Episode 81
Dr. Fenwa Milhouse on Female Urology, Incontinence & the Truth About Slings
In this candid conversation, Dr. Fenwa Milhouse board-certified urologist and fellowship-trained specialist in female pelvic medicine joins me to talk about conditions that affect so many of our patients but are often dismissed or misunderstood. She also happens to be my urologist, so I know firsthand the impact of her work.
We discuss her journey into urology, the importance of representation in medicine, and her focus on female pelvic health from prolapse and incontinence to the surgical and non-surgical treatments that can dramatically improve quality of life.
From mid urethral slings to bulking agents like Bulkamid, Dr. Milhouse breaks down the options for restoring bladder control and day to day comfort. We also explore how pelvic floor dysfunction can affect self-image and sexual wellbeing and why informed consent must include conversations about pleasure, not just pathology.
Highlights:
- Representation in Urology: Dr. Milhouse shares how meeting a Black woman urologist shaped her path into a field traditionally dominated by older white men and how that representation continues to matter.
- Prolapse Realities: From “it felt like I had a scrotum” to “an egg between my legs,” Dr. Milhouse describes how patients experience pelvic organ prolapse and what options exist to restore both anatomy and confidence.
- Incontinence Treatments Explained: A breakdown of surgical and non-surgical options—like mid urethral slings and Bulkamid and how patient goals and downtime factor into decision making.
- Preserving Sexual Function: Why asking about cervical orgasms matters, and how uterine sparing procedures can protect sexual wellbeing during prolapse repair.
- Medical Bias and Advocacy: A frank discussion about racism, bias, and the emotional toll that clinicians of color face—both from patients and within the healthcare system.
If you found this episode helpful, please subscribe, rate, and leave a comment. Your support helps us reach more people who deserve real, respectful conversations about their health.
Connect with Dr. Milhouse
Connect with Dr. Rahman:
Transcript
Welcome back to another episode of Gyno Girl Presents, Sex, Drugs and Hormones. I'm Dr. Sumitra Raman and as you heard on my intro, I have a very special guest today, good friend, colleague, and my own favorite urologist. I'm choking, hold on. Sorry, my own favorite urologist.
Fenwa Milhouse, MD (:You
Fenwa Milhouse, MD (:I did that out.
Sameena Rahman (:Dr. Fenwell from Millhouse, welcome to Sex, Dreads and Horrors.
Fenwa Milhouse, MD (:Thank you. I love the title of your podcast. really do. I love it. I love it. Thank you for having me. And I'm pleased to be your favorite urologist. And yes.
Sameena Rahman (:thank you. SDH. Sex, Drugs, and Hormones. We love it.
Of course.
Considering my older brothers are urologists. Anyway, so how's it going? I'm so happy to have you here. You're such a fun person to be around and you are like literally my urologist. So which we could talk about, but I figured like you could tell me a little bit about your journey into the field of really female urology. I know you see both, but really you're
Fenwa Milhouse, MD (:Yeah. I don't know how it feels about that. Yep.
Fenwa Milhouse, MD (:Yes.
Sameena Rahman (:focused, honed in on female urology. And you're down the street from me. So we actually do get to see each other every so often. But and then I just want to talk about some of the issues that plague so many of the patients that we see around quality of life with regard to urinary incontinence and prolapse and all that stuff. So the first.
Fenwa Milhouse, MD (:Yeah.
Fenwa Milhouse, MD (:Yeah. So I'm a board certified urologist. I am also fellowship trained in female pelvic medicine and reconstructive surgery, which is basically like female urology. I own my own practice. Yes. Just around down the street, so to speak from Dr. Raman, who I have to give you your flowers. You were a big inspiration and really a big
Sameena Rahman (:Mm-hmm.
Fenwa Milhouse, MD (:big sister type cheerleader when I did this whole owning my own practice thing. And, you know, when I went to you, I thought, you know, she could easily be like, you got to figure out your own. Like I figured out my own, you know, and because some of the stuff we do overlaps could easily have kind of said, well, I don't want to help my, my
Sameena Rahman (:Yeah.
Sameena Rahman (:Yeah.
Yeah.
Sameena Rahman (:Overlap.
Fenwa Milhouse, MD (:competition, but you were not like that at all. You were such a girl's girl, which I love because I'm a girl's girl too. And you were like, oh, let me help you. Yeah, no one helped me, but I'm just going to tell you like this is what you should do. And, you know, kind of giving me your own tips and kind of what you did to get your foot in the door. So I do appreciate that very much. And I always cherish you for that. Thank you. Yes.
Sameena Rahman (:Yeah, No. Yeah. No, absolutely.
Sameena Rahman (:Yeah.
Sameena Rahman (:No, of course. I like I always say, like there's millions of vulvas in Chicago and we need a very few number to keep us, we need a few number to keep our doors open.
Fenwa Milhouse, MD (:Yeah, and like literally some we see some patients, we share like a handful of patients that see both you and me and like sure see both of us.
Sameena Rahman (:The same. Yeah. Yeah. yeah. No, sure. No, I agree. Well, Dr. Melhouse said this and I'm like, yeah, she's right. Yeah. You should try. Yeah. Yeah. No, you should do that. That's absolutely right. That's nice. I like that we can collaborate like that. But,
Fenwa Milhouse, MD (:Yeah. And I'm like, whatever she said, when they say, I've seen Dr. Raman, I'm like, you're in the right place. Like, whatever she says.
Fenwa Milhouse, MD (:Yup. Yup. So, so anyway, how I got into this field, um, I did not think I was going to be a urologist when I first learned about it in medical school. thought that is for men, by men. I saw pictures of urologists and like the urologist that I knew of, which was very few. They were men, old men, um, mostly white men. And I thought I'm a black woman. Like there's nothing for me. And, um, they treat prostates and
Sameena Rahman (:Mm-hmm.
