Can a “normal” pelvic exam mask life-altering pain? On this episode of BackTable Women’s Health, host Dr. Karen Toubi interviews board-certified OBGYN Dr. Chailee Moss about why common vulvovaginal pain and skin conditions are frequently missed or dismissed as “normal” exams. Dr. Moss explores how gaps between gynecology and dermatology, limited training, and the under-recognition of non-life-threatening but highly morbid pain contribute to these diagnostic challenges, including mental health impact and even suicidality in some cases.

---

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Timestamps

00:00 - Introduction
03:56 - Why Pain Gets Missed
08:58 - Building Trust With Time
10:51 - Vulvodynia Workup Basics
16:02 - Hormonal Vestibulodynia Clues
21:21 - New Treatments On Horizon
23:07 - Lichen Steroid Maintenance
26:25 - Biopsy Decisions And Mimics
30:30 - Multimodal Treatment Planning
33:00 - Pelvic Floor PT Done Right
35:55 - When To Consider Surgery
37:33 - Clinical Trials Ketotifen Botox
40:40 - Conclusion and Resources

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More about this episode

They discuss rebuilding trust through time, attentive listening, and clear communication, along with a detailed evaluation process that includes medication review, targeted symptom questions, Q-tip mapping, vulvoscopy, cultures, and selective biopsy. The approach informs an individualized, multimodal treatment plan. Additional topics include lichen steroid counseling,differentiating mimickers like yeast and irritant dermatitis, and connecting patients to resources such as ISSWSH, ISSVD, and support groups.

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Resources

Experiences of Care and Gaslighting in Patients With Vulvovaginal Disorders https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2833711

ISSWSH

https://www.isswsh.org/

Pudendal Hope

https://www.pudendalhope.info/

Tight Lipped

https://www.tightlipped.org/

The National Vulvodynia Association

https://www.nva.org/

---

BackTable Women's Health is the go-to podcast for gynecologists, gynecologic surgeons, and other healthcare professionals focused on women’s health.

Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty.

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How do you decide which noninvasive prenatal testing option is best for your patient, and when should you reach for single-gene NIPT? In this episode of BackTable Women’s Health, host Dr. Nicole Faulkner interviews maternal-fetal medicine specialist Dr. Andrei Rebarber to break down the evolving world of prenatal genetic testing. They discuss the importance of pan-ethnic carrier screening, the clinical scenarios where single-gene NIPT is most useful, and how to navigate counseling and follow-up for a wide range of patients.

---

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This podcast is supported by

Natera
https://www.natera.com/info/fetal-focus

---

Timestamps

00:00 - Introduction
04:43 - Prenatal Genetic Testing Basics
07:10 - Larger Panel Screening Benefits
10:49 - Defining Single-Gene NIPT
14:51 - Counseling and Invasive Options
18:26 - Accuracy Data and No Call Rate
22:03 - Patient Acceptance of Test
24:18 - When to Test and Screen
26:13 - Counseling Carrier Results
30:12 - In Utero Treatment
32:36 - Workflow for Generalists
35:33 - How to Interpret Literature
40:08 - Closing Remarks

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More about this episode

Dr. Rebarber shares how witnessing in-utero transfusions for severe Rh disease inspired his career in OBGYN and maternal-fetal medicine, highlighting the importance of treating the fetus as a patient and the rapid growth of fetal therapy. The episode reviews ACOG-guided carrier screening for conditions like cystic fibrosis and hemoglobinopathies, the trend toward larger, pan-ethnic screening panels, and why carrier findings are common but true “double-carrier” couples are relatively rare. Dr. Rebarber also discusses the clinical utility of single-gene NIPT—a cell-free placental DNA test for select recessive conditions—especially when partner testing isn’t possible or when patients wish to avoid invasive procedures. The conversation compares screening and diagnostic strategies, including CVS and amniocentesis, and provides practical insight into interpreting test performance and emerging research.

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Resources

EXpanding Prenatal Cell Free DNA Screening Across moNogenic Disorders (EXPAND)
https://clinicaltrials.gov/study/NCT06808880?tab=study

---

BackTable Women's Health is the go-to podcast for gynecologists, gynecologic surgeons, and other healthcare professionals focused on women’s health.

