Departments
Urogynecology & Reconstructive Pelvic Surgery
We treat women with urogynecological disorders, which arise from pelvic floor dysfunction, such as urinary and bowel incontinence, pelvic organ prolapse, interstitial cystitis, and related sexual dysfunction. These symptoms are caused by damage to the muscles of the pelvic floor. Our specialists help women understand their condition, recognize their symptoms, and match them with the treatment that best suits their comfort level and lifestyle. Many people assume pelvic floor disorders only affect a small number of elderly or disabled women, or are an unavoidable consequence of aging. However, they are actually very common—one in three adult women suffer from incontinence or prolapse—and are treatable. Our patients receive care and treatment at our Pelvic Medicine and Continence Center. The center offers a wide range of treatment options, both surgical and nonsurgical. Our doctors are active researchers working to further advance understanding of pelvic floor dysfunction. One of our primary research goals is to develop minimally invasive treatment options so that our patients are the first to benefit from these advances.Urology
Urologic diseases affect more than 20 million men, women, and children in the United States. Yale Medicine Urology, named one of the nation’s best urology programs by U.S. News & World Report, cares for adults and children with conditions that affect the bladder, kidneys, pelvic floor, penis, testicles, and urinary tract. Some urologic conditions are present at birth, and others develop over time. Whether for a routine checkup or highly specialized care, our urologists and caregivers provide the most advanced treatment, grounded in research. Our urologists are leaders in the fields of female pelvic medicine and reconstructive surgery, as well as men’s health. Our oncology team has made key research breakthroughs in the treatment of metastatic bladder cancer and kidney cancer. In addition, we offer specialized care for kidney disease, incontinence, stone disease, sexual medicine, neurogenic bladder, transgender care, and reconstructive surgery after trauma. We use the most advanced technology and procedures to give our patients the best care available. Our urologists offer Artemis MRI-ultrasound fusion for prostate biopsy, advanced imaging, laparoscopic and daVinci Si robotic surgery, Holmium Laser Enucleation of the Prostate (HoLEP), as well as UroLift and GreenLight laser procedures. Our doctors and the hospitals where we provide care rank among the best in the country. In addition to providing treatment at Yale New Haven Hospital, Smilow Cancer Hospital, Yale New Haven Children’s Hospital, Greenwich Hospital, and Lawrence + Memorial Hospital, we also have offices located in communities across Connecticut. Above all, at Yale Medicine Urology, we believe in the importance of the patient-doctor relationship. It is the cornerstone of what we do—provide compassionate, quality urologic care to every patient, every day. A multidisciplinary team of urologists, specialty-trained nurses, caregivers, and support staff will take care of patients and their families. The urologist leads the care team, providing a diagnosis and treatment recommendations, as well as performing surgery, if needed, and overseeing the patient’s recovery and postsurgical care. The nurse coordinator is the patient’s advocate and care manager throughout care. Studies show that using nurse coordinators can reduce the length of hospital stays and enhance patient outcomes. Practice nurses provide the day-to-day care during clinical appointments or hospital stays. They administer medications, track vital signs, review general test results, respond to patients’ specific needs, and report to other members of the team. They are available around the clock to answer questions and to help patients through their care. The intake specialist helps to ensure patients are ready in advance of their appointment and have all forms and records completed and sent in advance. Intake specialists are experts at understanding the patient appointment and transfer process. If faced with a diagnosis oNeurogenic Bladder Program
We know that a diagnosis of neurogenic bladder, a form of bladder dysfunction, can significantly impact overall quality of life, and we want to help. Our experts will develop a treatment plan that fits our patients’ lifestyle and will work closely with others who are involved in their care, including neurologists, physiatrists, and primary care specialists. Patients with known, established neurologic diseases who also have bladder symptoms are referred to our urologists for further evaluation. We deliver the best and most current available treatment options for neurogenic bladder, including bladder training, sacral neuromodulation and catheterization. We also offer bladder reconstructive surgery, when needed.Lower Urinary Tract Dysfunction (LUTD) & Genitourinary Reconstruction
