tissues become weakened or damaged (typically during childbirth), one or more of the pelvic organs drop out of normal position and literally fall into the vagina. As a result, the organs may press against the vaginal wall and produce a hernia-like bulge causing discomfort, limiting sexual and physical activity or impaired bladder or bowel function.

As we live longer and remain active during these later years, studies show that about 11% of women will need treatment of their prolapse. The kind of treatment your doctor may suggest for you will be determined by the degree and type of prolapse you have. Mild prolapse will often respond to Kegel exercises. A non surgical approach of using a Pessary (a plastic device worn in the vagina at all times) may be the best solution for some women.

 Women who feel their condition compromises their quality of life may want to consider pelvic repair surgery. Prolapse repairs can be done through the vagina. During the procedure, the surgeon repositions the prolapsed organs and secures them to surrounding tissues and ligaments. Increasingly we use synthetic mesh, such as that for abdominal hernia repairs, creating a “hammock” to lift the prolapsed organ and return it to it’s normal position. This is better than traditionally surgery that uses already weakened tissues, resulting in a more durable repair. With the newer minimally invasive treatments, surgery time is reduced, recovery time is quicker and most women experience less pain and more rapid return to regular activities.


Robotic Surgery for Pelvic Organ Prolapse

Robot-assisted sacrocolpopexy is performed in order to correct prolapse (falling of vagina, uterus, bladder, or rectum). In this procedure, which is sometimes done with a hysterectomy, mesh is used to anchor the vagina to the sacral cone (a large triangular bone located in the upper back if the pelvis), thereby lifting the vagina into its normal anatomic position.

Sacrocolpopexy is one of the most successful operations used to correct vaginal vault prolapse, and it is considered by many to be the “gold-standard”. It helps to maintain natural vaginal depth and length. Robotic surgery offers a minimally invasive approach, and because robotic sacrocolpopexy avoids the need for a large abdominal incision, women undergoing this procedure are able to experience a less painful recovery with a significantly quicker return to normal activities than would be possible with open surgery.

How is Robotic Sacrocolpopexy Performed

In this procedure, the patient is placed under general anesthesia and 6 small incisions are made in the upper abdomen. In cases of uterine prolapse, a hysterectomy will also be performed with or without preservation of the cervix. It involves attaching one end of a synthetic mesh to the vagina and the other end to the sacral promontory (upper part of the tail bone or lower part of the spine). Finally, tissues are sewn over the mesh to form a barrier between the mesh and surrounding pelvic organs so that the mesh is covered.

Advantages of Robotic Sacrocolpopexy

  • Reduced recovery time and hospital time
  • Less post-operative pain
  • Maintain natural vaginal length and depth


  • Mesh erosion
  • Chronic pelvic pain
  • Pain with intercourse
  • Failure (recurrence rate <10%)
  • Risks of having surgery itself, including but not limited to bleeding, infection, damage to surrounding structures including bowel and bladder, blood clot, and death


Stress Urinary Incontinence Urethral Sling (TOS)

This revolutionary procedure restores bladder control for women who loose urine when they cough, laugh, sneeze, or exercise (stress urinary incontinence). 1 in 6 women suffer from stress urinary incontinence and many recall that it began after childbirth.  

While Kegel exercises should be attempted first, unfortunately they often fail for more advanced stress urinary incontinence. If a woman has finished having children, a minimally invasive treatment can fix urinary incontinence, allowing her to return to a full and active life.

How does a urethral sling work?

The doctor inserts a strip of mesh-like tape through a ½ inch vaginal incision under the urethra to create a supportive sling. This reestablishes support and allows the urethra to remain closed when appropriate, preventing urine loss during sudden movements or exercise. The procedure takes approximately 15 minutes—and can be performed as an outpatient. Patients treated with a urethral sling go home a few hours after the procedure and can expect a short recovery period, returning to most activities in a few days. During this time, there should be little interference with daily activities; however, you should avoid heavy lifting and intercourse for 4-6 weeks. Dr. Joy Cox, Dr. Jennifer Tatalovich and nurse practitioner Lisa Fournace have a special interest in helping patients with urinary incontinence.


Urinary Incontinence

Urinary incontinence — the loss of bladder control — is a common and often embarrassing problem. The severity of urinary incontinence ranges from occasionally leaking urine when you cough or sneeze to having sudden, unpredictable episodes of strong urinary urgency. Sometimes, the urgency may be so strong you don't get to a toilet in time.

Although urinary incontinence affects millions of people, it isn't a normal part of aging or, in women, an inevitable consequence of childbirth or changes after menopause. It's a medical condition with many possible causes, some relatively simple and self-limited and others more complex. In many situations, urinary incontinence can be stopped. Even if the condition can't be completely eliminated, modern products and ways of managing urinary incontinence can ease your discomfort and inconvenience.


Endometrial Ablation

Most women with heavy periods (menorrhagia) don’t know that recurrent heavy bleeding is not normal — it is a recognized medical condition that afflicts 1 in 6 women worldwide. Many women think that bleeding heavily for consecutive days or changing their pad every hour is something they have to live with. Consequently, they tolerate their period limiting their participation in daily activities.

Heavy menstrual bleeding can be treated simply, safely and successfully. The doctors at Heritage Medical Associate's Heritage Women's Center will help you come to a treatment decision by assessing the amount and frequency of your bleeding and by looking at how your periods affect your life. Several factors will be important to your decision, including whether or not you plan to have children in the future and whether you want ongoing therapy or a one time treatment.

Treatment options for heavy periods include hormones like birth control pills and the Mirena IUD, and increasingly endometrial ablation. 

Endometrial ablation is a procedure that can be performed at our outpatient surgery center, or under local anesthesia in the convenience of our office.  For more information about Endometrial Ablation, please contact our office.