Dr Payam Nikpoor is a gynaecologist and urogynaecologist at Jean Hailes for Women’s Health.
During my early years as a junior doctor in Adelaide, I had the honour of working with Professor Gus Dekker who is a world-renowned obstetrician. He was a true leader in his field, and he was the main reason I got into obstetrics and gynaecology training.
Some years later I got to work at the Royal Adelaide Hospital with some great gynaecologists. The one who inspired me most was Dr Graham Hamdorf, one of the masters of gynaecological surgery and a fantastic teacher (a very critical one). During my training under his supervision, I was just amazed every time I operated with him. In fact, he probably is the main reason I chose the path of gynaecology and pelvic floor surgery.
Watching women get good results and have some quality of life was the most rewarding feeling and that set me on the path of exploring female pelvic floor disorders as a specialty.
A urogynaecologist is a gynaecologist who takes an extra three years of training to sub-specialise in female pelvic floor disorders. These conditions include urinary incontinence and bladder dysfunction, pelvic organ prolapse (or simply prolapse) and lower bowel dysfunction (poor bowel control).
A urogynaecologist works with several other specialities including women’s pelvic physiotherapists, continence nurses, colorectal surgeons and urologists.
Pelvic floor disorders are common and affect women of all ages. Women either do not know how common these symptoms are, or may not see them as a problem as they are perceived as part of ageing, or they are embarrassed to bring it up with their doctors.
Women may present with complaints of urinary leakage with sneezing or coughing, difficulty holding their urine … some suffer from difficulty emptying their bladder, while some experience recurrent urine infections.
Furthermore, women may experience prolapse [when pelvic organs slip down out of place] in the form of feeling heaviness, bulge and pressure in the vagina, or protrusion. These symptoms may interfere with bowel function and lead to constipation or inability to completely evacuate bowel contents.
Treatment is a step-by-step journey and needs to be individualised for each woman. We need to have a good understanding of the underlying condition. This is achieved by detailed ‘history taking’ and gynaecologic examination. Sometimes women might need more detailed investigations. The most important aspect of a treatment pathway is the treatment goal, and this is set by the woman.
Treatment always starts with a non-surgical approach, including conservative management such as physiotherapy, vaginal pessaries and medications depending on the nature and severity of the condition. Some women need or prefer to have surgery, while some are not suitable for surgery.
The treatment pathway is ultimately a joint decision between the woman and her gynaecologist.
I have two kids and spending time with family is what I do and enjoy most. We do painting, singing, dancing and jigsaw puzzles (and all the other things parents with kids do).
In my own time, I enjoy watching movies, cycling and cooking.