Our specialists treat a diverse range of benign (non-cancerous) urinary tract conditions, including male urinary issues (enlarged prostate, difficulty urinating, overactive bladder, urinary incontinence), female pelvic floor disorders (urinary incontinence, overactive bladder, pelvic organ prolapse), urinary tract reconstruction, and penile and scrotal reconstruction. Genitourinary tract reconstruction Our fellowship-trained specialists offer a wide range of options to address congenital or acquired issues of the urinary tract and male genital tract. We partner with patients to achieve their goals, restore urinary and sexual function, and improve quality of life. Benign prostatic hyperplasia Benign prostatic hyperplasia (BPH) is one of the most common reasons patients have bothersome voiding symptoms or difficulty with urinating. Our specialists can help get to the root cause and offer several treatments, including minimally invasive surgeries such as Urolift. We were also the first in Connecticut to offer Holmium Laser Enucleation of the Prostate (HoLEP). Neurogenic bladder We expertly treat those experiencing loss of bladder control after an injury to the nervous system. Our specialists serving those with neurogenic bladder help deliver treatments that can restore independence and make symptoms more manageable. Urogynecology / Female Pelvic Medicine and Reconstructive Surgery [FPMRS] More than 50% of women report bladder issues, such as urine leakage or overactive bladder (urinary urgency or frequent urination). Another common issue is pelvic organ prolapse, a condition in which the uterus and vagina can drop, causing a feeling of a vaginal bulge. There are nonsurgical treatments, such as pelvic floor physical therapy, as well as effective office procedures and minimally invasive surgeries that can treat many of these symptoms. Our specialists will work with our patients to develop an individualized treatment plan and get them back to their active lifestyle, restoring their quality of life.Gynecologic Specialties
Providing patient-centered, compassionate gynecologic care is our priority. Our diverse team of gynecologists offers consultative and treatment services for a comprehensive range of gynecologic conditions. Our clinical expertise in prevention, screening, and diagnosis of gynecologic cancers, prevention and treatment of gynecologic infections, fibroid management, management of endometriosis and pelvic pain, contraceptive services, and gynecologic care for patients with HIV are just a few examples of areas in which we are proud to be making a difference in our community. We offer state-of-the-art approaches to individualize the care of women with complex gynecologic conditions, including those that are precancerous, require minimally invasive surgery, or other advanced medical or surgical treatments. We care for patients of all ages across the entire community, including those who are underserved. We offer expertise in treating a variety of conditions including: Abnormal pap smears Abnormal uterine bleeding Chronic pelvic pain Complex surgical histories Endometriosis Fibroids Menopausal symptoms Ovarian cysts Pelvic infections Precancerous changes in the vulva, vagina, cervix (dysplasia), or uterus (hyperplasia) Sexual dysfunction Additionally, we provide the following specialty services: Minimally Invasive Gynecologic Surgery (MIGS) . We offer an array of advanced laparoscopic, robotic, vaginal, and hysteroscopic surgical techniques to manage benign and precancerous gynecologic conditions. Office-based procedures. We offer several in-office procedures including colposcopy and LEEP, contraceptive implant and IUD insertion and removal, diagnostic hysteroscopy, endometrial and vulval biopsies, and trigger point injections in a safe, comfortable, and convenient setting. Transgender care. We offer surgical consultation for women transitioning to men. Pre-invasive gynecology care. We provide multidisciplinary evaluation and management of abnormal pap tests and precancerous conditions of the uterus, cervix, vagina, and vulva using the most up-to-date practice guidelines, in collaboration with gynecologic pathologists. Chronic Pelvic Pain. We provide a comprehensive, patient-centered approach to pelvic pain. We work with a multidisciplinary team (colorectal, urology, interventional radiology, social work, physical therapy, and vascular surgery) to address pelvic pain, which often has multiple causes. We are committed to working closely with local practices, community-based health centers, and colleagues in other medical specialties to ensure coordination of timely and appropriate gynecologic care for our patients. Our multidisciplinary approach includes partnership with primary care, other surgical specialties, pathology, radiology, social work and care coordination. We are committed to serving the community and providing access to care. Our collaborative care model includes working with the Connecticut Veterans Administration Health Care System, CornEndometriosis Program
