Asking for help isn’t always as simple as it sounds. Most people treasure their independence, and admitting that they can’t handle a problem on their own—even a medical one—can sometimes be a challenge. Whether it’s an issue they think they can put off until later, is embarrassing in nature or is just too scary to tackle head on, the consequences of not seeking assistance from a primary care doctor or specialist can be devastating down the line.

Fortunately, however, Central Florida is blessed with a number of compassionate physicians who make it easy for local residents to feel comfortable seeking the care they need because of their down-to-earth demeanor. When it comes to women’s health in particular, many of these professionals are leading the way with cutting-edge advancements in a number of areas, including pelvic floor disorders, infertility and ophthalmology. 

Orlando Family Magazine recently spoke to specialists in those three categories to learn more about important health concerns for women and how they are being treated.

Pelvic floor disorders

As much as he is enjoying the warmer weather in his recent relocation from New Jersey to Central Florida, Dr. Charbel Salamon, the new chief of urogynecology at Orlando Health Winnie Palmer Hospital for Women & Babies, is even more excited about joining an organization that aligns perfectly with his career goals.

“To have an entire hospital dedicated to women’s health was very attractive to somebody like myself who has dedicated their professional career to treating women with pelvic floor disorders,” he says.

“I think there’s a lot of embarrassment and self-image issues surrounding pelvic floor disorders and also a lack of education about them, so a lot of women don’t necessarily seek any treatment. There’s a lot of misinformation about whether the treatments are effective or not effective and how complicated they are, and that makes people shy away from seeking information or treatments. That’s why I jumped at the opportunity to be able to educate the women of Orlando and Central Florida about pelvic floor disorders and to help them see it in a lighter way and feel less embarrassed and more empowered to take action.”

Pelvic floor disorders, or PFDs, include pelvic organ prolapse and problems with bladder or bowel control. They are caused by damage or weakening of the pelvic floor and are quite common, Dr. Salamon says, affecting one in four women. Pregnancy is often the first factor that can contribute to a PFD but over time, genetic predisposition, aging and menopause also play a role, with many women experiencing a significant PFD by their early to mid-40s.

The good news, explains Dr. Salamon, is that most PFDs, especially when addressed early on, can be treated with behavior and lifestyle changes, physical therapy and/or plastic devices called pessaries, which provide support to pelvic organs and can be fitted during a trip to the doctor’s office. Winnie Palmer is also developing other methods beyond this introductory treatment, including the use of Botox injections for an overactive bladder, which can be given every six to nine months and provide women peace of mind for their bladder control issues throughout that time period.

“There’s no downtime, practically, for most of those things,” Dr. Salamon says. “That’s obviously very exciting because not only is it minimal downtime but they have a very high success rate, around 70 to 80%, which is seven or eight out of 10 women who have these problems that we can actually treat within the office environment.

“And for the ones who need to go to the operating room, we actually have the most advanced minimally invasive interventions that also require minimal downtime. For bladder control it’s literally a couple of days. For larger problems like prolapse, which is the physical drop of the bladder or other organs, we have robotic procedures that only require a couple of weeks of downtime.”

No matter which course of treatment is decided upon, Dr. Salamon hopes to continue educating women about the positive outcomes that can be achieved. In the past, many considered PFDs a part of life and something they had to learn to deal with, but he stresses that even the smallest issues should lead them to see a medical professional.

“Urogynecology, which is the field that is officially known as female pelvic medicine and reconstructive surgery, was born about 25 to 30 years ago,” he says. “We have made so many strides in terms of opening up the discussion about bladder control issues and prolapse issues. These are now things that are talked about that you wouldn’t imagine that anybody would have talked about on Oprah or Dr. Oz or in a magazine. There is definitely a much increased awareness about these things. Unfortunately, there are a lot of misconceptions, especially with younger women who think they’re too young to have this problem. … We want to make sure we increase the awareness and add to the level of awareness that is already improving over the last decade or so in the United States.”

Women’s infertility

Similar to PFDs, there has long been a stigma associated with women’s infertility, and many of those affected have chosen to keep the issue private. Dr. George Patounakis, medical director at Reproductive Medicine Associates (RMA) of Florida, has seen progress in this regard and notes the benefits of social media in helping to find others dealing with the same problem.

“[B]ut we still have a long way to go in terms of making it just like any other issue,” he says. “People who have high blood pressure or high cholesterol, you’ll see them talking at parties like, ‘Oh, I’m on this medication now,’ or ‘I’m on this diet because I have high cholesterol or blood pressure.’ But you don’t really hear that about infertility. There’s still that stigma associated with it, but both are still medical conditions and we should approach them and think about them in similar ways.”

Women who are having trouble conceiving can take advantage of RMA, a nationally renowned network of clinics that has a 20% higher success rate than the national average when it comes to successful pregnancies. Dr. Patounakis shares his recommendations for when it is time to seek help.

“One big determinant is age,” he says. “Women under 35, if they’ve been trying for 12 months to become pregnant and it hasn’t happened, then it’s time to seek a specialist. If they’re over 35 and they’ve been trying for six months to become pregnant and it hasn’t happened, then they should also see a specialist.

“If there are any known issues of fertility such as irregular periods that don’t come every month, or if there’s a known issue on the male side of the equation, then … they should be seeking the care of a specialist even sooner.”

Dr. Patounakis adds that women have more options than ever when it comes to fertility treatments. And the common fear that he hears—that women are going to become pregnant with triplets or quadruplets as a result of in vitro fertilization—is no longer a concern.

“[T]he answer is that if it’s done the safe way—which is the way that we do it by transferring one embryo at a time—no, that’s not going to happen,” he says. “You may get twins because the embryo splits when it’s inside of you, but that’s about it and that’s pretty rare. That happens about 1 to 2% of the time. The fear that treatments are going to make you end up like Octomom or something, that’s a thing of the past—the distant past.”

Diabetic retinopathy

According to The Office on Women’s Health, diabetes affects about 15 million women in the United States, and compared to men with the disease, women have not only a higher risk for heart disease but also a higher risk for blindness. Florida Retina Institute, a team of fellowship-trained ophthalmologists with 10 locations throughout Central Florida, specializes in the treatment of diabetic retinopathy, which causes damage to retinal blood vessels and can lead to vision loss.

Symptoms of diabetic retinopathy may include blurred vision or floaters, but many patients experience no signs of a problem at all, which makes routine dilated eye exams crucial.

“The American Academy of Ophthalmology recommends annual eye exams for Type 1 and Type 2 diabetes,” says Dr. Jaya Kumar, a board-certified vitreoretinal specialist at Florida Retina Institute. “When patients are seen and they are noted to have abnormalities, they may have to come in more frequently. When the primary doctor or endocrinologist first diagnoses you with diabetes, you should come in and see an eye doctor within a few months of your diagnosis.”

If detected early, diabetic retinopathy can be treated with medication, controlling blood sugar levels and laser procedures. Vitrectomy surgery is an option for advanced cases.

“This is definitely preventable,” Dr. Kumar says. “If we detect it and find it early, we can treat it. That’s the key.”