Skip to Main Content

Incontinence and Female Sexual Dysfunction

Incontinence and Female Sexual Dysfunction

Dr. Tuckson's guest is Dr. Lori Warren, a partner at Women First of Louisville and co-director of the MIGS Fellowship at UofL.
S13 E15 Length 27:51 Premiere: 1.14.18

Helping Women with Incontinence and Female Sexual Dysfunction

Female sexual dysfunction does not get nearly as much media attention as its male counterpart, especially in television advertising, but it affects millions of women. Urinary incontinence is also a common problem for women due to a variety of causes, and is often difficult to discuss between patient and provider. The good news is that there are more treatments than ever before to help women overcome sexual dysfunction and/or incontinence in order to regain normal, healthy function in the most personal aspects of their daily lives.

In this episode of Kentucky Health, host Dr. Wayne Tuckson talks about the causes of female sexual dysfunction and incontinence with a Louisville OB-GYN. We also learn about the latest and most effective treatments for both conditions. Viewers are cautioned that some may not be comfortable with the physiological terms and descriptions of female sexuality discussed in this program.

Dr. Lori Warren is an obstetrician and gynecologist with Women’s First in Louisville, and is the co-director of the MIGS Fellowship program at the University of Louisville’s OB-GYN department.

Warren is the founder of the nonprofit Pass the Pearls, which is dedicated to spreading awareness about minimally invasive surgical options for women in obstetrics and gynecology. And she also operates Spa V, a medical practice in Louisville devoted to vaginal and sexual health that offers patients different, more holistic services than she provides at Women’s First.

Warren strives to stay at the forefront of innovation in treating women’s sexual dysfunction and incontinence. She says that there are a variety of technical advances that make surgery far less invasive than in years past, and less stressful for the patient. She mentors young medical students in this techniques through the MIGS (Minimally Invasive Gynecological Surgery) Fellowship.

“Now, a lot of our surgeries can be done through very tiny incisions – really big surgeries – through tiny incisions where the patient goes home a lot quicker,” she says. “These women are taking care of their families, many of them are working full time. It makes a huge impact on their lives if they can get back to work quicker.”

Causes and Remedies for Female Sexual Dysfunction
Warren says that the issues of female sexual dysfunction and urinary incontinence are difficult to discuss for some patients, while others are upfront about their problems. Sexual dysfunction can manifest in a variety of ways. “It’s a range of different things,” she says. “It can be lack of desire, lack of arousal, difficulty achieving an orgasm, it can be pain. Painful sex is also along the range of sexual dysfunction.”

In many cases, but certainly not all, sexual dysfunction affects women after they go through menopause around age 50. Warren says that women, as they age, produce less hormones, specifically estrogen. This causes profound changes in the vagina that affects its sensitivity – the vaginal wall will thin out, resulting in a lack of moisture but also changes in the collagen and elastin levels, which give tissue firmness and help it remain in its original shape.

Warren says that these changes can be assessed during a physical exam. The medical term is vaginal atrophy. “The mainstay of treatment for vaginal atrophy is using local estrogen,” she recommends. While some women will require systemic estrogen therapy for other changes that come with menopause, such as hot flashes, night sweats, and so on, other women seek only to alleviate specific problems with sexual dysfunction. For them, local estrogen applied directly to the vaginal area is the preferred treatment option.

There are different reasons younger women may experience a lack of sexual interest, Warren says. Usually, it’s not due to a lack of estrogen. Instead, it may derive from an endocrine disorder, changes in overall health and lifestyle, from a sexually transmitted disease, or from body image issues.

Warren says that anatomical problems within the vagina may also affect sexual function. Some may experience prolapse issues, where a weakness in the pelvic floor causes the uterus to shift downward, resulting in painful intercourse. There is an increased chance of prolapse after childbirth for women and as they age.

