The Pelvic Floor Files: Restoring Balance with a Urogynecologist Dr. Maria Canter
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Episode Notes
Dr. Maria Canter, one of the first surgeons in the U.S. to be double board-certified in both Female Pelvic Medicine & Reconstructive Surgery and Obstetrics & Gynecology, joins the show to talk candidly about pelvic floor dysfunction and its impact on postpartum recovery, sexual health, and overall well-being.
With compassion and clarity, Dr. Canter breaks down the physical and psychological factors behind pain, incontinence, and libido challenges after childbirth—and what real healing can look like. She emphasizes early intervention, individualized care, and the importance of removing shame from the conversation around pelvic health.
Whether you're newly postpartum or years into your healing journey, this episode offers validation, evidence-based guidance, and hope.
Topics Discussed:
What urogynecology is and what conditions it addresses
How to recognize pelvic floor dysfunction postpartum
When to seek help for urinary or fecal incontinence
First-line treatments including pelvic floor therapy, estrogen, and pessaries
Understanding pelvic organ prolapse and risk factors like connective tissue disorders
Pain with intercourse: causes, treatments, and the role of estrogen, physical therapy, dilators, and trigger point injections
Psychological impacts on libido and pain anticipation
The role of partners and sex therapy in restoring intimacy
Cognitive behavioral therapy and mind-body techniques for chronic pelvic pain
The importance of communication, self-advocacy, and shame-free care
Advances in pelvic surgery, robotics, and emerging treatments like platelet rich plasma
Encouragement for women in isolated or underserved areas to access support
“We don’t really talk that much about postpartum pelvic floor trauma, not to mention the potential psychological trauma. It can feel like you’re the only one in the world going through it. It’s important for patients to know that is absolutely not true. You’re definitely not alone. There are many providers now who are available to help you. We have many promising treatments to get you back to where you want to be and improve your quality of life. ”
Show Notes
What is Urogynecology? (00:01:22)
Dr. Kantor explains urogynecology, pelvic floor dysfunction, and common conditions treated.
Recognizing Pelvic Floor Dysfunction Postpartum (00:02:48)
Signs and symptoms of pelvic floor dysfunction after childbirth, including incontinence and prolapse.
When to Seek Help for Incontinence (00:06:20)
Guidance on when to consult a specialist for postpartum incontinence and the importance of early intervention.
Pelvic Floor Physical Therapy and Treatment Options (00:07:31)
Overview of pelvic floor therapy, exercises, and first-line treatments for dysfunction.
Understanding Pelvic Organ Prolapse (00:11:28)
Causes, risk factors, and symptoms of pelvic organ prolapse, including rectocele and genetic predispositions.
Ehlers-Danlos Syndrome and Hernias (00:15:05)
Discussion of connective tissue disorders like Ehlers-Danlos and their impact on pelvic health.
Fecal Incontinence and Postpartum Healing (00:16:37)
Fecal incontinence causes, healing challenges, and the role of estrogen in tissue recovery.
Pessaries and Non-Surgical Management (00:19:15)
Explanation of pessaries, their fitting, use, and the importance of vaginal estrogen for prevention of infections.
Materials and Types of Pessaries (00:22:53)
Description of pessary materials, shapes, and their specific uses for different types of prolapse.
Dr. Kantor’s Path to Urogynecology (00:24:10)
Dr. Kantor shares her journey into urogynecology and the influence of mentorship.
Complex Cases and Surgical Considerations (00:27:51)
Managing complex pelvic floor cases, preoperative testing, and the interplay of multiple dysfunctions.
Complexity of Women’s Pelvic Health (00:30:10)
The multifaceted nature of women’s pelvic health and the need for individualized care.
Postpartum Sexual Dysfunction: Causes and Treatments (00:31:19)
Exploring reasons for postpartum sexual dysfunction, including pain, dryness, and anxiety.
Treating Pain with Intercourse (00:33:38)
Approaches to managing pain during sex, including estrogen, lubricants, physical therapy, and dilators.