Endometriosis, a common gynecological disease, affects one in 10 women in the U.S., and is diagnosed in up to half of women who experience infertility . Due to its nonspecific symptoms, endometriosis often goes undetected for years. Many individuals attribute their chronic pelvic pain to menstrual cramps rather than recognizing it as a symptom of endometriosis. Additionally, some may remain unaware of their condition due to silent symptoms. It can take up to a decade for some patients to receive a proper diagnosis. Normally, the uterine lining (endometrium) grows along the interior walls of the uterus, providing a cushioned and receptive environment for embryo implantation during pregnancy. However, in endometriosis, the endometrium grows outside the uterus, commonly on the exterior of the uterus, ovaries, fallopian tubes, bladder, intestines, or other pelvic structures. This displacement frequently leads to chronic pelvic pain and may cause secondary symptoms, such as irritability, difficulty sleeping , anxiety , depression , or low self-esteem. Over time, endometriosis induces inflammation, bleeding, and scar tissue formation within the pelvic cavity, regardless of whether the patient experiences pelvic pain. The presence of scar tissue can hinder fertility. Early diagnosis of endometriosis, before the formation of scar tissue, can help preserve fertility. A delayed diagnosis may pose challenges for conception, even with assisted reproductive procedures like in vitro fertilization (IVF) . To confirm endometriosis, clinicians biopsy a small sample of uterine tissue and examine it under a microscope for signs of the condition. For patients diagnosed with endometriosis, the news may bring emotional relief after years of pelvic pain without a clear cause. Our providers offer treatments to alleviate chronic pain and related physical and emotional symptoms, and assess whether endometriosis has contributed to infertility. Treatment options for endometriosis include medications and/or surgical procedures, such as excision surgery, to relieve pain, remove scar tissue, and improve organ function. These treatments may also prevent a recurrence. In cases of endometriosis-related infertility, clinicians may recommend IVF or other assisted reproductive therapies to enhance pregnancy chances. Many patients with endometriosis benefit from therapy alongside medical treatments. Additionally, we conduct various research projects, offering patients access to medication and testing at no cost. Throughout the infertility journey, our counselors support patients with endometriosis, explaining different assisted reproductive technologies and helping patients understand their options fully.Obstetrics, Gynecology & Reproductive Sciences
Yale’s Department of Obstetrics, Gynecology and Reproductive Sciences is dedicated to helping women at all stages of life. A global leader in women’s health, Yale is known for its innovative contributions to diagnosis and treatment, including: Developing the first fetal echocardiography Pioneering the first obstetrical ultrasound Developing the first fetal blood sampling and first fetal transfusion Offering the first chorionic villus sampling in New England Co-authoring the first U.S. study for first-trimester risk assessment Developing the first comprehensive first-trimester risk assessment program in New England Inventing fetal monitoring and many prenatal diagnostic and treatment techniques Our physicians tap into the broad expertise of our entire institution to provide compassionate, customized care for all of our patients, from adolescence through adulthood. Through eight subspecialty areas, we offer the most advanced diagnostics and therapies that harness the latest advances in technology. Recent clinical research includes a new emphasis on therapeutic vaccines in gynecologic oncology, novel treatments for endometriosis and menopause, a comprehensive patient safety program in maternal-fetal medicine, and an advanced fetal therapy program. Specialized care is offered in the following areas: Family planning Gynecologic oncology Gynecologic specialties Maternal-fetal medicine Obstetric specialties & midwifery Pediatric & adolescent gynecology Reproductive endocrinology & infertility Urogynecology & reconstructive pelvic surgery Maternal-fetal medicine service offers 24-hour on-site dedicated space for complex pregnancies and fetal care First in Connecticut to perform in-utero laser therapy in pregnancies complicated by twin-to-twin transfusion syndrome Outstanding survival outcomes for all types of gynecologic surgery, from open to robotic Pioneer in caring for patients with sexual intimacy issues after cancer surgery Fetal therapy program Midwifery and birthing centerSexuality, Intimacy & Menopause Program
