Deciding to first see healthcare professionals about a urogynaecological condition

This section covers:

  • Approaches before seeking medical help for urogynaecological symptoms
  • Reasons for seeing healthcare professionals
  • Reasons for not seeing healthcare professionals
  • First appointments about urogynaecological problems

In this section we use the terms:
Pelvic organ prolapse (prolapse) is a condition in which pelvic organs, like the bladder and uterus (sometimes called the womb), move down or slip out of place and may bulge into the vagina.

Urinary incontinence is the unintentional loss of wee/urine. There are other bladder symptoms that do not involve incontinence, such as needing to urinate a lot, getting up at night a lot for a wee, or difficulties emptying the bladder.

UTIs (Urinary Tract Infections) are when bacteria infect the system that stores urine (such as the bladder). There are other types of conditions that can involve bladder irritation and pain, such as interstitial cystitis (also called bladder pain syndrome).

The first healthcare professional that people usually saw about urogynaecological concerns was their GP, or a nurse at a GP surgery. Women who had concerns soon after birth sometimes talked to their midwives first. Laura, Jasmine, Rebecca, Jordan, and Jan had seen out-hours and urgent care GPs about urinary tract infections (UTIs).

Though she has since had good experiences of urogynaecological services, Rosie was initially put off by embarrassment, knowing health services are busy and feeling that her symptoms were not as “horrific” as others’ health problems.

Deciding to see a healthcare professional about urogynaecological symptoms was straightforward for some people, but taking that first step could be very difficult or uncertain for others. As Jacqueline said, “it’s not an easy thing to go in and speak to anybody about” such personal and sensitive topics. Fiona described building herself up to “bite the bullet” and ask for medical help, and Catherine described this as a “daunting” step.

Some women, like Jenny, Pauline, and Kerry, who had prolapse, saw a GP very soon after developing symptoms. For others, it took a while to realise something was different; as Jenni explained, urinary incontinence “just sort of crept up on me”. You can read more about urogynaecological signs and symptoms here.

Others decided not to seek medical help and tried to put their concerns to the back of their minds, like Emma who had prolapse symptoms for nine years before she saw a GP. Not everyone we spoke to had seen a healthcare professional about their urogynaecological symptoms.

Sabrina hasn’t seen a doctor about urinary incontinence. At first, she felt it was “just like ‘I’ve had a baby, it happens’”. Now her symptoms are impacting on her more, she is planning on seeing her GP.

Approaches before seeking medical help for urogynaecological symptoms

Before seeing a healthcare professional, women sometimes tried to manage their symptoms themselves through lifestyle changes like self-directed pelvic floor exercises, using shop-bought pads and taking over-counter cystitis or UTI remedies. Freia, who has urinary incontinence, described having a “mentality” based on her upbringing and generational attitudes; she explained, “I think, especially in the recent pandemic, that you need to do the most you can yourself before you go”.

Eve, Mary X, Hope, and Beth looked online for information on symptoms and possible diagnoses before going to a doctor. Alice got advice from a relative with a health background and started bladder training before seeing her GP.

Hope looked online for information about her symptoms before contacting her GP. The doctor agreed she probably had prolapse, and signposted her to some online resources about pelvic floor exercise.

Reasons for seeing healthcare professionals

For those we spoke to who had seen a healthcare professional about urogynaecological symptoms, the main reasons were to get a diagnosis, advice, and treatment to improve things.

There was sometimes a particular ‘trigger’ or ‘turning point’ for seeking medical help. Pauline’s prolapse affected her job and she couldn’t risk losing her income. For Fiona, her prolapse affected her sex life which was particularly important to her in the run up to her wedding. The final straw for Chelsea was when she couldn’t attend a family wedding because of recurrent UTIs. Georgina and Alice wanted to be less restricted by their symptoms when the Covid-19 lockdowns ended.

For others, the trigger to seek help was a worsening of symptoms or a general sense that ‘enough was enough’. Minnie explained, “It had got to the point where I had to do something”. Freia had felt a lot of “pressure” from friends and family to do something about her urinary incontinence, which influenced her decision to see a GP. Some people read about possible conditions online [link to TS25] and went to see doctors to find out more and get a diagnosis.

Sharon felt she had the “headspace” to see a doctor about her symptoms after returning to work from maternity leave.

Many of the people we talked to had seen GPs about urinary tract infections (UTIs), which could be one-offs or, for some, repeated and persistent. For some people, seeing a GP about UTI symptoms, having urine tested, and getting antibiotic treatment had been quite straightforward.

For others who kept having problems with UTIs returning or symptoms never going away with short-course antibiotic treatment, this pattern often led them to want a different approach from their doctors. This included seeing UTIs or UTI-like symptoms as an ongoing issue, and wanting more tests and investigations into the causes of the problem.

After having urinary tract infections every week or so for nearly nine months, Fiona asked her GP for some investigations.

An unrelated healthcare appointment was sometimes the prompt to talk to a GP about urogynaecological symptoms. Jenni explained, “it’s very easy to accept things and I think if I hadn’t gone to see the [health MOT] nurse last month and she hadn’t said to me, “Come on, you can do something about it,” I would probably have gone on accepting it [urinary incontinence] for a bit longer. Until probably I would have got really upset”. It was Kezia’s osteopath who first suggested she might have prolapse when she described her symptoms.

The nurse at Catherine’s smear test suggested she see a doctor about her concerns.

