POP Healthcare Priorities and Global Evolution Insights, with Oscar Contreras Ortiz, MD, FACOG

Women’s breast and heart health directives receive a considerable amount of press time, but somehow despite massive prevalence, pelvic organ prolapse (POP) has never comfortably been accepted as a topic of open conversation. The good news is female pelvic health care is slowly becoming a bit more energized after thousands of years of being stuffed in the closet. The bad news is we are truly not clinically or academically prepared for concerns that underscore the POP pandemic.  With half the female population experiencing pelvic organ prolapse and multiple intersecting pelvic floor conditions, how will we address need?  When will women be routinely screened for POP? Who will fill research and clinician shortfall? We have much work to do to enable the clinical, academic, and research arms to spawn in a way that will effectively address coming need.

I’ve had the privilege of conversing with an internationally respected urogynecologic Key Opinion Leader from Argentina, Oscar Contreras Ortiz, MD, FACOG, who graciously shared his opinions regarding global POP concerns.

Sher: The stigma of embarrassing symptoms has shrouded pelvic organ prolapse in secrecy for nearly 4000 years. What do you feel is the most important role healthcare could take collectively to generate a significant shift in pelvic organ prolapse awareness at the patient level?

Dr. Ortiz: The significant shift in pelvic organ prolapse awareness would be to consider genital prolapse within a holistic concept that is “Female Pelvic Floor Dysfunction”. Prolapse is defined as a hernia beyond the vaginal wall”, that is to say the anatomical lesion from the pelvic floor dysfunction. Because of this isolated lesion the patient delays the consultation from 5 to 12 years due to embarrassment, and because it does not significantly alter the patient’s quality of life being able to reduce the prolapse usually without pain, allowing a social and sexual life.
This anatomical lesion goes along with urinary incontinence, bladder dysfunction (urinary frequency), anal incontinence, and/or pain in sexual relations and/or changes in bowel function, etc, in fifty percent of the patients.
When these functional alterations are associated, the consultation is produced between 1 to 5 years from the symptom onset and only 1 out of 4 patients do it. The hiding of the symptom (worldwide) is due to embarrassment, isolation, depression, social activity limitation, low self-esteem, and productivity may decrease with the impact that this produces in quality of life. That is why the holistic concept of pelvic floor dysfunction allows evaluating the predominant factors of the quality of life alteration.

Sher: Considering childbirth and menopause are the most common causes of pelvic organ prolapse, what do you feel the potential is that at some point in the near future, women will be consistently screened for pelvic organ prolapse during routine pelvic exams?

Dr. Ortiz: Some key points should be considered for the holistic concept of pelvic dysfunctions and they are related to:
         1. Adequate medical training and information to the community. Adequate medical training is considered within the article“Guidelines and Enabling Objectives for Training Primary Healthcare Providers, Gynecologists and Obstetric and Gynecology Residents in Female Pelvic Floor Medicine and Reconstructive Surgery”. Oscar Contreras Ortiz, Diaa EE. Rizk, Gabriele Falconi, Lucas Schreiner, and Viridiana Gorbea Chavez, Neurourology and Urodynamics, Volume 35, Issue S1, February 2016, Pages: S6–S109, that refers to the inclusion of urogynecology and pelvic floor dysfunctions within basic OB/GYN medical training.

         2. Information for the patients. We should design basic information adapted to the target population according to the levels of education of the patient where basic concepts would first be included and then more specific ones. These concepts should have specific characteristics; information should be brief, available to both groups, with illustrative material, indications of risk factors and positively encourage the patient about the results of the early consultation.

Sher: Within your vast international networking within the urogynecologic and urologic female pelvic health community, what is the greatest clinician concern being addressed today?

Dr. Ortiz: The great concern is focused in the different capacities and possibilities of the regions. For this reason, the following should be analyzed:
           1. Quality of life impact.
           2. Relationship between cost-effectiveness and cost-benefit.
           3. Characteristics of population target.
           4. Quality of primary health care in the area.
           5. Diagnosis methodologies according to the grades of evidence that would allow grades of recommendation related to the above-mentioned points.

Sher: Considering the shift in POP awareness that is finally spawning, do you feel the research and clinician communities at large will grow quickly enough to address need on the global plane?

Dr. Ortiz: There are numerous non-consensual proposals in the nomenclature, in research designs and therapies not validated by randomized control trials that have motivated different therapeutic and diagnostic opinions in permanent review.
Technological development and its adaptation for clinical use are not always related with its analytical validation. From this the differences in regional consensus are derived.

Sher: We have so much more to do: we have so much more to learn. As healthcare, research, academia, industry, and advocacy move the needle forward side by side, we will springboard a comfort zone enabling global evolution.

~Every Voice Matters~

Oscar Contreras Ortiz, MD, FACOG biography: Dr. Ortiz is an International Urogynecological Association (IUGA) co-founder, International Federation of Gynecology and Obstetrics (FIGO) former Working Group on Pelvic Floor Medicine and Reconstructive Surgery Committee Chair, international Urogynecologic Key Opinion Leader, and is Consultant Head Professor of the Faculty of Medicine, University of Buenos Aires, Argentina. Dr. Ortiz is the recipient of 5 international awards, has submitted 144 academic papers in Argentina and 93 international academic papers, and has contributed multiple chapters in academic books.