Another common condition that can lead to painful intercourse and a loss of sexual desire is endometriosis. “Endometriosis is a condition where glands that should be inside the lining of the uterus, which is called the endometrium, actually get out into the pelvis,” Warren says. This can cause scarring and also lead to infection.

There are surgical remedies for prolapse and endometriosis, and as noted above, Warren is a champion of newer, minimally invasive procedures. She is also experienced in cosmetic surgery such as labioplasty and vaginoplasty. “Those procedures help with the aesthetic of the vagina,” she says. Labioplasty alters the appearance of the labia minora (folds of vertical tissue on the exterior of the vagina), while vaginoplasty is used for vaginal tightening. Many women seek cosmetic surgery after giving childbirth, Warren says, especially if the birth was difficult.

Urinary Incontinence: Diagnosis and Treatment
As with female sexual dysfunction, Warren says that no two cases of urinary incontinence among women are exactly the same. One of the more common types is known as stress urinary incontinence, which occurs during exertion. This can affect women after childbirth, but is more prevalent among active women such as athletes or those who exercise regularly.

“It can be life-changing if they get the right treatment, because although some women aren’t really bothered by it, other women, it really affects their quality of life,” Warren says. “They know where every bathroom in town is, and they’re really hampered by leaking urine.”

During a physical exam, Warren will look for a different angle of the urethra relative to its normal placing. That is evidence of stress urinary incontinence, she says. Some patients might be candidates for surgical treatment, but there are several holistic treatments that can be applied prior to surgery.

“I talk to patients about doing the Kegel exercises,” she says. “I think a lot of people know what that is, it is where we contract the pelvic floor. You do three sets of ten, and you really work on improving those pelvic floor muscles. That can also be done with a physical therapist.”

Warren says some clinical studies have shown that losing weight can decrease incontinence, and she will recommend a diet and exercise regimen to patients if appropriate. The standard surgical treatment for stress urinary incontinence is a trans vaginal taping. In this surgery, a mesh taping is placed under the urethra to keep it in its normal position. “The improvement in incontinence is really life-changing for these women, and that has the highest success rate of about 85 to 90 percent,” she says.

Another type of incontinence, where urinary loss is constant, is often the result of an overactive bladder, Warren says. When examining patients who present with this type, Warren will check whether the nerve transmissions between brain and bladder along the spinal cord are normal, and check for a condition called intrinsic sphincter deficiency, which results in low pressure inside the urethra.

“The more typical type of incontinence that seems to happen, is my patients will say, ‘I can’t make it to the bathroom. I don’t leak when I cough or sneeze, but boy, when I have to go, I have to go, and I cannot make it,’” Warren says. “And those patients can be treated sometimes both with physical therapy and medication.”

Two newer treatment modalities that can help restore sexual function and desire and also reduce incontinence are CO2 (carbon dioxide) laser surgery and platelet-rich plasma injections. Warren is excited about the effectiveness of both treatments.

“Plastic surgeons have been doing fractionated CO2 for over 20 years in resurfacing the face, the neck, and different areas for cosmetic reasons, and there are special vaginal probes that are now available that deliver this type of energy to the vagina,” Warren says. “And this can help to what we call ‘rejuvenate’ the vagina by making it younger, by making that vagina thicker, much like estrogen does, and also improving the blood flow, what we call angiogenesis, or new blood vessels around the urethra and along the vagina, so that some of the changes from the lack of estrogen can be mitigated by using the CO2 laser. And it also can  help with incontinence and the overactive bladder problem I was talking about.”

Injecting platelet-rich plasma has also been used for a variety of conditions – orthopedics, dermatology, plastic surgery, and even for hair restoration. In the procedure, the patient has blood drawn which is then placed into a machine, which centrifuges the blood and separates out the platelet-rich plasma.