Sameena Rahman (:Right.
Right, man.
Mm-hmm.
Fenwa Milhouse, MD (:penis problems and whatnot. And then I met a black woman urologist who gave us a lecture in our second year of medical school. And I was blown away and really took a liking to her because here she was this representation that looked like me in this field that was very much did not have a lot of diversity. And so I saw myself
Sameena Rahman (:Yeah.
Sameena Rahman (:Wait, who was it?
Sameena Rahman (:Mm-hmm. Yeah.
Sameena Rahman (:Yeah.
Fenwa Milhouse, MD (:for the first time as a urologist in her. And I thought she was super dope and I was wanting to be like her. And so I shadowed her and a bunch of other urologists and they just seem to really like what they do. And they seemed really relaxed and relatable, fun, like just good vibes. And it seems really like shallow to say, but I chose urology off of good vibes.
Sameena Rahman (:Mm-hmm.
Sameena Rahman (:Yes.
They're fun. Urologists are fun. Yeah.
Sameena Rahman (:yeah no and i chose gynecology in spite of the bad vibes that i i'm like these women are bitchy like i don't know
Fenwa Milhouse, MD (:Yeah, you're like...
Fenwa Milhouse, MD (:Yeah, I was like, I like these vibes over here. so became your, and part of what I saw in this shadowing during medical school was a lot of female urology. And so I kind of was already in that like trajectory before I even started residency. And in fact, I considered Ob-Gyn for the women's health part of things. And then I realized it within urology, like, you can do women's health and be a urologist.
Sameena Rahman (:in your.
Fenwa Milhouse, MD (:And I was like, oh sold, know hook line sinker like I'm and You know the rest is history. So now I do see about like 70 % women maybe 60 % women and then the rest I see Penis owners I should say it's 60 70 % balboa owners and the rest penis owners and I like that I can do both. I like that within like sexual health
Sameena Rahman (:Yeah. Yeah.
Sameena Rahman (:Yeah.
Fenwa Milhouse, MD (:I can see both, you know, mean, sides of whatever. I hate to like, bind, be so binary, because you know, they're, you know, gender is a constant within all of that stuff. But, but I like that. Yes.
Sameena Rahman (:You can see the team. Yeah. Yeah.
Sameena Rahman (:Right, Yeah. But I don't see a penis owner. like, guess, like sometimes the patients come in and they're like, well, can you help me? I was like, well, I probably know what he needs, but I'm not gonna, I'm not gonna see. I'm not gonna, but I can tell you who can, Dr. Minow, Dr. Minow's down the Yeah.
Fenwa Milhouse, MD (:But I'm, yes, yeah, like I'm, yeah, yeah.
Down the street. yep, yep. So yeah, I get to do like vulva vaginal reconstruction. I get to do men and women's sexual health. I get to do incontinence. I can do hormones for men and women. That's the bulk. And I even do some like cosmetic stuff, like cosmetic gyn and cosmetic penis stuff. actually one of the most common procedures that I do in my office are penis fillers.
Sameena Rahman (:Yeah.
Fenwa Milhouse, MD (:I do those more than I do vasectomies these days. Yeah, yeah. I get to do all of those things. Yeah.
Sameena Rahman (:Yeah, we might want to do a little intro into those. mean, because I have all types that listen. even some of my Volvo owners are like, well, I need some help with my, you know, they always need help with their, if they're heterosexual, they need help with their partners. Because women are carrying the bulk of that, I think, you know, in terms of getting their partners to where they need to go. Now that's really cool. And I actually love how outspoken you are, like, when it comes to like just,
Fenwa Milhouse, MD (:Yeah.
Fenwa Milhouse, MD (:Yes.
Sameena Rahman (:owning who you are, you know, the day because I I when I sometimes I read some of your posts about people who write bullshit, like responses to you. And I'm like, what is wrong with these people? I mean, what kind of America are we living in right now? It's a whole different topic. And you're like, what you said to me that you wouldn't come to me because I'm black or something, whatever. So stupid.
Fenwa Milhouse, MD (:like, and I repost their stuff and I expose them.
Fenwa Milhouse, MD (:Yeah, yeah. I mean, if you talk crazy to me, I'm going to expose you, not so, cause I want people to like attack them because I'm like, you realize you're talking on this public page and you're, you know, um, you know, saying something really offensive. Like, let me just share it with the world, you know.
Sameena Rahman (:Yeah.
Sameena Rahman (:Yeah.
Sameena Rahman (:Right, right. When people don't even realize that as women of color in this profession, the kind of stuff that we hear, you know, like it's very shocking sometimes when I tell patients, when I tell other colleagues that are not women of color, I'm like, well, you don't even know. Like sometimes, you know, people don't want to see you because X, Y or Z or, know, they say offensive things to you. So I always say like medical bias works in both ways, right? Like we can...
Fenwa Milhouse, MD (:Yeah.
Fenwa Milhouse, MD (:Yeah.
Yes, yes.
Sameena Rahman (:prevent bias to our patients, we also need to be protected as clinicians too.
Fenwa Milhouse, MD (:Absolutely, their medical racism isn't just.
the discrimination that patients get, but it's discrimination that the people within medicine get, that we get from our colleagues, we get from other staff member, we get from patients. I mean, one of the craziest things a patient told me was like, slavery wasn't all bad. Like a patient was who I was actually taking care of had the goals to tell me this. And you know what I'm like, you need me, I don't need you and you're a tele-asus. yeah, yeah.
Sameena Rahman (:Yeah.
Sameena Rahman (:Yes.
Sameena Rahman (:you
Which is like, Yeah, exactly. Yeah, what is wrong with you? It's so funny. She must have been from the, or they must have been from the South because, I grew up in the South and you never learn why the Civil War happened. It's not, it was just about states rights. And that's what I learned forever. Until I read like Malcolm X's book and I was like, it wasn't about states rights. But that's what you get brainwashed back, that you guys, that's like, anyway, but we have to keep speaking up.