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Osteoporosis may present after menopause, but prevention starts decades earlier. In this episode of BackTable Women’s Health, Dr. Carla Gunn, guest host and OBGYN, interviews Dr. Pooja Luthra, an endocrinologist at UConn Health, about osteopenia, osteoporosis, and practical strategies for lifelong bone health.

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Timestamps

00:00 - Introduction
03:28 - Why Bone Health Matters Early
05:23 - Bone as a Vital Sign
08:02 - Amenorrhea and Early Screening
09:51 - Calcium, Vitamin D, and Protein
15:11 - Menopause Bone Biology Explained
21:58 - Metabolic Diseases and Bone Risk
25:58 - Early Screening Red Flags
27:53 - Hormone Therapy Bone Benefits
30:59 - Reading DEXA Scores
33:42 - FRAX Scores
35:09 - Modern Treatment Sequencing
38:02 - Bisphosphonates Mechanism and Concerns
41:16 - Secondary Labs and Referrals
44:23 - Closing Thoughts

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More about this episode

Dr. Luthra explains how peak bone mass is largely established by early adulthood, followed by accelerated loss during the perimenopausal/menopausal transition due to estrogen decline, inflammatory cytokines, altered calcium absorption, and increased bone resorption. She reviews prevention strategies, including adequate calcium, vitamin D, and protein intake, resistance training, and avoiding smoking and excess alcohol use. The discussion also covers high-risk conditions that can negatively impact bone health, including amenorrhea, premature ovarian insufficiency, hyperthyroidism, diabetes, and chronic kidney disease, along with considerations for earlier screening in these patients. Dr. Luthra walks through DEXA interpretation, including T-scores, Z-scores, trabecular bone score (TBS), and FRAX assessment. She closes the conversation by outlining treatment sequencing with anabolic agents before antiresorptives, bisphosphonate safety, alternative therapies, and secondary osteoporosis workup labs.

---

Resources

FRAX Tool:
https://www.fraxplus.org/calculation-tool

---

BackTable Women's Health is the go-to podcast for gynecologists, gynecologic surgeons, and other healthcare professionals focused on women’s health.

Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty.

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"The treatment of cervical cancer is definitely a team sport." Hear how recent radiation advancements are impacting gynecologic cancer care, and how to partner with your radiation oncologist to tailor therapy. This BackTable Women’s Health / Tumor Board episode features hosts Dr. Mona Guo and Dr. Marcia Ciccone joined by USC radiation oncologist and brachytherapy director Dr. Andrew Lim discussing modern radiation techniques, indications for definitive/adjuvant therapy, and toxicity management in gynecologic cancers.

---

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Timestamps

00:00 - Introduction
02:39 - Modern External Beam IMRT
05:47 - Planning With CT And AI
08:14 - Daily Setup Imaging Workflow
13:30 - Dose and Fractionation Basics
18:50 - HDR Image Guided Brachy
21:50 - Brachy Vs External Boost Evidence
24:54 - Managing Side Effects and Menopause
28:49 - Hormone Therapy Benefits
30:37 - Dilators and Pelvic Rehab
33:12 - Long Term Radiation Effects
38:14 - Spacers and Prolapse Planning
41:42 - Reirradiation and Plan Review
44:05 - Palliative Radiation Choices
46:50 - Gamma Knife Explained
50:16 - Conclusion

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More about this episode

Dr. Lim contrasts historical four-field box radiation with contemporary IMRT, CT-based planning, daily cone-beam verification, and AI-assisted contouring with dosimetrist support. They review pelvic radiation treatment timelines, emerging hypofractionation data, and the essential role of image-guided brachytherapy for cervical cancer, including outpatient workflows and improved tumor coverage with reduced bladder/rectum dose. The group covers patient counseling on expected side effects, radiation-induced menopause, fertility, sexual health, vaginal stenosis prevention with dilators/pelvic floor therapy, late effects, re-irradiation considerations, spacers, palliative regimens, and stereotactic radiosurgery/Gamma Knife for brain metastases.

---

BackTable Women's Health is the go-to podcast for gynecologists, gynecologic surgeons, and other healthcare professionals focused on women’s health.

Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty.

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What happens when maternity care deserts stop being just a “rural problem” and start impacting your own labor and delivery unit? On this episode of BackTable Women’s Health, host Dr. Nicole Faulkner interviews Dr. Yamicia Connor about the evolving “birth worker crisis.” Dr. Connor reframes the issue as a long-standing structural collapse accelerated by deliberate policy decisions, not simply sudden burnout.

---

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Timestamps

00:00 - Introduction
03:30 - Structural Collapse Explained
05:41 - What Providers Can Do
09:40 - Data On Care Deserts
14:24 - COVID Like System Failure
19:50 - Limits Of Telehealth
20:57 - Think Systemwide Care
23:52 - Insurance Access Shifts
25:04 - Support Midlevel Workforce
27:06 - Build Future Infrastructure
29:39 - Burnout Is System Failure
31:02 - Defunding Surveillance Risks
32:51 - Stop Calling It Burnout
34:35 - Conclusion

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More about this episode

Dr. Connor describes how the systematic decoupling of clinical science from federal and state infrastructure has shifted legal and operational risk onto individual physicians, leading to illogical practice patterns and confusion about the standard of care, especially in settings like emergency departments. A review of the 2024 March of Dimes data showing over 35% of U.S. counties are now maternity care deserts, and JAMA-tracked data in states like Idaho, where nearly a third of OBs left between 2022 and 2024. She warns that as more rural units close, regional and academic hospitals will absorb sicker and less managed patients, straining L&D units, NICUs, staffing, and training pipelines. To address this crisis, Dr. Connor calls for system-level coordination, stronger leadership from professional societies, improved care navigation, expanded mid-level support, and enhanced telehealth infrastructure to extend obstetric expertise.

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Resources

Maternity Care Deserts Across the US https://www.marchofdimes.org/maternity-care-deserts-report

Change in Number of OB/GYN Physicians Practicing Obstetrics After the Dobbs Decision https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2837058

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BackTable OBGYN is the go-to podcast for gynecologists, gynecologic surgeons, and other healthcare professionals focused on women’s health.

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From surgery to systems to access, medicine is shaped as much by barriers to care as it is by innovation and the latest techniques. In this episode of BackTable OBGYN, Dr. Kimberly Kho, a complex benign gynecologic surgeon, joins host Dr. Amy Park to discuss her work expanding access to women’s healthcare, including building a surgical program in Hawaii, studying childcare as a barrier to care, and exploring the diagnosis and management of adenomyosis.

---

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Timestamps

00:00 - Introduction
08:35 - Faculty Development in Hawaii
12:26 - Childcare as Access Barrier
16:20 - Survey and Trial Findings
18:10 - Annie's Place Childcare Center
24:23 - Childcare Barrier Example
25:43 - Applying Community Solutions
27:04 - What Is Adenomyosis
30:22 - Diagnosis Strategies Beyond Hysterectomy
34:07 - Risk Factors and Age Myths
36:03 - Fertility and Pregnancy Risks
38:02 - Medical and Surgical Treatments
41:20 - Uterine Sparing Procedures
45:59 - Closing Thoughts

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More about this episode

Dr. Kho discusses her recent transition to the University of Hawaii, where she is building a complex benign gynecology program to serve patients across the state and broader Pacific region. Her work emphasizes faculty development through mentorship, strengthening research infrastructure for generalists, fostering inter-island collaboration, and implementing surgical coaching.

She then reflects on her time at Parkland, where she expanded access to minimally invasive gynecologic surgery, demonstrated by a significant reduction in open hysterectomy rates. She also shares how her team identified unmet childcare needs as a major barrier to care, leading to multiple research initiatives, a clinical trial, and ultimately the creation of a five-year, no-cost, onsite childcare center (Annie’s Place) developed through hospital and community partnerships.

The episode concludes with an in-depth discussion of adenomyosis, covering its pathophysiology, imaging-based diagnosis, common symptoms, and fertility implications. In the absence of formal guidelines or FDA-approved therapies, Dr. Kho reviews current management strategies, including medical therapy, uterine artery embolization (UAE), and endometrial ablation techniques.