This plasma has a greater concentration of growth factors, which can help to rejuvenate tissue, and in Warren’s practice, it is injected into the vagina. “Platelet-rich plasma can be used both for sexual dysfunction and also for urinary incontinence,” she says. “It’s an amazing field that’s really just beginning. It does great work, but I think it’s going to be used for even other indications as time goes on.”

Program Details

Kentucky Health

About Kentucky Health

Learn how to improve your health through education and increased awareness. Dr. Wayne Tuckson, a colorectal surgeon in Louisville, hosts.

TV Schedules

Jump to Recent Airdates

Upcoming

Telemedicine: Better Than Dr. Google

William C. Thornbury, MD, medical director and CEO of Medical Associates Clinic in Glasgow, Kentucky, and board chair of the Kentucky Medical Association, talks about advances in telehealth.

  • Friday April 23, 2021 1:30 pm ET on KETKY
  • Friday April 23, 2021 12:30 pm CT on KETKY
  • Friday April 23, 2021 6:00 pm ET on KET
  • Friday April 23, 2021 5:00 pm CT on KET
  • Friday April 23, 2021 11:30 pm ET on KET
  • Friday April 23, 2021 10:30 pm CT on KET
  • Sunday April 25, 2021 12:30 am ET on KETKY
  • Saturday April 24, 2021 11:30 pm CT on KETKY
  • Sunday April 25, 2021 7:00 am ET on KET2
  • Sunday April 25, 2021 6:00 am CT on KET2
  • Sunday April 25, 2021 9:00 am ET on KETKY
  • Sunday April 25, 2021 8:00 am CT on KETKY

Public Health: Where Do We Go From Here?

The COVID-19 pandemic illuminated the strengths and limitations of our public health infrastructure. Craig Blakely, Ph.D., dean of the University of Louisville School of Public Health, discusses the future of public health.

  • Sunday April 25, 2021 12:30 pm ET on KET
  • Sunday April 25, 2021 11:30 am CT on KET
  • Sunday April 25, 2021 5:30 pm ET on KETKY
  • Sunday April 25, 2021 4:30 pm CT on KETKY
  • Monday April 26, 2021 2:00 pm ET on KET2
  • Monday April 26, 2021 1:00 pm CT on KET2
  • Friday April 30, 2021 1:30 pm ET on KETKY
  • Friday April 30, 2021 12:30 pm CT on KETKY
  • Friday April 30, 2021 6:00 pm ET on KET
  • Friday April 30, 2021 5:00 pm CT on KET
  • Friday April 30, 2021 11:30 pm ET on KET
  • Friday April 30, 2021 10:30 pm CT on KET
  • Sunday May 2, 2021 12:30 am ET on KETKY
  • Saturday May 1, 2021 11:30 pm CT on KETKY
  • Sunday May 2, 2021 7:00 am ET on KET2
  • Sunday May 2, 2021 6:00 am CT on KET2
  • Sunday May 2, 2021 9:00 am ET on KETKY
  • Sunday May 2, 2021 8:00 am CT on KETKY

Emergency Departments in Rural Kentucky

Dr. William Moss, medical director of the emergency department at Med Center Health in Bowling Green, talks about the changing dynamics in emergency departments in rural Kentucky.

  • Sunday May 2, 2021 12:30 pm ET on KET
  • Sunday May 2, 2021 11:30 am CT on KET
  • Sunday May 2, 2021 5:30 pm ET on KETKY
  • Sunday May 2, 2021 4:30 pm CT on KETKY
  • Monday May 3, 2021 2:00 pm ET on KET2
  • Monday May 3, 2021 1:00 pm CT on KET2
  • Friday May 7, 2021 1:30 pm ET on KETKY
  • Friday May 7, 2021 12:30 pm CT on KETKY
  • Friday May 7, 2021 6:00 pm ET on KET
  • Friday May 7, 2021 5:00 pm CT on KET
  • Sunday May 9, 2021 12:30 am ET on KETKY
  • Saturday May 8, 2021 11:30 pm CT on KETKY
  • Sunday May 9, 2021 7:00 am ET on KET2
  • Sunday May 9, 2021 6:00 am CT on KET2
  • Sunday May 9, 2021 9:00 am ET on KETKY
  • Sunday May 9, 2021 8:00 am CT on KETKY

Sepsis: The Serious Side of Infections

Dr. Tuckson speaks with Dr. Benjamin Klausing, an infectious disease specialist with Baptist Health Medical Group, about sepsis, a potentially deadly condition that occurs when our bodies are not able to mount an effective immune response to a virus, bacteria or fungus.

