A small leak during a big laugh might hint towards a bigger story. In this episode exploring the pelvic floor, Dr. Olga Ramm and patient Nicole Curutchet answer the age-old question- what’s really going on down there? Nicole Curutchet starts off by sharing her experience of developing pelvic floor prolapse, which felt like a “tampon that’s halfway coming out.” She tackles the issue of finding the right provider, and shares about her surgery and recovery. On speaking out despite stigma, she says, “this is our bodies and it’s the truth, and we don’t want people to suffer, so why not talk about it?”  

For many people with vaginas, pelvic floor leakage, pain, and other symptoms, are often dismissed as just a fact of life. Dr. Ramm and Nicole argue that it doesn’t have to be that way. A variety of treatments exist for managing pelvic disorders, including physical therapy, insertable devices, and surgery.  

As Dr. Ramm reveals “birth remains the most common inciting injury to the pelvic floor…It’s something that affects a whole lot of us.” Dr. Ramm also discusses research that shows that trauma of all kinds impacts the pelvic floor, “almost like a linear relationship between the number of adverse events that you report and the prevalence of chronic pelvic pain.” 

In a topic often characterized by silence, Dr. Ramm encourages providers to proactively ask about the pelvic floor. She emphasizes the value of informing patients about all the types of care available to them and respecting patient autonomy: “You don’t have to follow a specific algorithm. Let the patient make the choice based on their individual values, their goals for themselves and their own personal case scenarios that they want to avoid.”  

• Dr. Olga Ramm’s Website: https://www.ucsfhealth.org/providers/dr-olga-ramm  
• UCSF Center for Urogynecology and Women’s Pelvic Health: https://www.ucsfhealth.org/clinics/center-for-urogynecology-and-womens-pelvic-health
• Study That Links Duration of Pushing Phase to Degree of Obstetric Anal Sphincter, Led By Dr. Olga Ramm Injuries: https://pubmed.ncbi.nlm.nih.gov/29324610/
• Chronic Pelvic Pain Society of North America: https://www.pelvicpain.org/public
• The Body Keeps the Score: https://www.besselvanderkolk.com/resources/the-body-keeps-the-score  

Past episodes of our podcast to follow this one up:  

• Vagina Obscura: A Conversation with Rachel E. Gross 

• The Clitoris and Its Friends with Rachel Gross 

Dr. Olga Raam is the director of the UCSF Center for Urogynecology and Women’s Pelvic Health. She specializes in pelvic floor disorders and performs reconstructive pelvic surgeries with a focus on minimally invasive and robotic techniques. In her research, Ramm investigates topics related to urogynecology and reconstructive pelvic surgery, including surgical outcomes, birth trauma, care equity, and patient consent. In addition to patient care, Ramm is passionate about surgical education. She has held leadership roles in undergraduate and graduate medical training for urogynecology and reconstructive pelvic surgery at UCSF. 

Nicole Curutchet is an accomplished senior customer success manager. She has over 25 years of experience working with C-level relationships for a variety of Fortune 500 companies.  

In this episode, Dr. Eleanor Bimla Schwartz and Dr. Kelly Treder discuss misconceptions about tubal sterilization, including debunking notions that it is 100% fool-proof, that the surgery is reversible, that it is more effective than other contraceptive options, and that there is little to no pain post-surgery. “I think we do have fairly widespread misunderstanding of what it means to have your tubes tied. A lot of people seem to have the understanding that that would be something you could easily untie and that it would be a procedure that you could undo,” Dr. Schwartz says. They highlight how important it is for providers to share information with patients about other long-acting contraception options (arm implant, IUD, vasectomy) and their effectiveness with preventing pregnancy, side effects, cost, accessibility, and longevity compared to surgery. Because of this, it is crucial for providers to be informed about the nuances of different contraceptive options. Dr. Schwartz and Dr. Treder provide firsthand insight into what difficult conversations surrounding contraceptives with patients can look like. “I think it’s just our obligation to make sure that they know about all available options, that they’re not arriving at this decision that they need to have a surgery because they think it’s the only thing that’s safe for them or the only thing that will work well for them,” says Dr. Schwartz.  

This episode is a follow up to S4 E5 Lesser-Known Forms of Birth Control and Downplayed Side-effects: Providing Empowering Contraceptive Carewith Dr. Karlin and health educator Mariana Horne.

Click here to view the episode transcript. 

Resources recommended in the episode:  

• Bedsider.org is an online resource designed to help individuals explore, compare, and access birth control options. Bedsider offers a comprehensive description of various contraceptive methods, such as IUDs, implants, pills, and sterilization using interactive tools, real-life stories, and educational content.  

• Advancing Access is a UCSF resource that provides clear, evidence-based information on long-acting reversible and non-reversible birth control methods, including costs, benefits, and where to access care.  

• https://www.cdc.gov/nchs/nsfg/index.htm – National Survey of Family Growth  

CAPTC related trainings and resources 

– Shared Decision Making in Contraceptive Counseling  

– Person-Centered Contraception Counseling for Family Pact Clients  

– Same-Day Placement of LARC: Solutions to Common Barriers  

Brief Bio  

Dr. Eleanor Bimla Schwartz Dr. Schwartz, MD is a professor of medicine at UCSF and the chief of the Division of General Internal Medicine at the San Francisco General Hospital. She has a particular interest in identifying ways to meet the needs of diverse populations, including women with chronic medical conditions and other underserved populations.  

Dr. Treder Dr. Kelly Treder, MD, MPH, is a board-certified OB-GYN at Boston Medical Center and an assistant professor of OB-GYN at Boston University School of Medicine. She specializes in family planning and is committed to health equity.  

Marnina “the Queen” Miller, human rights activist and co-executive director at the Positive Women’s Network (PWN), recounts her journey living with HIV as a young woman in the American South, finding a sense of belonging in the national community of PWN, and spearheading initiatives for HIV advocacy and treatment for people of all backgrounds. Marnina discusses some of the unique challenges that Black women face within their communities as they search for inclusive care and acceptance after HIV diagnosis. She also delves deep into the world of policy, closely examining how political advocacy can impact HIV criminalization and reproductive rights. Marnina highlights the importance of coming together to provide comprehensive sexual health education. She emphasizes moving past equity and towards liberation from HIV stigma: “I want liberation… I don’t want equity. I don’t want equality. I want liberation. I want to be free of HIV stigma.” 

Read the transcript of the episode.

About Positive Women’s Network 

Marnina Miller’s LinkedIn & Instagram 

Marnina Miller is a highly accomplished human rights activist, speaker, trainer, and social media strategist with a profound commitment to fostering positive change in society. She is currently the Co-Executive Director of the Positive Women’s Network- a nationwide group that fosters support, care, and community for women living with HIV.  

Link to Past Episodes with Similar Content: 

Monica Gandhi, MD: HIV as a Movement, Not Just an Infection 

The Clitoris and Its Friends: The Anatomy of Pleasure with Rachel Gross   

Intimacy Starts with I: Women, Self Love, and HIV with Michelle Lopez 

Have any questions, concerns, or love letters? Send us a message on Instagram @comingtogetherpod or email us at captc@ucsf.edu  

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