The Sexuality, Intimacy, and Menopause Program is one of the only clinics of its kind in the country. By combining both medical and psychological interventions, it is designed to help women who experience sexual dysfunction after cancer. Sexual dysfunction after cancer is common; however, sexual side effects often go untreated after having successfully treated a patient’s cancer. Our doctors look to manage not only the physical issues, but also any psychological concerns that may arise. Founded by Elena Ratner, MD, MBA, associate professor of Obstetrics, Gynecology & Reproductive Sciences and co-chief for the Section of Gynecologic Oncology, and Mary Jane Minkin, MD, clinical professor of Obstetrics, Gynecology & Reproductive Sciences, the clinic began nearly a decade ago. Psychologist Dwain Fehon, PsyD, associate professor of Psychiatry and chief psychologist of Psychiatric Services at Yale New Haven Hospital, is a vital member of the team. He and his staff provide essential emotional care that helps improve our patients’ relationships and personal health. Many women have concerns related to intimacy and menopause because of cancer surgery or treatment. Our specialists consult with patients to address the difficult physical and emotional aspects of cancer care and treatment, and create a personalized care plan for each patient. We have developed a unique focus on menopause management for cancer survivors and “previvors”—healthy women who have their breasts or ovaries removed because of a genetic risk of developing cancer. What types of patients do we see? Women who experience: Changes in sexual function as a result of chemotherapy, radiation, or surgery for cancer Menopause symptoms as a side effect of cancer treatment Early menopause or sexual changes after surgery for cancer risk reduction What we provide: Menopause symptom management Resources for cancer survivors on maintaining sexual health Access to complementary and supportive services Access to individual and couples counseling What to expect from an appointment: Our team will first discuss each patient’s medical and cancer history, as well as what type of treatment they have had. They will be asked about symptoms of menopause and sexual problems, such as hot flashes, night sweats, changes in sexual desire, painful intercourse, vaginal dryness, or changes in mood or sleep patterns. Depending on their symptoms, patients may have a gynecologic exam. The team will then discuss options for symptom management and improving their sexual health. They will also have the opportunity to talk about emotional and relationship issues affecting their life. Women are welcome to bring their partners to the appointment.Gynecologic Oncology Program
The focus of the team of clinicians who form the Gynecologic Oncology Program at Smilow Cancer Hospital is to provide comprehensive and compassionate care for women with gynecologic cancers. Women diagnosed with vulvar, vaginal, cervical, uterine, fallopian tube, or ovarian cancers are provided with exceptional care from Yale’s experienced team of gynecologic oncologists at the hospital’s dedicated Women’s Center. In addition, the team also treats soft tissue tumors of the pelvis, gestational trophoblastic disease, as well as women with precancerous changes that have been identified in the vulva, vagina, and cervix, including dysplasia and carcinoma in situ, or premalignant changes of the endometrium, including adenomatous hyperplasia. The physicians of the Gynecologic Oncology Program offer a wide spectrum of advanced strategies for the diagnosis and treatment of gynecologic cancers, including colposcopy evaluation, conformal radiotherapy, and novel, targeted chemotherapies. The multidisciplinary program has experts from the obstetrics, gynecology, and reproductive sciences; radiation oncology; radiology and biomedical imaging; genetics; pathology; pharmacy; and social work. A dedicated patient coordinator facilitates patient appointments and communication, coordinates services, and supports each patient and their family. Surgery for previously untreated gynecologic cancer Surgical treatment of cancer is the most common option for previously untreated cancers. These operations include radical