Fenwa Milhouse, MD (:Yeah. It's like states rights. Yeah. I grew up in the South too. Yup.
Yeah, let's be real. Exactly. Yes. Yep.
Sameena Rahman (:can and I appreciate that you do for all people which is great. Well let's talk a little bit about some of the cool stuff that you get to do. You know one of the issues that women often complain about especially you know in midlife and beyond and we talk a lot about hormones on this this platform but really when you start having this bulge in your vagina right like you feel something you're doing some jumping jacks you're you can't have a bowel movement without pushing down on your vagina like all of these things that are
Fenwa Milhouse, MD (:Thank you. Yeah.
Sameena Rahman (:from your pelvic floor issues that develop. So can we talk a little bit about the different types of vaginal reconstruction you do for these herniations that happen in the vagina, whether or not it's the herniation of the bladder into the vagina or the herniation of the rectum into the vagina and how this impacts people's quality of life.
Fenwa Milhouse, MD (:Yeah. So I, so it's, see something called pelvic organ prolapse and it is basically a hernia through your vagina where things are coming out of the vagina that should not be coming out. and a lot of times patients will come and say, I felt or saw something and they immediately kind of freak out. they think the worst. They're like, my God, I'm like,
Sameena Rahman (:Mm-hmm.
Sameena Rahman (:Mm.
Fenwa Milhouse, MD (:gonna die or this is cancer or tumors growing or something you know and fortunately it's rarely like a it's almost never an emergency type of thing but it can certainly affect normal bladder and bowel function it can affect
Sameena Rahman (:You're just right. Right.
Sameena Rahman (:Mm-hmm.
Fenwa Milhouse, MD (:sexual function, I'll talk about that shortly. And if nothing else, it just doesn't make you feel like a woman. You know what I'm saying? I get a lot of like, I just don't feel like a woman anymore. feel like something is really wrong with me. I feel a lot of shame. People who men with pelvic organ prolapse tend to feel more shame and like be self, have poor self image. And that plays a lot into their sexual dysfunction. and they may hide it from their partners for a very long
Sameena Rahman (:Yeah.
Yeah. Yeah.
Sameena Rahman (:Right.
Fenwa Milhouse, MD (:time, they may hide it in ways like they just don't, they kind of close off intimacy, they may decide to just retreat into their own selves. And so it's not like, it's not
Even though it's not technically life threatening, it can really affect multiple aspects of a person's wellbeing. Studies show that depression is higher in people who suffer with pelvic floor issues like prolapse.
Sameena Rahman (:Yeah.
Fenwa Milhouse, MD (:I love treating pelvic organ prolapse. It's a fun procedure to do because you see the fruits of your labor right away. A lot of what we do in surgery or medicine, you have to wait to see the like, to see, you know, the improvement. Okay, come back and let me see how things go in six weeks, three months, whatever. You don't get to see like the immediate effects, like with pelvic organ prolapse surgery, I get to see the patient walks in.
Sameena Rahman (:Mm-hmm.
Sameena Rahman (:Yes. Yes.
Sameena Rahman (:Yeah.
Fenwa Milhouse, MD (:with a broken vagina, if you will, and then they leave the operating room with me having reconstructed and put it back together. Patients tend to immediately, you know, feel the difference, you know, and be like, my God, I felt like a ball was hanging between my, my vagina or felt like I'd grown a scrotum. And now I'm leaving the hospital. These are the, these are verbatim things that have said to me, like I've had a patient, it's like, I feel like I've
Sameena Rahman (:Love it.
Sameena Rahman (:Yeah.
Sameena Rahman (:These are the terms they say though. Yeah. Yeah. Yeah.
Fenwa Milhouse, MD (:I've grown a scrotum. A really common thing people say is I feel like a tampon is in that's not quite up. Like if you've ever worn a tampon and it's not quite in the right place, or if it's like a tampon that has been in there way too long and now it's like starting to descend, you feel this, you have an awareness of something between your legs. That's a common way people have described it, like an egg between them.
Sameena Rahman (:to learn more.
Yeah.
Yeah.
Fenwa Milhouse, MD (:I've had some people like basically had to change how they walk and move because it's so much prolapsed. It's like completely prolapsed out.
Sameena Rahman (:Mm. Gapy, yeah.
Fenwa Milhouse, MD (:And it can, as you know, like, ascorate, things can ascorate and things can bleed. And it can get in the way of like peeing and pooping, as I was alluding to, where people have to push, push in to kind of get the flow started or push in to like evacuate their bowels. That's called splinting. And it's a tail, one of a telltale sign of prolapse or pelvic organ prolapse. If you feel like you have to like push into your vagina, like get
Sameena Rahman (:Yeah.
Sameena Rahman (:Yeah. Yeah.
Fenwa Milhouse, MD (:going. Worst cases of pelvic organ prolapse I've seen is where patients couldn't urinate at all. It was so out that it was blocking their channel, their urethra. And so they were in retention of urine. They could not urinate. And where we had to put a catheter in, I've seen it so bad where the retention led to kidney failure. And that's like, you know, really rare. But when that happens, obviously something has to be done.
Sameena Rahman (:All right.
Sameena Rahman (:really.
Sameena Rahman (:Mm-hmm.
Yeah. Yeah.
Sameena Rahman (:Yeah.
Mm-hmm.
Fenwa Milhouse, MD (:And so most of what I do is surgical repair for prolapse, although there is non-surgical like pest replacement, but a lot of patients by the time they get to me end up choosing prolapse surgery. And I offer all methods of prolapse surgery. I offer both uterine sparing and
traditional hysterectomy and prolapse repair. Uterine sparing is basically like we don't have to take your uterus and we can fix your prolapse with keeping your uterus. This is gonna be like maybe a diverge, but I feel, and you tell me how you feel about this.