  • Sunday May 9, 2021 12:30 pm ET on KET
  • Sunday May 9, 2021 11:30 am CT on KET
  • Sunday May 9, 2021 5:30 pm ET on KETKY
  • Sunday May 9, 2021 4:30 pm CT on KETKY
  • Monday May 10, 2021 2:00 pm ET on KET2
  • Monday May 10, 2021 1:00 pm CT on KET2
  • Friday May 14, 2021 1:30 pm ET on KETKY
  • Friday May 14, 2021 12:30 pm CT on KETKY
  • Friday May 14, 2021 6:00 pm ET on KET
  • Friday May 14, 2021 5:00 pm CT on KET
  • Friday May 14, 2021 11:30 pm ET on KET
  • Friday May 14, 2021 10:30 pm CT on KET
  • Sunday May 16, 2021 12:30 am ET on KETKY
  • Saturday May 15, 2021 11:30 pm CT on KETKY
  • Sunday May 16, 2021 7:00 am ET on KET2
  • Sunday May 16, 2021 6:00 am CT on KET2
  • Sunday May 16, 2021 9:00 am ET on KETKY
  • Sunday May 16, 2021 8:00 am CT on KETKY

A Tribute to Health Care Providers

In this special episode, Dr. Wayne Tuckson honors the many health care workers on the front lines of this pandemic, particularly those who lost their lives to COVID-19. He speaks with Dr. William Moss, Dr. William Moss, medical director of the emergency department at Med Center Health in Bowling Green; Delanor Manson, chief executive officer of the Kentucky Nurses Association; and Elizabeth A. Johnson, president and executive director of the Kentucky Association of Health Care Facilities and Kentucky Center for the Assisted Living.

  • Sunday May 16, 2021 12:30 pm ET on KET
  • Sunday May 16, 2021 11:30 am CT on KET
  • Sunday May 16, 2021 5:30 pm ET on KETKY
  • Sunday May 16, 2021 4:30 pm CT on KETKY
  • Monday May 17, 2021 2:00 pm ET on KET2
  • Monday May 17, 2021 1:00 pm CT on KET2
  • Friday May 21, 2021 1:30 pm ET on KETKY
  • Friday May 21, 2021 12:30 pm CT on KETKY
  • Friday May 21, 2021 6:00 pm ET on KET
  • Friday May 21, 2021 5:00 pm CT on KET
  • Friday May 21, 2021 11:30 pm ET on KET
  • Friday May 21, 2021 10:30 pm CT on KET
  • Sunday May 23, 2021 12:30 am ET on KETKY
  • Saturday May 22, 2021 11:30 pm CT on KETKY
Jump to Upcoming Airdates

Recent

Telemedicine: Better Than Dr. Google

  • Monday April 19, 2021 2:00 pm ET on KET2
  • Monday April 19, 2021 1:00 pm CT on KET2
  • Sunday April 18, 2021 5:30 pm ET on KETKY
  • Sunday April 18, 2021 4:30 pm CT on KETKY
  • Sunday April 18, 2021 12:30 pm ET on KET
  • Sunday April 18, 2021 11:30 am CT on KET

