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Ask the Expert

Ask the Expert

A Q&A on Women’s Pelvic Health

Urinary issues, vulvovaginal atrophy, and sexual dysfunction are NOT insignificant problems. In fact, 1 of 20 women in their 20s suffer with urinary incontinence. This increases to 50% by the time they reach 60. Women post hysterectomy, breast cancer survivors, and 50% of postmenopausal women suffer symptoms of vulvovaginal atrophy, and 40% of women of all ages suffer distress due to sexual dysfunction. Yet, only 14% ever discuss these issues with their physician, and unfortunately their concerns are sometimes dismissed as physicians seem to struggle with this conversation as well. Many women have come in for consults with questions for Dr. Hettiarachchi that we would like to share with you:

Q: What is the difference between a Gynecologist and a Pelvic Specialist?

A: The difference between a Gynecologist and a Pelvic Specialist is that a Gynecologist focuses on managing uterine, ovarian, pregnancy, and menopausal health versus a Female Pelvic Specialist whose focus is on the health of the entire female pelvic region, including vaginal and vulva tissue, the urinary tract, and the female sexual system as well as aesthetic appearance. A Female Pelvic Specialist can offer medicinal treatments, laser and other non-hormonal therapy, as well as perform complex surgery for prolapse and incontinence.

Q: Are there any side effects, pain, or downtime for the non-surgical treatments offered and are they safe?

A: Most important is to make sure you are examined, evaluated, and treated by an expert in the field to determine if a non-surgical treatment is an appropriate option for you. Non-surgical options include CO2 Laser therapy, radio frequency therapy, and a platelet rich plasma shot. These therapies are safe for breast cancer survivors as they are non-hormonal options. MonaLisa Touch laser is a five-minute treatment with mild discomfort and vaginal pressure. Some patients may experience mild spotting and external itching for a few days. Intercourse can be resumed after three to seven days. It treats urinary symptoms, vaginal pain and discomfort, and may improve laxity. The thermaVa is a 30- to 40-minute treatment with no discomfort. Women return to work immediately with no sexual downtime. This treatment focuses on aesthetics, laxity, urinary issues, and sensitivity. The O-shot takes about 30 minutes in office. Your own blood sample is processed so it can be gently injected to enhance sexual pleasure and improve urinary symptoms. There is no downtime, very little discomfort when injected, and no pain after. In fact, women report immediate results and improvement to achieve orgasm. The O-Shot may be prescribed in conjunction with laser or radio therapies.

Q: As a new breastfeeding mom, I have noticed looseness and dryness. Are there any options for me?

A: Yes! About 12 weeks postpartum any one of these non-hormonal treatments would be a safe option that would in no way affect your breast milk nor baby. So many new moms suffer with vaginal and urinary issues as a result of lowered estrogen during lactation, and unfortunately, get discouraged and stop breastfeeding. Suffering from these pelvic symptoms may also influence their relationship with their partner. It is encouraging to know that there are therapies available so that lactating moms can improve their pelvic health and comfort, continue breastfeeding, and maintain a strong bond with their partner.

Thank you to all of my patients who have found the courage to discuss this sacred topic and spread the word that there are treatments that can change women’s lives. If you can’t find the answers you need, please call, email me or come in for a complementary consult. I’m honored by your interest.


Dr. John Hettiarachchi, Fellow of the American College of Surgeons, is board certified in Urology and Urological Surgery and subspecialty certified in Female Pelvic Medicine and Reconstructive Surgery. The Charlotte Center for Pelvic Health is the first and only pelvic specialty practice in the Charlotte region offering multiple cutting-edge non-hormonal, non-surgical therapies. 

1-855-65-TOUCH (1-855-658-6824)
19901 W. Catawba Ave., Suite 201
Cornelius, North Carolina


Dr. John Hettiarachchi, FACS FPMRS

Dr. John Hettiarachchi, FACS FPMRS