What Every Woman Needs to Know About Her Plumbing “Down There”!

By on December 24, 2020

Nobody wants to talk about their plumbing and how it works, especially when it’s broken.  These are very private matters about our private parts!  However, because I have been married almost 20 years to my husband Dr. Henry Ruiz, reconstructive urologist surgeon, and because I live in the small city of McAllen, all kinds of strangers and friends ask me serious urological questions almost every day. In fact, I am known as the Dick Doctor’s Wife! These interactions, literally with hundreds of people around town for almost 20 years, led me to write my book, in order to help people around the world better understand their plumbing and how to get it fixed. 

It turns out that the subject of urology really does require a lighthearted approach. A little humor always helps to break the ice and start the conversation.  Everyone can come up with a penis or vagina joke because that is the only safe way to start the conversation about hidden body parts.  I used my access to the doctor himself to get clarification and answers to the most common urological conditions that I have been fielding for years.  I am not an expert of course but I have been able to help lots of people by sharing my knowledge, helping people to better understand their own plumbing and where to go for help. 

After 20 years of inquiries from strangers and acquaintances alike, I started to notice a common theme for both men and women.  It was so common in fact that I was able to come up with the top 10 most prevalent urological conditions.  Who knew that everyone at some point will have the need to see a urologist? 

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Did you know that women wait an average of 5 years to address their urological problems?  This is because discomfort is “normal” for most women and they are almost always busy doing something.  Eventually, they succumb to the urological problem and pick up the phone to call their doctor.  This is the part where you need to pay very close attention!  There is a BIG difference between your gynecologist and a urologist. 

Your gynecologist may offer to help with your urological problem and perhaps even make you think that it’s their “specialty”.  It is not.  A gynecologist is not trained in urological procedures or surgeries and should not even prescribe urological medications in case there is an underlying urological condition.  Period!  Do yourself the favor and make an appointment with a board-certified urologist to get your urological problem fixed properly the first time.  When it comes to surgeries, you usually only get one chance to work on those delicate tissues “in there” and end up with a great result.  With that in mind, make sure you pick a board-certified urologist to fix the plumbing “down there”!


Let’s talk about the top urological conditions for women and what you can do about them. So let’s start with the most obvious issue that all of us will deal with and be absolutely shocked when it happens.  Whatever you do, don’t sneeze, laugh, cough, or jump if you have a leaking problem.  If you do, you may find significant evidence of incontinence, or simply put, peeing your pants. Yes, this problem is real for almost every woman approaching menopause or well past it.  You can thank gravity and DNA for this gem. 

Now, every woman knows that a little bit of tinkle is absolutely not enough to drag her into the office of an unknown entity called a urologist or whatever the heck it’s called.  It is simply traumatic to think that one more person is going to look up there for anything other than a baby or the purpose of not making a baby.  I have come to understand a wide variety of situations that will aggravate incontinence and truly affect the quality of life for a woman.  With incontinence, a woman will literally spend her day planning out where all the bathrooms are just in case. This behavior actually has a name and it is called “bathroom mapping”. This is not only aggravating, but it becomes not worth it to go out and do the things you love.

A woman can experience incontinence and be required to use an excessive number of pads and even go as far as having to change her clothes because they get wet from leakage.  The final kicker that may get you to your local urologist is when you start to develop a fear of smelling like urine.  The other fear that will get you to the urologist is the realization that you may have a leak at any given moment due to laughing, sneezing, or coughing. The problem with incontinence is that it limits a woman’s freedom and she may have to stop doing the activities or social interactions that facilitate leakage due to laughing, exercising shopping, and all the other fun stuff that requires you to be away from the bathroom.

Younger women are not excluded from incontinence.  The number one reason for the younger woman to seek out a urologist is because they may leak urine during sex.  It often happens for years and may just be a slight amount in the beginning. Over time, it starts to interfere with sex, and when an orgasm occurs, there is more involved than one would like to mention.  This shift in the severity of incontinence is what gets the younger women to seek help.

The good news is that there are many solutions to help women address their leaky pipes.  And, if you are a man reading this article, you too can leak, especially after any kind of urological surgery.  There is no getting around leaky plumbing unless you are smart enough to get to your local board-certified urologist, who can present a number of options to solve your issue.

