Pelvic & Sexual Health
What Is a Urogynecologist? What They Treat and When to See One
A urogynecologist is a doctor who specializes in pelvic floor disorders in women: bladder leakage, overactive bladder, pelvic organ prolapse and problems with bowel control. Most first train as OB/GYNs (some as urologists), then complete an extra fellowship in Urogynecology and Reconstructive Pelvic Surgery. They offer both non-surgical treatment and surgery.
If you've been told "that's just what happens after kids" or "it's normal at your age," this is the specialist who can tell you what's actually going on, and what can be done about it. Most people who finally book wish they had gone years earlier.
What they treat
Urogynecologists look at how the bladder, vagina, uterus and rectum, plus the muscles holding them up, work together. Common reasons to go:
- Stress urinary incontinence: leaking with coughing, sneezing or exercise
- Urge incontinence and overactive bladder: sudden urges, frequent peeing, waking at night to go
- Pelvic organ prolapse: the bladder, uterus or rectum dropping into the vagina. People often describe it as "something falling out" or sitting on a small ball.
- Fecal incontinence: leaking stool or gas
- Trouble emptying the bladder
- Recurrent urinary tract infections
- Bladder pain syndrome / interstitial cystitis
- Complications from prior pelvic surgery or mesh
- Fistulas: abnormal openings between the bladder or bowel and the vagina
- Pelvic floor injuries from childbirth, including major tears
Read more about the two most common reasons: stress vs urge incontinence and pelvic organ prolapse.
Their training
Board-certified urogynecologists in the U.S. typically have:
- Medical school
- A four-year residency in obstetrics and gynecology (or a urology residency)
- A fellowship, typically three years, in Urogynecology and Reconstructive Pelvic Surgery
- Subspecialty board certification through the American Board of Obstetrics and Gynecology or the American Board of Urology
The subspecialty used to be called Female Pelvic Medicine and Reconstructive Surgery (FPMRS), and you'll still see that name on some websites and insurance directories.
Urogynecologist vs. gynecologist vs. urologist
| General gynecologist | Urogynecologist | Urologist | |
|---|---|---|---|
| Patients | Women, all gyn needs | Women with pelvic floor disorders | All genders, urinary and male reproductive |
| Training | OB/GYN residency | OB/GYN or urology residency plus pelvic floor fellowship | Urology residency |
| Incontinence | Basic evaluation and many treatments | Full range, including complex and repeat cases | Yes, especially kidney or bladder causes |
| Prolapse | Diagnosis, pessaries, some surgeries | Full range of prolapse surgery and pessaries | Some, depending on training |
| Kidney stones, bladder cancer | No | Usually refer out | Yes |
Many general OB/GYNs handle mild incontinence and fit pessaries. A urogynecologist adds depth when problems are complex, when first treatments haven't worked, or when surgery is on the table.
Your first visit, step by step
Plan on a longer appointment than a regular gyn visit. Expect:
- A detailed history of bladder, bowel and sexual symptoms, pregnancies, surgeries and medicines. Yes, they'll ask about stool and gas. They ask everyone.
- Questionnaires about how symptoms affect daily life
- A bladder diary to complete before or after the visit (if they mail one ahead, fill it in; it shortens the path to an answer)
- A urine test to check for infection or blood
- A pelvic exam, often while you bear down or cough, sometimes standing. It feels odd to be asked to push or cough during an exam, but that's how prolapse and leakage show themselves.
- A post-void residual check, usually a quick ultrasound to see how much urine stays in your bladder after you pee
Some women need more testing:
- Urodynamics: measures bladder pressure and function while the bladder is filled through a thin catheter. It takes a while and is mildly uncomfortable rather than painful for most people.
- Cystoscopy: a small camera looks inside the bladder.
Do they only do surgery?
No. Even though they're surgeons, much of their work is non-surgical, and they usually start with the least invasive option. Many patients never have an operation.