Reasons for not seeing healthcare professionals

Embarrassment and stigma about urogynaecological symptoms, body parts and sex lives were reasons why some people had ‘put off’ seeing healthcare professionals. Clare thought it had been easier to talk about “a personal aspect of her life” like urinary problems when she had a good rapport with healthcare professionals.

Phoebe and Catherine said it takes “a lot of courage” to talk about sensitive topics to healthcare professionals. Some of Fiona’s symptoms reminded her of losing a close family member to bowel cancer, and she wondered whether “maybe that’s why I put it off a little bit more”. Vicky worries that embarrassment and the fear of being dismissed might particularly hold older women back from seeing help.

Anna thinks there is a stigma about having to regularly use health services for recurrent UTIs and that many people see UTIs as “mild problems”.

The fear of what might happen at the appointment was another reason for not seeking medical help. Jordan highlighted that having and seeking help for urogynaecological symptoms could be especially challenging for those who have experienced sexual trauma.

Jessy is “avoiding” seeing a GP about urinary incontinence as she doesn’t want an internal examination after past bad experiences: “I’m basically traumatised… I’m terrified, I’m just like ‘mm, nah, maybe another day, nah. No’”.

Jessy hasn’t seen a doctor about her urinary incontinence, as she expects she would need an internal examination. She had distressing previous experiences of internal examinations and having a coil fitted.

Emma hasn’t seen her doctor about urinary incontinence. Based on what happened to her mum, she expects she would be prescribed medication and she knows she doesn’t want to take this.

For those who thought their urogynaecological conditions were caused by pregnancy, birth and/or menopause, they felt that it was just something they had to “put up” with, alongside the many other women similarly affected. As Jasmine said, pelvic floor problems are often seen as “part of the life of being a mother”. Jenny said that “I just thought [urinary problems] was another one of those things you got when you got older.” The expectation was that healthcare professionals would also dismiss or trivialise their urogynaecological symptoms as normal and unimportant.

It could also be difficult to find time for medical appointments, especially for those with children, work, and busy lives. Catherine explained that, as a new mum, “you kind of forget a little bit about yourself”, even though the symptoms were “always in the back of my mind going ‘oh yeah, I’ve got to go to the doctors about that’”.

At first, Cynthia’s prolapse symptoms were a lower priority as she focused on looking after a new baby. She then started to feel she should accept her situation as time went on.

Alice thinks there are a few reasons why younger people may not seek medical help for urogynaecological symptoms.

Some people we talked to had felt dismissed about a previous health concern, which dampened their willingness to see a healthcare professional about urogynaecological symptoms. This was the case for Georgina who also had endometriosis (a condition where tissue similar to the lining of the uterus grows in other places, such as the ovaries and fallopian tubes). Past experiences of being “told to go away and get on with it” (Holly) or feeling that doctors think you are being “overdramatic” (Jane) were hard to shake off. María didn’t think a doctor would do anything or give her a referral to secondary care for urinary incontinence so “I don’t even want to spend my saliva on calling the GP”.

First appointments about urogynaecological problems

For those who had seen healthcare professionals about urogynaecological symptoms, the first appointments were important as it could reinforce or challenge their reasons behind seeking (or put off seeking) medical help.

The first appointments could be reassuring that their concerns were important and give them information about what to expect next in terms of treatment and referrals. But some people we spoke to felt they had been dismissed and overlooked, for example if they weren’t offered enough (or any) information about the condition, possible treatments and next steps.

Kerry describes the process of attending the first appointment with her GP and finding out what her symptoms meant.

Sue Y’s first appointment with a GP left her feeling that there wasn’t much that could or would be done about her prolapse and urinary incontinence.

The first mention to a healthcare professional about urogynaecological concerns could leave a lasting impression and influence how willing women felt about going back at a later date. Jane recalled being told by the first GP she saw that she had UTIs because she was “obviously wiping the wrong way” and “not washing properly”. She accepted this at first and felt “humiliated”, leaving a lasting impact on her with “a lot of shame”.

After the advice Jacqueline was given didn’t help her, it was several years before she felt it was worthwhile going back to her GP again to ask for help about her prolapse.

Mehar had seen a GP many times about UTI, but when her dipstick tests stopped showing infections, her GP only offered psychological therapy. This left her questioning herself.

Pauline’s first impression from a GP was that she should just put up with her prolapse. She had to insist on being examined, and thinks that the reluctance she encountered was because of NHS funding cuts.

Women we talked to who developed urogynaecological symptoms following birth had often mentioned their concerns to midwives and GPs. However, the responses, like being told to wait and see what happens (Elly, Beth) or that contraception was more of a priority (Phoebe), were sometimes off-putting. Elly couldn’t understand why her doctor wouldn’t examine her when she was worried about prolapse after birth.

Chloe feels that she should have been referred to a pelvic floor physiotherapist after giving birth.

Vickie asked her GP to examine her at the 6-8 week postnatal check. Her GP seemed reluctant and she initially felt “a little bit guilty” about this, but then felt “cross” that she had needed to insist.

Those who had sought medical help during and after Covid-19 restrictions often found that there were disruptions and changes in healthcare services, it was difficult to get an appointment and it took longer to see a doctor. Jan found that her appointments tended to be shorter because of time constraints. Seeking care over the phone could be difficult too, as the doctor could not do an examination or read body language. Jenny found that using the online consult system to request antibiotics was a “nightmare”. These problems were not the same for everyone though, and Rosie appreciated that her GP examined her at a time when she knew many healthcare appointments were not in person.

Some of these problems, including long waits and cancellations, were also the case for those referred to hospital services. You can find out more here about the structure of healthcare services for urogynaecological conditions and people’s experiences of using these services.