I feel like we take too many uteruses out for benign reasons, right? Like we're like, take it out, take it out, take it out, take it out. I'm like, it doesn't have to come out. And just because we're done with the baby making doesn't mean we want to come out. In fact, studies have shown that women when they're offered options of like keeping their uterus for prolapse.
Sameena Rahman (:For sure. For benign reasons, yeah. Yes, absolutely. Take it out. Yeah. Doesn't have to come out.
Sameena Rahman (:Right.
Sameena Rahman (:Yeah.
Fenwa Milhouse, MD (:A large portion of women will choose to do that, even though these are mostly like post-reproductive women that definitely are like done with kids or post-menopausal, but they just like don't really want to part with this. Yeah. What do you think? Yeah.
Sameena Rahman (:Absolutely.
Yeah.
Yeah. Mm-hmm. They don't, yeah. I mean, it's an organ, right? Like, you know, nobody really wants to have like organs removed when they don't. And I think so many women connect with it as part of who they are. It represents something to them, like, you know, their babies houses if they did. But there's some connections. Some people have sexual, like really good orgasms from their cervix and, know, from their, from, you know, and so you're gonna.
Fenwa Milhouse, MD (:Yeah.
Fenwa Milhouse, MD (:Yes.
Sameena Rahman (:Remove that even though it's like a big debate in like the OB-GYN literature like should we do super cervical or not or preserve sexual function. But you know there's three nerves that innervate the cervix and you know when people do leaps and they do other things on these cervices, know some orgasms are compromised and so I feel like we have to take all that into consideration if it's not something that you have to remove for cancer or you know other issues.
Fenwa Milhouse, MD (:I totally agree with you. And I don't know how many prolapse surgeons do this, but I always ask about
Sameena Rahman (:Right.
Fenwa Milhouse, MD (:sexual function and orgasms. And I have had women tell me that they get cervical orgasms, that they enjoy deep penetration to their cervix. And for those, then the last thing I want to do is take their cervix or shorten their vagina with like a vaginal hysterectomy. In those patients, we either do a uterine sparing or we do a super cervical. So we can keep that cervix, keep that vaginal length.
Sameena Rahman (:Mm-hmm.
Sameena Rahman (:Yeah.
Right. Yeah.
Sameena Rahman (:Right.
Mm-hmm.
Sameena Rahman (:Right. Yeah. Yeah.
Fenwa Milhouse, MD (:But I think there I know not I think that there are plenty of surgeons who don't even inquire about these things and then women just have procedures now Overwhelmingly, I don't want to poop who a hysterectomy like overwhelmingly Studies do show that women who get prolapse surgery have better sexual function afterwards like it tends to Improve sexual function no matter what type of surgery they do and I think that's
Sameena Rahman (:No.
Sameena Rahman (:Right.
Fenwa Milhouse, MD (:because sexual function is so impacted by the presence of this bulge. yes, yes, gaping and yes, and like the body image thing, and then just like the logistics with maneuvering this like bulge coming out.
Sameena Rahman (:and intricately.
Yeah, yeah. Or the feeling of a gaping vagina, right? Like people always are like, her vagina's so gaping.
Fenwa Milhouse, MD (:getting that restored no matter how you do it just is a plus. And so I feel good about doing any type of prolapse surgery as far as sexual function is most likely gonna improve no matter what I do, whether I take the uterus or don't. And then I do both vaginal and robotic.
Sameena Rahman (:Right. Right.
Sameena Rahman (:Right.
Fenwa Milhouse, MD (:approach and the times that we do robotic, which is a machine that allows us to see 3D and really go inside the abdomen without doing a cut. We can use small cuts on the belly, quick recovery. In fact, these patients of mine, don't even stay overnight in the hospital.
Sameena Rahman (:Right.
Fenwa Milhouse, MD (:is when we want to do a more robust repair and potentially use mesh. And when I say mesh, that's when patients get a little...
Sameena Rahman (:I know, because I hear all the lawyers talking about veg.
Fenwa Milhouse, MD (:Yes, yes. Their eyes are like immediately like, mm-mm. And then I tell them, listen, you all, like.
Sameena Rahman (:Yeah.
Fenwa Milhouse, MD (:There's not like evil mesh out there. The mesh that we use nowadays and who's doing mesh has greatly, greatly like reduced mesh complications. And by and large mesh complications were like in the minority in the first place, but it was like the vaginal prolapse mesh kits that were large sheets of mesh like.
as as your hand and palm that we used in the vagina, those were the most problematic ones if you were gonna do one. And now people don't even do those. mean, they're basically all but off the market. The mesh we're talking about with like robotic repair.
Sameena Rahman (:All
Fenwa Milhouse, MD (:and we'll talk about stress incontinence and leakage in a moment, and we use mesh there. Those are low risk mesh. And even ACOG, the American College of Gynecologists and SUFU, Society for Urodynamics in Female Urogenital Reconstruction, they have come out in support of like, know, favor of the low risk mesh that we can offer individuals.
Sameena Rahman (:That's great. Yeah, I think that's what you hear about and we should talk about like TVTs and those kinds of things that you know, you said like there's a lot of negative press around the complications and non-sexual function. So I think that's worth discussing. But I do think that you're totally right. And I even like when it comes to people's sexual function, even if I'm going to do a leap on someone, ask them like, do you think that you have cervical orgasms? Do you have a vaginal?
Fenwa Milhouse, MD (:Yeah.
Sameena Rahman (:Like, or do feel like you've got, you know, do you have penetrative orgasm? Do you have it only with the clear? You have to ask what type they have because those are the people when you don't ask, then they're like, wait, nobody told me this and now my orgasm is gone. And so I feel like we already like discount women's pleasure so much is a medical profession that if we're not asking, then we're just contributing to women not seeking it either. So.