Non-surgical
- Pelvic floor physical therapy referral
- Bladder training and diet changes
- Pessaries for prolapse or incontinence
- Medicines for overactive bladder
- Vaginal estrogen for menopausal tissue changes
Office procedures
- Bladder Botox injections
- Urethral bulking injections
- Percutaneous tibial nerve stimulation
Surgery
- Midurethral slings for stress incontinence
- Prolapse repair through the vagina or abdomen (including laparoscopic or robotic sacrocolpopexy)
- Sacral neuromodulation implants
- Repair of fistulas or childbirth injuries
Seeing a urogynecologist doesn't commit you to surgery. It gets you a full evaluation and the complete list of options.
Questions to ask
- What type of incontinence or prolapse do I have, and how severe is it?
- What can I try before surgery?
- How long should I try a treatment before deciding whether it works?
- If I need surgery, which procedure, and why?
- What are the success rates and possible complications in your experience?
- Will mesh be used, and what kind?
- How long is recovery, and when can I go back to work, lifting and exercise?
- Will this affect sex or a future pregnancy?
- Do you work with a pelvic floor physical therapist you'd recommend?
Bring your medicine list, prior surgical records and a bladder diary if you have one. If you're planning more children, say so; it can change which treatments make sense.
When to see a doctor, and when to see a urogynecologist
Start with your gynecologist or primary care clinician for new bladder or pelvic symptoms. Ask for a urogynecology referral if:
- Leakage or urgency hasn't improved after first-line treatment
- You can feel or see a bulge in the vagina
- You're considering surgery for incontinence or prolapse
- You've had pelvic surgery before and symptoms came back
- You have both bladder and bowel control problems
- You've had complications from vaginal mesh
- You keep getting UTIs without a clear cause
Get prompt care for blood in the urine, being unable to pee, fever with urinary symptoms, or bleeding after menopause.
Finding a urogynecologist in New York
Urogynecologists practice at academic medical centers, hospital systems and private practices across the five boroughs, Long Island and the Hudson Valley, though they're concentrated in Manhattan and the larger suburban hospital systems. Whether you need a referral depends on your plan: many PPOs let you book directly, while HMO and many Medicaid managed care plans require one from your primary care clinician or gynecologist. When choosing, check:
- Board certification in Urogynecology and Reconstructive Pelvic Surgery
- Whether they take your insurance, and whether you need a referral
- Which hospital they operate at, if surgery is a possibility
- Whether they work closely with pelvic floor physical therapists
Browse urogynecologists in the New York area, or narrow it down, for example urogynecology in Manhattan or Suffolk County. You can also search by ZIP code.
Frequently asked questions
What does a urogynecologist do?
A urogynecologist diagnoses and treats pelvic floor disorders in women, including urinary and fecal incontinence, overactive bladder, pelvic organ prolapse, and some bladder pain conditions. They offer both non-surgical treatments and pelvic reconstructive surgery.
What is the difference between a urologist and a urogynecologist?
A urologist treats urinary tract and male reproductive problems in all genders. A urogynecologist is a subspecialist, usually trained first as an OB/GYN, who focuses on female pelvic floor disorders and how the bladder, vagina, uterus and bowel work together.
Do I need a referral to see a urogynecologist?
It depends on your insurance. Many PPO plans let you book directly, while HMO and many Medicaid managed care plans require a referral from your primary care clinician or gynecologist.
Sources
- AUGS — What Is a Urogynecologist? (patient resources)
- American Board of Obstetrics and Gynecology — Urogynecology and Reconstructive Pelvic Surgery subspecialty
- ACOG — Urinary Incontinence in Women (Practice Bulletin 155)
- ACOG/AUGS — Pelvic Organ Prolapse (Practice Bulletin 214)
This article is for general education and is not medical advice. It does not replace an evaluation by a licensed clinician who knows your history. If you think you have a medical emergency, call 911.