Hospice and Palliative Care: The Bridge Over Troubled Waters

  • Sunday April 18, 2021 9:00 am ET on KETKY
  • Sunday April 18, 2021 8:00 am CT on KETKY
  • Sunday April 18, 2021 7:00 am ET on KET2
  • Sunday April 18, 2021 6:00 am CT on KET2
  • Sunday April 18, 2021 12:30 am ET on KETKY
  • Saturday April 17, 2021 11:30 pm CT on KETKY
  • Friday April 16, 2021 11:30 pm ET on KET
  • Friday April 16, 2021 10:30 pm CT on KET
  • Friday April 16, 2021 6:00 pm ET on KET
  • Friday April 16, 2021 5:00 pm CT on KET
  • Friday April 16, 2021 1:30 pm ET on KETKY
  • Friday April 16, 2021 12:30 pm CT on KETKY
  • Monday April 12, 2021 2:00 pm ET on KET2
  • Monday April 12, 2021 1:00 pm CT on KET2
  • Sunday April 11, 2021 5:30 pm ET on KETKY
  • Sunday April 11, 2021 4:30 pm CT on KETKY
  • Sunday April 11, 2021 12:30 pm ET on KET
  • Sunday April 11, 2021 11:30 am CT on KET

The Impact of Racism on Health Outcomes

  • Sunday April 11, 2021 9:00 am ET on KETKY
  • Sunday April 11, 2021 8:00 am CT on KETKY
  • Sunday April 11, 2021 7:00 am ET on KET2
  • Sunday April 11, 2021 6:00 am CT on KET2
  • Sunday April 11, 2021 12:30 am ET on KETKY
  • Saturday April 10, 2021 11:30 pm CT on KETKY
  • Friday April 9, 2021 11:30 pm ET on KET
  • Friday April 9, 2021 10:30 pm CT on KET
  • Friday April 9, 2021 6:00 pm ET on KET
  • Friday April 9, 2021 5:00 pm CT on KET
  • Friday April 9, 2021 1:30 pm ET on KETKY
  • Friday April 9, 2021 12:30 pm CT on KETKY
  • Monday April 5, 2021 2:00 pm ET on KET2
  • Monday April 5, 2021 1:00 pm CT on KET2
  • Sunday April 4, 2021 5:30 pm ET on KETKY
  • Sunday April 4, 2021 4:30 pm CT on KETKY
  • Sunday April 4, 2021 12:30 pm ET on KET
  • Sunday April 4, 2021 11:30 am CT on KET

A Tribute to Health Care Providers

  • Sunday April 4, 2021 9:00 am ET on KETKY
  • Sunday April 4, 2021 8:00 am CT on KETKY
  • Sunday April 4, 2021 7:00 am ET on KET2
  • Sunday April 4, 2021 6:00 am CT on KET2
  • Sunday April 4, 2021 12:30 am ET on KETKY
  • Saturday April 3, 2021 11:30 pm CT on KETKY
  • Friday April 2, 2021 11:30 pm ET on KET
  • Friday April 2, 2021 10:30 pm CT on KET
  • Friday April 2, 2021 6:00 pm ET on KET
  • Friday April 2, 2021 5:00 pm CT on KET
  • Friday April 2, 2021 1:29 pm ET on KETKY
  • Friday April 2, 2021 12:29 pm CT on KETKY
  • Monday March 29, 2021 2:00 pm ET on KET2
  • Monday March 29, 2021 1:00 pm CT on KET2
  • Sunday March 28, 2021 5:30 pm ET on KETKY
  • Sunday March 28, 2021 4:30 pm CT on KETKY
  • Sunday March 28, 2021 12:30 pm ET on KET
  • Sunday March 28, 2021 11:30 am CT on KET