Fenwa Milhouse, MD (:Yes.
Fenwa Milhouse, MD (:to.
Fenwa Milhouse, MD (:When they say, I have a question for you. Like, so if they say, yeah, my, my orgasms are cervical, like, and you need to do a lead, like what do you, how do you counsel them? How does that change what you do?
Sameena Rahman (:I just say, know what, always, based on what the category is, it's like CIN2 or 3, I just tell them that my goal is to remove the least amount of tissue with the most robust way. We don't do these honking leaps anymore where we take a huge amount. And I said, Nina, I can never give you your tissue back. So if for some reason we have to go back because there's some precancerous cells that don't get cleared on their own over time, then that's something we can address in six months or a year.
Fenwa Milhouse, MD (:Mm-hmm.
Sameena Rahman (:I'll just try to take the least amount that I can that will hopefully be curative for you.
Fenwa Milhouse, MD (:Yeah. Yeah. Yeah. Yeah. Like for me, if they say that for pelvic organ prolapse, like I said, then I'm going to be like, well, we shouldn't, we should avoid the like lap or that lab nor vaginal hysterectomies and consider super cervical or non hysterectomy prolapse.
Sameena Rahman (:So I use a very small loop.
Sameena Rahman (:Mm-hmm.
Sameena Rahman (:Right.
Fenwa Milhouse, MD (:to, know, and I tell them like, you know, and even the ones that choose, they're like, no, I don't have cervical orgasms and choose to do hysterectomy. do always tell them there may be a theoretical risk of like changing your sexual function when we do a hysterectomy. Fortunately, I haven't really seen patients complain, but as you know, women may not complain, but I, but I tell them like, we don't know what the numbers really are.
Sameena Rahman (:Right.
Sameena Rahman (:Yeah.
Fenwa Milhouse, MD (:but there is a little bit of a foreshortened vagina when we do it. So, you know, that might be perceived sexually post-operatively and feel different to you sexually than, know, before a hysterectomy.
Sameena Rahman (:Right, no, that's very true. And I think it's, know, and it's even like, even if you can't avoid some of these things, at least you asked and at least you kind of prepared them, right? Like that this may or may not happen. Because the worst is when they just come, they feel like it comes out of nowhere. And then they're just angry that they didn't even know what was a possibility.
Fenwa Milhouse, MD (:prepared. Yeah. Agree.
Fenwa Milhouse, MD (:Yes.
Yes, I saw a patient. is not
prolapse, I saw to speak to this like anger with patients like, I didn't know at least somebody could have told me I saw a patient. I did not do the surgery. It was a male patient who had a circumcision as an adult and he had a circumcision with another urologist and he had a significant, significantly less sensation, gland sensation. and he was a note, he was upset by it and the circumcision looked great. Like he healed beautifully and it looked great.
Sameena Rahman (:well.
Yeah.
Sameena Rahman (:Yeah.
Fenwa Milhouse, MD (:his penis function normally and he was getting orgasms but he was just upset with a decreased sensation and I was like yeah that's something that we well it's something that I can't counsel patients on like and he was like no one the doctor never told me about this and I always counsel all this is another where I counsel all my patients that have circumcisions my male patients hey you might notice changes in sensation and these tend to change in sensation may make it less
Sameena Rahman (:consent. Yeah.
Sameena Rahman (:Yeah.
Sameena Rahman (:Right.
Fenwa Milhouse, MD (:may be decreased after we take this foreskin. And then most people make their best decision and they proceed with it and they knowing that this might be a possibility, but at least they have heard it.
Sameena Rahman (:Yeah.
Sameena Rahman (:Right. Absolutely. Yeah. And I think that's informed consent, right? That's what we try to do. And so I feel like it's the best way to go for those patients. But sometimes I think patients get overwhelmed with everything you tell them to. some, as I'm always like, just bring someone in so they know. Yeah.
Fenwa Milhouse, MD (:Yes. The other thing is, did they really not tell you or did you just not remember that's also possible? Because I know sometimes patients are like, I don't remember this and I'm like document everything. So I'm like, no, I wrote it down. I read it six or ever where we talked about it. Yeah.
Sameena Rahman (:Right, Yeah, exactly. So.
Sameena Rahman (:Yes. You signed it actually. Well, let's talk a little bit about incontinence and I'll give you hip up permission to talk about my case. Yeah, you can. I I think I've spoken a little bit about this before, but I do have moderate to severe stress incontinence from my, after my third child who I had six years ago.
Fenwa Milhouse, MD (:can bring you up, use you as an example. Yeah. Yeah.
Sameena Rahman (:She was small, she was only six pounds, but I don't have great collagen. Three, that was a serious three. Yeah, that was true, three. Three in a minute. So, and I've truthfully been a little scared to get a sling, mainly because I don't want that kind of downtime.
Fenwa Milhouse, MD (:But it's three. You had three.
Yes. Yeah. Yeah.
Fenwa Milhouse, MD (:Okay, so I was going to say, what scares you? Like, okay.
Sameena Rahman (:It's not the surgery, it's just the downtime afterwards. Like then I can't do like my normal exercising and all the things that I want to do. You know, it's like a long time to not do it right? Six weeks, right? Or is that not true?
Fenwa Milhouse, MD (:All right. Okay, y'all. Okay, so she...
She's being a little, maybe, maybe slightly, I don't want to say ridiculous, that's me eating it, but, over dramatic, maybe. Okay, all right, so Dr. Ron has stress incontinence, is leakage with activity, cough, laps, sneeze. think you remember, I remember you telling me like, yeah, if I'm on a trampoline, forget it, forget it. I can't enjoy the trampoline with my kids.
Sameena Rahman (:I don't know, it's true.
Sameena Rahman (:Yes. Yeah. Forget it. That's my test. Because right after the procedure, I was jumping. I was like, yes, the traveling test worked. I could jump. But yeah.