Variations in Sexual Pain and Management (00:36:54)
Different presentations of sexual pain and tailored interventions, including trigger point injections.
Partner Support and Sex Therapy (00:38:43)
The role of partners, sex therapy, and communication in recovery and intimacy.
Cognitive Behavioral Therapy for Chronic Pain (00:39:57)
The importance of CBT and mind-body techniques for chronic pelvic pain and sexual dysfunction.
Libido, Exhaustion, and Communication Postpartum (00:42:56)
Impact of postpartum exhaustion on libido and the importance of open communication with partners and providers.
Normalizing Pelvic Floor Issues and Seeking Help (00:45:12)
Encouragement to seek help for pelvic floor issues and reassurance about the commonality of these experiences.
A Day in the Life of a Urogynecologist (00:46:25)
Dr. Kantor describes her varied workdays, including surgery, office visits, and the use of robotics.
Robotic Surgery and Technological Advances (00:47:31)
Explanation of robotic-assisted surgery (Da Vinci), its benefits, and evolving technology in the field.
Research Interests: Platelet Rich Plasma (PRP) (00:49:49)
Dr. Kantor’s interest in regenerative medicine, especially PRP, and its potential applications.
Science of PRP and Future Hopes (00:52:58)
How PRP works, its uses, and Dr. Kantor’s hopes for future research and technological advances.
Words of Wisdom for Isolated or Underserved Patients (00:55:37)
Advice and hope for women in rural or underserved areas, emphasizing online resources and therapy.
Accessing Care and Online Resources (00:56:36)
How to find pelvic floor therapy and information online, and when surgical care is necessary.
Fun Fact: Biotech and Sexual Health Devices (00:58:15)
Dr. Kantor shares a humorous story about attending a biotech expo and discusses innovative sexual health devices.
Closing Remarks and Resources (01:00:10)
Final thanks, resources for listeners, and encouragement to connect with the podcast and its community.
Guest information
Dr. Maria Canter is double board-certified in Female Pelvic Medicine and Reconstructive Surgery as well as Obstetrics and Gynecology—making her one of the first surgeons in the country to hold both certifications. Known for her thoughtful and individualized approach, Dr. Canter takes the time to understand each patient's unique needs and creates personalized treatment plans with the goal of improving their quality of life. She specializes in minimally-invasive techniques that allow for quicker recovery and lasting relief.
Originally from the Washington, D.C. area, Dr. Canter attended Georgetown University School of Medicine and went on to complete her residency in Obstetrics & Gynecology at Georgetown University Medical Center, where she received the Minimally Invasive Endoscopy Award. She then completed a three-year fellowship in Female Pelvic Medicine and Reconstructive Surgery, during which she earned multiple awards for her academic and research contributions—including the American Urogynecologic Society’s prestigious June Allyson Award for her work in urine proteomics.
In 2016, Dr. Canter opened the Urogynecology Center NoVa, a practice devoted to helping women regain comfort, confidence, and control in their lives. With over a decade of experience caring for patients in Northern Virginia, Dr. Canter says she feels deeply grateful for the work she gets to do. “I have the privilege to take care of women,” she says. “I get to build relationships, renew confidence, and restore quality of life for people who are often used to putting everyone else first.
Resources
Cystocele (prolapsed bladder or anterior vaginal prolapse): occurs when the supportive tissues between the bladder and vaginal wall weaken, causing the bladder to bulge or sag into the vagina.
Ohnut: stretchable, stackable rings worn by the penetrating partner to limit penetration depth.
Pessary: a removable device, typically made of silicone, inserted into the vagina to help with symptoms of pelvic organ prolapse or stress urinary incontinence. It's a non-surgical treatment option that can be used long-term or as a temporary measure before or instead of surgery.
Rectocele: a bulge of the rectum into the vaginal wall, caused by weakening of the muscles and tissues supporting the rectum.