hysterectomies for cervical cancer, cytoreductive surgery for ovarian cancer, radical vulvectomies for vulvar cancer and total abdominal hysterectomies, bilateral salpingo-oophorectomies, and lymphadenectomies for the staging and treatment of endometrial cancers. Conventional laparoscopic and robotic surgery is available to women in need of surgery for uterine cancer, as well as for removal of the uterus, tubes, and ovaries. Prophylactic surgery, including hysterectomy, bilateral salpingo-oophorectomy, or bilateral salpingectomy with ovarian conservation, is also available to women looking to prevent ovarian cancer occurrence. Preservation of fertility in women with gynecologic cancers whenever possible is always a priority. We perform radical trachelectomies in women with early-stage cervical cancer who desire fertility preservation. For women with early-stage, low-grade endometrial cancers, hormonal therapy is prescribed. Chemotherapy Management The Gynecologic Oncology Program provides a full spectrum of chemotherapeutic agents used in the management of ovarian cancer, fallopian tube cancer, uterine cancer, mesenchymal tumors of the uterus, cervical cancer, vaginal cancer, and vulvar cancer. These chemotherapeutic agents may be used either for primary treatment or treatment of recurrent disease. Neoadjuvant chemotherapy, i.e., chemotherapy prescribed before surgical treatment, is often used for women with advanced ovarian cancer to reduce the sPolycystic Ovarian Syndrome (PCOS) Program
Polycystic ovary syndrome (PCOS) is one of the most commonly misdiagnosed conditions associated with female infertility . It is a prevalent yet intricate endocrine disorder marked by an imbalance of female reproductive hormones. Common symptoms include irregular menstrual periods, acne , and excessive facial or body hair growth. PCOS is often linked with obesity. In addition to fertility issues, women with PCOS face an increased lifetime risk of conditions such as diabetes , uterine lining pre-cancer, cholesterol abnormalities, high blood pressure , sleep apnea , and depression . Effective PCOS management typically requires a multidisciplinary approach involving primary care physicians (for general health, weight loss, diabetes risk, high blood pressure, and depression), gynecologists (for gynecological health and uterine lining protection), endocrinologists (for hormonal issues, including hair excess and acne, obesity, diabetes, and elevated cholesterol ), and reproductive endocrinology and infertility specialists (for pregnancy goals). Maternal-fetal medicine specialists may also be involved for fertility-seeking women at risk of gestational diabetes or pregnancy-related blood pressure problems. Mental health providers and nutritionists can also provide valuable support for improving overall well-being. Our aim is to optimize the family-building goals of women with PCOS while prioritizing the overall well-being of both mothers and babies. For overweight or obese women with PCOS, lifestyle modifications focusing on diet and exercise can lead to significant improvements in menstrual cycles, acne, and mood. Metformin, commonly prescribed for diabetes, may also benefit overweight or obese women with PCOS, as well as some undergoing fertility treatment. Treatment options for PCOS should be tailored to reduce symptoms (such as abnormal menstruation, acne, and excessive hair growth), address individual goals (such as fertility), and mitigate lifetime risks (such as diabetes, depression, heart disease, and uterine cancer ). Treatment may include birth control pills with or without anti-androgens for acne and hair growth, as well as medications like metformin. Our team is dedicated to helping patients with PCOS achieve their fertility goals through personalized treatment plans. Our approach begins with a comprehensive evaluation, including hormonal and metabolic profiling and an assessment of uterine and fallopian tube health. For couples in heterosexual relationships, semen analysis is a critical step. Endometrial biopsy may be recommended for women with irregular menstruation. Preconception consultations with high-risk obstetricians may also be advisable for those at higher risk of pregnancy complications. For women with PCOS-related infertility, various treatment options are available, such as ovulation induction with medications like letrozole. Metformin may be added if the ovaries are unresponsive to these medications. Injectable hormoGastrointestinal Motility Program