Fenwa Milhouse, MD (:Yeah, yeah, yeah. Which was great. Yeah. So, so there are different options for it, but two of the most common options treatment is a mid urethral sling, which is a really good surgical option, considered the gold standard. And it is a slip of mesh, like a hammock, like a tape of mesh that's placed under the urethra through small cuts in the vagina. and,
Sameena Rahman (:You TOTs? You do Transopter right now? Or does anyone still do TVT? You do TOT.
Fenwa Milhouse, MD (:I don't do transopterator. So transopterator is one route. I don't do transopterator because of it potentially has the risk of pelvic pain and I don't, there's other options that you can do. Like I really don't see any benefit to doing transopterator when I can do a retro pubic or do a single incision sling. So those are my, those are my two go-tos. Like I'll do a single incision mini sling. Yeah.
Sameena Rahman (:Does anyone do TVTs anymore? Like this, I'm dating myself based on what I did in training. TVTs, TOTs are not done that much.
Fenwa Milhouse, MD (:T okay. So TOT is trans-opterator. That's that is still done. It's not that it's not done. It's just, now you're going to be tough. People are going to be like running away from this. And then TBT is also, is still very much done. TBT is the gold, gold, gold standard, gold standard. It's the, what I call retro pubic.
Sameena Rahman (:I always found a barbaric when we did it.
Sameena Rahman (:Right. Yeah.
Fenwa Milhouse, MD (:But it's basically you go behind the pubic bone instead of going through like the thigh, if you will, for the people listening. TBT, the...
Sameena Rahman (:Yeah.
Sameena Rahman (:Hold on a second. What is that? okay.
Fenwa Milhouse, MD (:What you did not get trained on, because this came after, has been around, which has been kind of evolved over the last 15, 20 years, is these single incision or mini slings, which are these small pieces of mesh. So it's like a third of the standard mesh that we are used. So it's a small piece of mesh. I tell people to like, if you put up your index finger, it's like about the same dimensions of your index finger. So that's how much mesh it is. It's just a small piece.
Sameena Rahman (:Yes.
Okay.
Sameena Rahman (:Okay.
Fenwa Milhouse, MD (:And it's one cut in the vagina instead of like having multiple cuts. It's one small cut in the vagina that's like an inch or less. And it literally takes me 15 minutes to do. It's like such a short, easy procedure. love doing them. And because it's a small piece of mesh, I do like doing that like on my surgery naive people, especially
Sameena Rahman (:The two months. Right.
Sameena Rahman (:Oh right, didn't read the eraser.
Sameena Rahman (:Yeah.
Fenwa Milhouse, MD (:And, and ones that are moderate, mild to moderate stress incontinence, I can, I do probably 75, 80 % of my slings that way. and I have really good success rates. Like majority of my patients come back happy and they're like, yeah, I'm, you know, it's rare that I have a patient who I've did a sling that's like not improved. yep. Yep. Mid urethral.
Sameena Rahman (:Mm-hmm.
Sameena Rahman (:Mm-hmm.
Sameena Rahman (:Mm-hmm.
Sameena Rahman (:Okay, and you make a mid-garry swill incision and that's it and then you just pull it up just like the TVTs.
Fenwa Milhouse, MD (:And then it just goes like, wish you could see it with me in the OR. It's like you get this one trocar and you use it for both sides and you just, it just stops at the fat at the inner fascia, uh, derator. No. Yeah. And it just stops right there and that's it. And then you just close that one incision in the vagina and you're done. I mean, you do a cystoscopy, but, then you're done. don't prescribe pain medicines for it.
Sameena Rahman (:both sides, okay.
Sameena Rahman (:So you don't bring it up like you used to the TV teas. Yeah.
Sameena Rahman (:Okay, you're Yeah.
Sameena Rahman (:Mm.
Fenwa Milhouse, MD (:patients feel like themselves within a week, although the restrictions are still the six weeks. So this is the part that Dr. Ramon is like not like scared of, but she's not willing to commit to is the better term. And it's the six weeks where you don't have the time. You don't want to commit. Yeah. Yeah. Yeah. Get it. I get it. Six weeks of no exercise for sure. Nothing in the vagina. So, you know,
Sameena Rahman (:Mm.
Sameena Rahman (:Yeah, yeah, that's not what it's Yeah, it's not like I'm scared of it. It's like I don't you know, I don't want to not be able Yeah.
Sameena Rahman (:Yeah.
Sameena Rahman (:That's not an issue for me, but it's like...
Fenwa Milhouse, MD (:It might be an issue for the other doctor. It might be an issue for your hubbub. Okay.
Sameena Rahman (:But I'm like that not not being able to run or lift or those kind of things are well even for a while it was like and my baby was still small and that was lifting her a lot, but now she's Yeah, yeah when I first met you I think she was three and I was like I got it I'm still lifting her a lot. Yeah Yeah, she's six
Fenwa Milhouse, MD (:Yeah.
Fenwa Milhouse, MD (:Now she's not that small anymore. She's like what, seven years old?
Yes. Yeah. Yeah. She was like four or three or four. Now what? She's seven, seven, eight. Yeah. Six. Okay. Six. Yeah. So now you don't get to pick her up like that, but yeah. So, so anyway, it is, you know, six weeks of some fair downtime. mean, although you could work, you could go back to work and seeing patients, I would say within a week even. and, and so that is like the most common procedure.
Sameena Rahman (:Yeah. Yeah.
Fenwa Milhouse, MD (:that is done. but a a very common procedure that is done to Kind of probably second to it is something called urethral bulking Which requires really no downtime very little. and that's because we're not making huh That's what you did. Yeah, which is why people do it people do it because of that and it works by Volumizing like the urethra mucosa if you will so like the inner lining the tube that we pee out of
Sameena Rahman (:Mm.
Sameena Rahman (:That's what I did.