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Resources

Childcare needs as a barrier to healthcare among women in a safety-net health system
https://pubmed.ncbi.nlm.nih.gov/38886715/

Addressing childcare as a barrier to healthcare access through community partnerships in a large public health system
https://pubmed.ncbi.nlm.nih.gov/36261213/

Adenomyosis Pathophysiology, Diagnostic Advances, and Therapeutic Options
https://pubmed.ncbi.nlm.nih.gov/41926770/

---

BackTable OBGYN is the go-to podcast for gynecologists, gynecologic surgeons, and other healthcare professionals focused on women’s health.
Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty.
► https://www.backtable.com/app

Imaging, incisions, and Instagram: Dr. Ramirez on the cutting edge of endometriosis management. In this episode of BackTable OBGYN, host Dr. Mark Hoffman interviews Atlanta-based Complex Benign Gynecology (CBG/MIGS) surgeon Dr. Laura Ramirez about how her practice has shifted toward predominantly endometriosis care, driven in part by social media referrals bringing patients nationwide.

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Timestamps

00:57 - Introduction
02:22 - Mentorship Mission and Career Focus
06:13 - Social Media Referrals
08:10 - What Is Endo Surgery and Targeted Excision
13:27 - Multidisciplinary Care
16:53 - Lesions and Adhesions Approach
22:20 - Imaging and Case Triage
24:07 - Hysterectomy Expectations
27:28 - Going Solo on Bowel Endo
31:25 - Team Support and Mentors
34:27- Residency Training Gaps
40:39 - Call for Help Culture
43:07 - Challenging Surgeries
48:10 - Noninvasive Tests and Therapy Limits
51:26 - Conclusion

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More about this episode

Dr. Ramirez discusses why endometriosis surgery varies by patient, pathology, and surgeon experience. She emphasizes careful symptom-based assessment, recognizing atypical lesions, and setting realistic expectations. The conversation contrasts radical peritoneal stripping with her preference for targeted excision to reduce complications, highlights multidisciplinary management for central sensitization and overlapping bowel/bladder symptoms, and covers imaging triage, robotic vs. laparoscopic approaches, collaborating with colorectal specialists, and diaphragmatic endometriosis as an ongoing surgical challenge.

---

BackTable OBGYN is the go-to podcast for gynecologists, gynecologic surgeons, and other healthcare professionals focused on women’s health.
Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty.

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What if we trained surgeons to recover from complications, not just avoid them? In this BackTable OBGYN episode, Dr. Joseph Chen, a complex benign gynecologic surgeon at Kaiser Permanente and certified surgical coach, joins host Dr. Nicole Faulkner to explore how surgeons process and recover from complications.

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Timestamps

00:00 - Introduction
01:15 - Dr. Chen’s Origin Story
06:34 - Coaching Framework
08:08 - Second Victim Phenomenon
10:10 - Four Phases Of Stress
15:07 - Managing OR Chaos
19:22 - Delegation as Surgeons
22:11 - Peer Review Programs
25:09 - How Coaching Programs Work
30:52 - Timeline After Complications
33:16 - Avoiding The Advice Trap
35:37 - Debriefing With Residents
40:51 - Future of Coaching and AI
47:13 - Resolution of Complic

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More about this episode

Dr. Chen reflects on a serious complication during his fellowship that exposed an “emotional gap” in surgical training beyond technical solutions. This experience shaped his focus on psychological safety, crisis-management frameworks, and supportive coaching. He outlines the phases following an adverse event, from the initial chaos and cognitive overload to reflection, identity challenges, and resolution. Do these factors influence whether one experiences burnout, survival or growth.
This episode also recommends practical strategies such as focused breathing, effective delegation, and simulation training to improve performance under pressure. Dr. Chen discusses the “second victim” phenomenon, reviews data on surgeons’ emotional responses after complications, and emphasizes the importance of allowing time before debriefing. They advocate for peer support, non-punitive systems, and coaching programs to improve surgeon well-being, patient safety, and operating room efficiency. Finally, they explore future roles for AI and video review in surgical learning.