The Yale Medicine Gastrointestinal Motility Program is led by a team of gastroenterologists who subspecialize in motility disorders. We work in collaboration with radiologists, colorectal, surgeons, GI surgeons, thoracic surgeons, urologists, urogynecologists, and physical therapists to care for patients with complex motility disorders. As part of our multidisciplinary approach, our team meets monthly to discuss complex cases to ensure that each patient receives an individualized treatment plan. We strive to provide excellent care in a compassionate way. Our state-of-the-art services include: The Bravo pH Monitoring System, a catheter-free instrument that measures acidity levels in patients suspected of having gastroesophageal reflux disease (GERD). A small capsule is attached to the wall of the esophagus, which transmits data to a pager-sized receiver, which is worn for 48 hours. During this time, patients push a button whenever they experience symptoms, so we can determine if the symptoms correlate with incidents of acid reflux. When the test is over, data from the receiver is downloaded to pH analysis software, where it is analyzed. The SmartPill Capsule, a new technology available at only about a dozen medical centers around the country. The ingestible, wireless capsule measures pressure, pH, and temperature as it moves through the GI tract, allowing physicians to identify where abnormalities in intestinal transit are located. The SmartPill transmits information to a data receiver worn by patients. After the capsule has passed from the body, patients return the receiver to the physician, who is able to display and analyze the data within minutes. Impedance monitoring is a catheter-based system that enables doctors to diagnose nonacid reflux. Patients wear the monitoring system for 24 hours, and push a button whenever they experience symptoms. Physicians then download and analyze the data to determine whether the reflux is acidic or nonacidic, and whether the symptoms correlate with incidents of reflux.Family Planning
The Yale Family Planning program’s vision is to provide reproductive health care rooted in dignity, equity, and science. Our mission is to provide exceptional care through evidence-based medicine, essential education, rigorous research, and advocacy focused on abortion and contraception. We provide compassionate and evidence-based care for people when they need birth control, as well as when they face unexpected or unhealthy pregnancies and need abortion care or miscarriage treatment. We support our patients’ journeys with respect. We know that all people deserve comprehensive information about their treatment options to make the best decision for themselves and their families. When it comes to reproductive health, we put our patients’ needs above all else. Our team includes subspecialty-trained physicians and dedicated nurses who provide compassionate care for our patients and their families. When our patients’ medical needs are complex, we partner with an interdisciplinary team of high-risk obstetricians, anesthesiologists, and medical specialists. Our services include: Pregnancy prevention with contraception: Contraceptive counseling and care Specialty contraceptive care for women with complex medical conditions (bleeding or clotting disorders, kidney failure, prior heart attack, organ transplant, or weight-loss surgery) Expertise with intrauterine devices and arm implants Pregnancy loss care: All options for management of early miscarriage Surgical management of second trimester pregnancy loss Bereavement support for pregnancy loss Abortion care: Medical abortion care in the first trimester Surgical abortion care through 23+6/7 weeks gestation Option of general anesthesia (to be “asleep“) for the procedure Bereavement support for ending a pregnancy Preoperative visit. This visit will include counseling, a medical history review, an exam (possible ultrasound and pelvic exam) and possible blood testing. The doctor will also review preoperative instructions (including arrival time for procedures), and consent forms will need to be signed. Patients should plan 1 to 1.5 hours for this visit. A support person is welcome. Before a preoperative visit, patients may need to have a separate ultrasound visit. Operative visit. Generally, the operative procedure will be the next day. Patients must not eat or drink for at least 8 hours before the procedure time, usually not after midnight the night before. Since patients will be affected by the anesthesia for the rest of the day after the procedure, they must have a ride home with someone who is at least 18 years old. They should plan to spend 5 to 6 hours at the hospital this day. Contraceptive visit. At this visit, we will review the patients’ medical history, counsel them on options for contraception, help them select a method that is right for them, and start that method. To prevent a concern for possible pregnancy at this visit, patients should not have unprotected sex for 15 days b