Fenwa Milhouse, MD (:if we plump it up, then the, then the, the, um, lumen or the canal that we pee out of is tighter. Okay. It's tighter and then we have less opportunity for leakage. So it's a really quick in and out procedure. It takes like 10, 15 minutes to do. We can even sometimes do it awake. I think we did yours under sedation, but we do it awake too. And you go, you know, both of these procedures, you would go home that day, but with this bulking,
Sameena Rahman (:you
Fenwa Milhouse, MD (:Basically within a day or two, you can do whatever you exercise. Huh?
Sameena Rahman (:But you can bulk with different agents, right? You can bulk with different agents.
Fenwa Milhouse, MD (:You can balk with different agents, but by and large, Balkamed and I do not like get paid by them. You know, like I'm not a spokesperson or anything, but by and large Balkamed has emerged as the leader in urethra balking now and for good reason.
Sameena Rahman (:Yeah.
Okay, because people were doing the other bulking too, right? There was a different bulking that was done before.
Fenwa Milhouse, MD (:The other agents like collagen was used, very popular. Was it Dursphere was used? was, microplastique. The thing about some of these is they migrated. we don't, and there's been no reported migration with Bulkimed.
Sameena Rahman (:Yeah.
Sameena Rahman (:Okay.
Sorry, my office.
Sameena Rahman (:So you're saying what the other ones say migrated and caused complication.
Fenwa Milhouse, MD (:Okay.
You could see migration potential risk of migration. Yup. Yup. Um, and bulk of med has a pretty good efficacy. Um, and so I don't know anybody.
Sameena Rahman (:Okay.
Sameena Rahman (:Mm-hmm.
Fenwa Milhouse, MD (:Um, that doesn't, that does bulking that doesn't primarily or exclusively use bulk event at this point. Yeah. Yeah. Which is what we did for you. Yeah. So we're for a while. It's not going to work forever. And I tell everybody that I told you that it, is not like you ride into the sunset.
Sameena Rahman (:really? Okay, so that's the way to go now. Yeah. And it worked for a while, it just stopped working.
Yeah, yeah. I was like, I don't think I got what, six months or something like that. I feel like I got like six months or something, but that's low. Maybe it was a little, it might've been longer. I can't remember, but I just know like at some point when I was running one day, I was like, oh, I smell like. But I knew it wasn't gonna work forever. I just, you know, it was to temporize until I could, you know, tell myself, yeah, yeah.
Fenwa Milhouse, MD (:really? Yeah, that was a little short. Yeah.
Fenwa Milhouse, MD (:You're like, damn it, it's back.
Fenwa Milhouse, MD (:Just let me put a sling in you, please. Okay, let me help you.
Sameena Rahman (:I'll be a better post-op patient next time.
Fenwa Milhouse, MD (:yeah, you were terrible post-op patient. y'all she was terrible. She missed all her appointments. You missed all your appointments. Yeah. She missed all her appointments. And I'm like, no wonder it came back six, eight months later. Like you didn't.
Sameena Rahman (:I was. I would hate to operate on myself.
Yeah, that's true. Anyway, once I do it, I'm gonna do it right next time.
Fenwa Milhouse, MD (:Yes. And you went into retention, which is a known risk, but you were like in retention for a lot longer than usual.
Sameena Rahman (:Yeah.
then that hurts man. No wonder people love urologists when they relieve their blood. Yeah, it hurts.
Fenwa Milhouse, MD (:I know, I know when you can't pee. my God. And when that URL just puts that catheter in you and you're like, yes. Yes.
Sameena Rahman (:Yeah, that's good. Well, we have some good stuff then and I'm going to that's what I'll do the singles.
Fenwa Milhouse, MD (:But those are my, that is like my favorite surgery to do. Those procedures are also my favorite because again, it's one of those things that majority of the time when I see patients back there like, my God, I'm so happy. Thank you. Like I get so many thank yous. Yes. Yes. Yes. Yeah.
Sameena Rahman (:Yeah, yeah, it was a nice feeling for a long time. I'm not gonna lie. It felt good. Yeah. But it's also, you know, when you're so busy in life, like, you know, some people can't focus on the other, you know, that my mom died, I had all those things happen. And then, you know, so it was, you know, everything goes on the black burner.
Fenwa Milhouse, MD (:Understandable. Yeah. It does. But we do that to ourselves too, you know, a lot. Like we, we as women put a lot of our stuff on the back burner. You know what I'm saying? I know you tell your patients, but here you are doing exactly that.
Sameena Rahman (:Yeah, as women, yeah, for sure.
Sameena Rahman (:Well, we should. I tell my patients not to do it all the time.
But now I'm starting to. I'm going to like, got my mammogram done recently. Like I'm trying to get back.
Fenwa Milhouse, MD (:Oh good. Good. What was the, how late were you like from your mammogram?
Sameena Rahman (:I was 18 months, so wasn't
Fenwa Milhouse, MD (:18 months. Okay. That's not bad. I recently saw my primary doctor who was a woman and she was like, she was like, yeah, I haven't gotten a colonoscopy. And she was like five years overdue. And I'm like, my God, like take the time off and get your colonoscopy. Yeah. So we make, we doctors make terrible patients in general. definitely, yeah.
Sameena Rahman (:Yeah, that's so fun. Yeah Yes, yes, it's Anyway, that's really good. I'm glad that you were able to tell us all that because I feel like some people don't know that some of these things are Common, but not normal and they don't have to live with them and they don't have to you know Have the shame of smelling like Pete. was remember I told you when I when my baby was younger and
Fenwa Milhouse, MD (:Not normal.
Sameena Rahman (:They're not as like, who smells like pee? Mama or the bad? I have a problem. Yeah. So that's it, guys. That's it. I'm saying it right now. I'm going to do it sometime in the next year. I have to put it out there so that I can like, you know, when you put it into existence. Yeah. Yeah.
