Taking women's pelvic floor conditions seriously

As the new Division Director for Urogynecology and Reconstructive Pelvic Surgery at UK HealthCare, Dr. Johnnie Wright hopes to expand care for patients with complex pelvic floor disorders. This group of specialty providers treat patients with several pelvic floor related conditions that include pelvic organ prolapse, pelvic pain, urinary symptoms and more. 

Dr. Wright credits his mother for encouraging him to pursue medicine.

“My mother, sister and aunts were major positive forces in my life,” Dr. Wright said. “I give them credit for making me the person that I am today. I learned to treat people with the dignity and respect that every human deserves. I pursued medicine to give back to my community and nurture positive relationships.”

Dr. Wright enlisted in the U.S. Army National Guard in his final year of high school. During his final week of Army basic training, his mother passed away. At the completion of basic training, he pursued his undergraduate studies at The Citadel, The Military College of South Carolina. Fueled by his mother’s inspiration, he began his journey into medicine. 

Dr. Wright graduated from the Medical University of South Carolina and completed his internship and residency in Obstetrics and Gynecology at The Brooke Army Medical and Wilford Hall Medical Centers in Texas. He went on to complete a fellowship in Urogynecology and Reconstructive Pelvic Surgery at The Walter Reed National Military Medical Center in Bethesda, Maryland.  

After retiring from military service, Dr. Wright joined a practice in a small rural community hospital in North Carolina for about two years and worked as an Obstetrician Urogynecologist. When the University of Kentucky’s College of Medicine engaged him about starting a formal Urogynecology program, he and his family welcomed the invitation.

Pelvic floor empowerment

Among women who have had at least one child, one in three develops prolapse. Even more women will have some level of pelvic floor discomfort or pain.

“The need for our specialty in the state of Kentucky is huge,” Dr. Wright said. “There are a limited number of urogynecologic providers in the state.”

National subspecialty board certification for Urogynecology and Reconstructive Pelvic Surgery began in 2013. Before formal board certification, most pelvic floor procedures were completed by gynecologic surgeons who took an interest in pelvic floor dysfunction and corrective surgical procedures. This often meant that access to specialists was limited to facilities in large metropolitan areas. Patients in smaller and/or rural areas either had to travel or go without access to receive this specialty care.

Like many UK HealthCare specialties, Urogynecology and Reconstructive Pelvic Surgery receives referrals for patients with complex pelvic floor disorders that cannot be addressed in community health settings with fewer resources. 

Without the appropriate treatment for some pelvic floor disorders, women can struggle with pain or other symptoms. This can result in a decreased quality of life and mental health issues like depression and anxiety. Patients often dismiss, ignore or simply accept their symptoms. Delayed intervention can potentially result in irreversible damage and lifelong disability.  

“There’s a small subset of the population that feels, ‘Hey, if it’s not cancer or pain, I don’t need to worry about it, right?’” says Dr. Wright. “Some disorders can be addressed early and potentially avoid disability. Disorders that are not addressed before reaching an advanced stage can sometimes result in irreversible damage that cannot be improved with surgical intervention.”

Restoration of pelvic, physical and mental health should be the goal for intervention. Optimization of mental health is critical as those with pelvic pain or incontinence can experience depression, anxiety or social withdrawal. 

Patient education is often overlooked and is a critical part of treatment. According to Dr. Wright, education can be equally, if not more, important than the surgical/clinical interventions themselves. It is important to educate patients on:

• What their symptoms could mean.
• How pelvic floor dysfunction impacts their day-to-day life.
• Why these problems should be taken seriously and not ignored.

“We work closely with not only the patients, but also potential referring providers in their respective communities. We share with providers that we welcome the opportunity to see any patient with prolapse, incontinence, pelvic floor dysfunction or pelvic pain,” says Dr. Wright. “The beauty about an encounter is it typically results in something positive for the patients, even if it’s just education. I see it as an opportunity to get some pelvic floor empowerment that goes a long way with a lot of patients.”

Helping more women 

UK HealthCare Urogynecology and Reconstructive Pelvic Surgery is working diligently to increase access for patients with complex pelvic floor disorders. In 2023, the program saw about 5,000 patients and completed nearly 500 surgical cases. 

Dr. Wright expects the number of patients seen and procedures performed to steadily increase. It is his hope that increased access will allow the program to initiate meaningful clinical research, enabling UK HealthCare providers to better understand women’s pelvic floor needs as they relate to their unique circumstances.

As an Army veteran, Dr. Wright is aware of research addressing pelvic floor conditions in female paratroopers. While paratroopers have unique occupational hazards, Dr. Wright is intrigued by the opportunity to research whether other occupations place women at high risk for complex pelvic floor disorders. 

Given that Urogynecology is a relatively new subspecialty in Obstetrics and Gynecology, questions remain: 

• Are women who play specific sports at higher risk? 
• Do other activities impact chances of developing pelvic floor dysfunction? 
• Can we establish firmer data on prolapse or incontinence risks in women who have delivered a child vaginally vs. cesarean section? 

These are all avenues for potential study. For now, the program’s focus remains on patient access, treatment and education.

“As the program matures, more women in the Commonwealth will get the care they need to reduce and/or eliminate symptoms associated with complex pelvic floor conditions,” says Dr. Wright. As education and access expand, more women will realize they don’t have to ignore or power through their symptoms. Treatment and medical care that takes their pain and/or discomfort seriously is possible and available.

“I do think the tide is changing,” Dr. Wright said. “It’s about access and getting the word out to our primary care colleagues and potential referring partners on the front lines of health care that we’re here and we can help.”

To make a referral

To refer a patient, place an order for “Ambulatory Referral to Urogynecology” in EpicCare Link or call UK•MDs at 800-888-5533. UK HealthCare EpicCare Link (ukhealthcare.uky.edu/providerportal) is the preferred method for submitting electronic referrals. In addition, you can fax the referral to 859-323-0005 or call the clinic directly at 859-323-0790.