Lack of Desire

Urological issues are a definite roadblock when it comes to “sexual desire”.  With underlying urological issues, it becomes more obvious why both men and women suffer from a lack of desire at some point in their lives!  The human body and its plumbing is a delicate system and one that equalizes the human race, whether we want to admit it or not.  Lack of desire is usually the straw that breaks the camel’s back in most relationships, and almost always, it is a hormone imbalance for both men and women.  Men lose testosterone levels as they age and women have large hormone changes before, during, and after menopause.  Luckily, most men can slap on some testosterone and solve most of the common side effects of low testosterone such as fatigue, weight gain, and even erectile dysfunction. 

For women who have zero interest in any form of sex, which seems like way too much effort for something with zero return as far as they are concerned, this is the cue to get to the urologist.  Lack of desire is not just exhaustion or too much wine (though a great glass of wine is one of the greatest pleasures in life).  Lack of desire is often a hormone issue that needs to be treated, monitored, and adjusted by your urologist. Rarely, it can be an anatomical issue that requires an expert urologist, who can examine the patient and remedy the problem.  Most often it is a hormone imbalance and that’s the good news!

When you add into the mix that each woman is very unique in her sexual desires and then throw in the fact that it always seems to boil down to how a woman feels, it becomes a complicated subject and central to sexuality.  Most women understand this about themselves but may struggle to communicate it to their partners.  Lack of desire is a type of sexual dysfunction that a board-certified urologist is specifically trained to deal with.  Female sexual dysfunction has a very specific set of criteria that makes it a bit easier to identify.  Once your board-certified urologist identifies if you are suffering from sexual dysfunction, they can then determine the best treatment to help you.

Genitourinary Symptoms of Menopause (GSM)

It turns out that your vagina needs as much moisturizing and attention as your face, neck, and hands after menopause. Our vaginas need and deserve as much attention as our face.

In 2013, which seems like yesterday, the International Society for the Study of Women’s Sexual Health (ISSWSH), and the North American Menopause Society (NAMS), got together and decided to update the way we label a woman’s vaginal plumbing issues. The old terms like atrophic vaginitis and vulvovaginal atrophy were tossed out. The reason for this was because we have learned that there are more parts to your plumbing that need to be a part of the same conversation in order for you to keep your quality of life when you hit menopause. The new term that is used is called Genitourinary Syndrome of Menopause (GSM). If your doctor is not familiar with this term, then get another doctor because that means they are not reading all the current research being done to improve a woman’s plumbing in an effort to preserve her quality of life during menopause.

Research has proven that low dose estrogen in many forms is beneficial for solving GSM symptoms. We now know that women can implement a variety of methods to receive hormones safely and improve their skin, hair, memory, BMI, and of course their desire to get laid.  We have also learned that hormones improve the tissue “down there” and this helps to resolve incontinence to some degree.

Because estrogen plays a large role in urinary continence it is important that you are always able to empty your bladder each time you pee, or you can develop a urinary tract infection. Without proper levels of estrogen, this becomes an Olympic feat. Also, when estrogen is low or missing it becomes almost impossible to control your urethra and stop peeing on command. At some point during menopause, you will leak urine without even knowing it until you check your panties or start to smell yourself.

Your connective tissues down there need estrogen in the same way a bodybuilder needs food to function. The same is true for the tissues and organs involved in your sexual function. When estrogen is no longer present, sexual dysfunction shows up in the form of a decrease in collagen and tissue elasticity, along with fewer blood vessels. This change in lowered or missing estrogen starts GSM symptoms such as vaginal dryness, irritation (both vaginal and attitude), itching, tenderness, bleeding during sex, and pain when the big erection shows up to the party. Estrogen is a key ingredient to a woman’s fight against the negative impact of Genitourinary Syndrome of Menopause (GSM).

Get to Your Urologist

After 20 years of being with my reconstructive urologist surgeon husband, and being approached by hundreds of people who needed his help, I decided to write my book so I could tell the world that there is help for your human plumbing.  This information matters and has the potential to help every person on the planet.  I learned that it is impossible to escape the subject of human plumbing and my urologist husband confirmed it by reminding me that 100% of the human race will need a urologist at some point in their life. Let’s acquire and maintain good health down there with as much knowledge and preventive care as we can get!

Madeline Zech Ruiz has an MBA and worked in Corporate America prior to meeting her husband. She is the mother of two kids and takes care of her aging parents. She is the wife of the Dick Doctor and has been living at the University of Bladder, Uterus, Penis, and Vagina for the last 20 years with her reconstructive urologist husband in South Texas. Currently, she manages all the secret urological inquiries from anyone brave enough to ask for help from the Dick Doctor and enjoys serving her community all along the way.

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What Every Woman Needs to Know About Her Plumbing “Down There”!