Fenwa Milhouse, MD (:I know your kids make fun of you. remember you telling me this. Yes. Yes. You know you have a problem when the kiddos.
Fenwa Milhouse, MD (:Yes. Yes. Yes.
Fenwa Milhouse, MD (:You say it, then it's being held accountable because now people are going to listen and then they're going to ask you in real life. Yes. Yes. And then we'll do a follow up. We'll do a follow up. Yeah.
Sameena Rahman (:Because now people are like, did you get your slang? What's up? Did you your slang, that girl? Yeah. I'll jump in up and down and I'll be like, pee free. Pee free. That's funny. Anyway, thank you, Fama for being here today. What do you have to say to people that are having a hard time finding the right person? This is what I always ask people is, know, like, I feel like that's the biggest issue, right? Is trying to find the right clinician that will listen to you, especially as.
Fenwa Milhouse, MD (:That'll be funny. That'll be great.
Fenwa Milhouse, MD (:Yeah.
Fenwa Milhouse, MD (:Yeah.
Sameena Rahman (:women, women of color, that kind of thing.
Fenwa Milhouse, MD (:Yeah. Well, first of all, like go with your gut. Like if you are seeing somebody that doesn't, you don't feel like you're being heard, you feel like you're feeling very unsure. Don't like you have choices, hopefully. And please seek second or third opinions. In fact,
Any physician, good physician, the sign of a good physician is one who's not offended by you doing that. Like I tell patients, I don't want you to do any, I don't want you to let me treat you if you don't feel comfortable with me. And I certainly recommend and encourage you to get other opinions, you know, that doesn't intimidate me whatsoever.
Sameena Rahman (:Right.
Fenwa Milhouse, MD (:nor
Sameena Rahman (:Right.
Sameena Rahman (:WS is WSH.
Fenwa Milhouse, MD (:WSH ISS WSH org and they have a position finder Sufu and then there's Sufu Society for your dynamics and female your genital reconstruction, although that acronym has changed so many times So maybe it's changed again, but basically society for female urologist, huh?
Sameena Rahman (:Let's tell me, is it? huh. What is the urologics of that? Is it self-suff-suff?
Okay.
Sameena Rahman (:Yeah, all my odds throughout. Yeah. Is it all is it all the same as Sufu? Are they different?
Fenwa Milhouse, MD (:Odds is the same as Sufu. Odds is like the gyne version of Sufu. Yes, American Eurogyne, Eurogynecology Society, I think is the, what the acronym stands for AUGS, Odds, or Sufu, S-U-F-U. So, SUFU.org. You can find, I believe they have a physician locator as well.
Sameena Rahman (:version. Yeah.
Sameena Rahman (:Yeah.
Sameena Rahman (:Right.
Sameena Rahman (:Okay.
Fenwa Milhouse, MD (:And yeah, or you can, know, these are like the best places to start off with. If you're in Chicago area, if you're in the surrounding states, I'm happy to see you and be your female urologist slash urogynecologist. I have a practice in Chicago called Down There Urology. Yep. And I'm accepting new patients and I do a lot of
Sameena Rahman (:for these problems.
Sameena Rahman (:Yeah.
Absolutely.
Sameena Rahman (:We're going put all your info in the notes, how to get in touch.
Fenwa Milhouse, MD (:Pro public organ prolapse and stress incontinence and incontinence in general in men and women and I do treat incontinence in men, too I do have a partner named jug and cancel. Dr. Cancel who is Men's health specialist does a lot of male infertility a lot of erectile dysfunction a lot of testosterone low T a lot of that sort of stuff
Sameena Rahman (:Yeah. And you have a partner too, right? That treats.
Sameena Rahman (:Do you do semen, by the way, was gonna ask you, do you semen analysis in your office? Does he have a? Send that, okay, all right. I didn't know if there was an endro, because I think one of the andrology labs closed downtown. Yeah.
Fenwa Milhouse, MD (:We don't do it in our office, but we send people to get semen analysis done. Yeah. Yeah.
Fenwa Milhouse, MD (:Yeah, yeah, it's easy to do though. There's a again, full disclosure. I'm not a spokesperson for this company, but we use a company called fellow.
Sameena Rahman (:Yeah.
yeah.
Fenwa Milhouse, MD (:And they do at-home semen analysis that we trust them. Yeah, it's a very trustworthy in the urology community. It's a very trustworthy Lab and they'll send the patient a kit and then the patient jizzes and that kit sends it off and They will do a full semen analysis. They'll even cryo do cryo preservation. So they'll even do sperm banking I have a lot of patients with sperm banking because I have a lot of young men that have low T and I always encourage them
Sameena Rahman (:you
Sameena Rahman (:Yeah.
Sameena Rahman (:I didn't know this. don't know. Yeah.
Fenwa Milhouse, MD (:to do a semen analysis and sperm bank before we start low T because when we give testosterone it will decrease sperm production or a cease make it go away actually completely and sperm banking through fellow is not expensive it's like a hundred and fifty dollars or less per year it's cheap yeah
Sameena Rahman (:smart. Yeah. Yeah.
Sameena Rahman (:Yeah.
Sameena Rahman (:that's really good actually. Yeah. Well, that's good to know because I have a lot of patients whose spouses are like, need to get mine checked.
Fenwa Milhouse, MD (:Tell them to do a semen analysis at meet fellow doc. They can order it. They don't even need a doctor's order or anything like that through fellow. Yeah. Yes.
Sameena Rahman (:Oh, very good. Awesome. All right. That's a good piece of learn something new every day. anyway, well, thank you for your time and your fun and for being my neurologist. Okay. Thanks guys for joining me for another episode of Gyna Girl Presents Sex, Drugs and Hormones. I'm Dr. Sumita Raman, Gyna Girl. Remember, I'm here to educate so you can advocate for yourself. I'll see you next time.