Sepsis: The Serious Side of Infections

  • Sunday March 28, 2021 9:00 am ET on KETKY
  • Sunday March 28, 2021 8:00 am CT on KETKY
  • Sunday March 28, 2021 7:00 am ET on KET2
  • Sunday March 28, 2021 6:00 am CT on KET2
  • Sunday March 28, 2021 12:30 am ET on KETKY
  • Saturday March 27, 2021 11:30 pm CT on KETKY
  • Friday March 26, 2021 11:30 pm ET on KET
  • Friday March 26, 2021 10:30 pm CT on KET
  • Friday March 26, 2021 6:00 pm ET on KET
  • Friday March 26, 2021 5:00 pm CT on KET
  • Friday March 26, 2021 1:30 pm ET on KETKY
  • Friday March 26, 2021 12:30 pm CT on KETKY
  • Monday March 22, 2021 2:00 pm ET on KET2
  • Monday March 22, 2021 1:00 pm CT on KET2
  • Sunday March 21, 2021 5:30 pm ET on KETKY
  • Sunday March 21, 2021 4:30 pm CT on KETKY
  • Sunday March 21, 2021 12:30 pm ET on KET
  • Sunday March 21, 2021 11:30 am CT on KET

The Future of Long-Term Care in Kentucky

  • Sunday March 21, 2021 9:00 am ET on KETKY
  • Sunday March 21, 2021 8:00 am CT on KETKY
  • Sunday March 21, 2021 7:00 am ET on KET2
  • Sunday March 21, 2021 6:00 am CT on KET2
  • Sunday March 21, 2021 12:30 am ET on KETKY
  • Saturday March 20, 2021 11:30 pm CT on KETKY
Top

Season 13 Episodes

Public Health in Kentucky

S13 E25 Length 29:24 Premiere Date 4.15.18

Pain Treatment in the Age of Opioid Addiction

S13 E24 Length 28:57 Premiere Date 4.8.18

The Louisville Health Equity Report

S13 E23 Length 28:09 Premiere Date 4.1.18

Smoking in Kentucky: Hidden Cost Obvious Impact

S13 E22 Length 28:54 Premiere Date 3.25.18

Kidney Function and Renal Disease

S13 E21 Length 28:32 Premiere Date 2.25.18

Brain Tumors

S13 E20 Length 28:44 Premiere Date 2.18.18

Gastroenterology and Motility

S13 E19 Length 27:37 Premiere Date 2.11.18

Many Years, Many Medicines, Many Problems

S13 E18 Length 28:38 Premiere Date 2.4.18

A Day in the Life of an Ophthalmologist

S13 E17 Length 27:32 Premiere Date 1.28.18

A Day in the Life of a Thoracic Surgeon

S13 E16 Length 27:27 Premiere Date 1.21.18

Incontinence and Female Sexual Dysfunction

S13 E15 Length 27:51 Premiere Date 1.14.18

Building Healthy Communities

S13 E14 Length 28:44 Premiere Date 1.7.18

Music and Medicine

S13 E13 Length 28:34 Premiere Date 12.17.17

Health Ministries

S13 E12 Length 28:29 Premiere Date 12.10.17

Preventing Heart Disease

S13 E11 Length 28:40 Premiere Date 11.19.17

Prostate Cancer

S13 E10 Length 28:42 Premiere Date 11.12.17

Skin Diseases and Conditions

S13 E9 Length 26:22 Premiere Date 11.5.17

Treating Drug Addiction

S13 E8 Length 28:12 Premiere Date 10.29.17

Importance of Anesthesia

S13 E7 Length 28:34 Premiere Date 10.22.17

Public Sanitation Infrastructure

S13 E6 Length 26:39 Premiere Date 10.15.17

Health and the Outdoors

S13 E5 Length 28:47 Premiere Date 10.8.17

Universal Health Insurance

S13 E4 Length 28:43 Premiere Date 10.1.17

Strategies for Quitting Tobacco

S13 E3 Length 26:38 Premiere Date 9.25.17

Rural Physicians' Perspectives

S13 E2 Length 26:53 Premiere Date 9.17.17

Health Care in Rural Kentucky

S13 E1 Length 27:38 Premiere Date 9.12.17

Explore KET