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Resources

Medical error: the second victim. The doctor who makes the mistake needs help too
https://pubmed.ncbi.nlm.nih.gov/10720336/

Dare to Lead by Brené Brown
https://brenebrown.com/book/dare-to-lead/

Atlas of the Heart by Brené Brown
https://brenebrown.com/book/atlas-of-the-heart/

The Advice Trap by Michael Bungay Stanier
https://www.mbs.works/advice-trap-book/#purchase-options

---

BackTable OBGYN is the go-to podcast for gynecologists, gynecologic surgeons, and other healthcare professionals focused on women’s health.
Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty.

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What if we’re waiting too long to offer our OAB patients the treatments that actually work? In this episode of BackTable Urology, Dr. Jason Kim joins host Dr. Anjali Kapur to discuss updates in overactive bladder management and evolving guidelines, including a shift away from rigid stepwise care toward shared decision-making.

---

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Timestamps

00:00 - Introduction
03:06 - 2024 AUA/SUFU Idiopathic OAB Guideline
07:32 - Patient Experience with OAB
11:59 - Beta-3 Agonists vs Anticholinergics
15:15 - Botox Counseling and Dosing
18:11 - Tibial Nerve Stimulation
25:47 - Sacral Neuromodulation
32:09 - Cost Burden of OAB
39:38 - Evolution of OAB Care
41:39 - Future Research Directions

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More about this episode

The conversation positions OAB as a clinical diagnosis, supported by focused initial evaluation and selective use of advanced testing, with attention to the emerging role of ambulatory urodynamics. Dr. Kim and Dr. Kapur review management across the care continuum, including behavioral strategies, pelvic floor physical therapy, and pharmacologic options, with consideration of beta-3 agonists in older patients. The discussion also focuses on earlier use of minimally invasive therapies such as intradetrusor Botox and neuromodulation, and how introducing these options sooner may improve follow-up, reduce delays, and help patients achieve symptom control more efficiently.

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Resources

The AUA/SUFU Guideline on the Diagnosis and Treatment of Idiopathic Overactive Bladder (2024)
https://www.auanet.org/guidelines-and-quality/guidelines/idiopathic-overactive-bladder

Anticholinergic Drug Exposure and the Risk of Dementia
https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2736353

Randomized trial of percutaneous tibial nerve stimulation versus Sham efficacy in the treatment of overactive bladder syndrome: results from the SUmiT trial

https://pubmed.ncbi.nlm.nih.gov/20171677/

Trends in Utilization of Sacral Neuromodulation for Overactive Bladder: Insight From the AUA AQUA Registry
https://www.auajournals.org/doi/10.1097/UPJ.0000000000000916

A retrospective longitudinal evaluation of new overactive bladder patients in an FPMRS urologist practice: Are patients following up and utilizing third-line therapies?
https://pubmed.ncbi.nlm.nih.gov/33197059/

---

BackTable OBGYN is the go-to podcast for gynecologists, gynecologic surgeons, and other healthcare professionals focused on women’s health.
Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty.

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Are your patients looking for a nonhormonal option? Digital contraception could be the answer. In this episode of the BackTable Podcast, urologist Dr. Ruchika Talwar sits down with Dr. Kerry Krauss, an OBGYN and Senior Medical Advisor at Natural Cycles, to discuss the evolving landscape of digital health tools in women's reproductive care.

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This podcast is supported by

Natural Cycles
https://www.naturalcycles.com/

---

Timestamps

01:29 - Introduction
03:02 - Contraception Pain Points
06:16 - Natural Cycles Origin
09:46 - How The App Works
12:44 - Effectiveness And Variability
15:18 - Ideal Users And Red Days
17:34 - Modes Beyond Birth Control
19:19 - Clinical Insights From Data
22:04 - Future And Privacy
24:31 - Counseling And Adoption Tips
27:19 - Conclusion

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More about this episode

Dr. Krauss shares her journey into tech and wearables and provides insights into the functionality, effectiveness, and future prospects of Natural Cycles, a digital contraceptive app. The discussion covers the utility of basal body temperature tracking, the unique features of the Natural Cycles algorithm, and real-world applications and user experiences. They also explore the broader implications and potential surrounding the integration of digital health tools into patient care, emphasizing the importance of meeting patients where they are.