Dr. Mona Shahriari

Women on Women’s Health

By Kim Krieger

Photography by Tina Encarnacion

line art of woman doctor and patient

Women doctors were a rarity in the U.S. until just a few decades ago, and it wasn’t easy for a woman seeking a female obstetrician or general practitioner to find one. But times have changed — women surgeons, doctors, and health care practitioners of all sorts are everywhere.

At UConn Health, we’re proud to have an army of women caring for women in every specialty, as doctors, therapists, and nurses. Many have advanced degrees and research projects in addition to their clinical work.

We spoke to just a few of the many, many women who do research and provide clinical care for other women at UConn Health. We asked them why they do what they do, how caring for women is different than caring for men, and anything else they thought was important. This is what they said.


Gynecological Surgery

I need you to take it easy for just one week.

Dr. Danielle Luciano’s patients are usually younger women with pelvic pain or unmanageable periods related to uterine fibroids or endometriosis. Luciano tries medical treatments with the women first. If that doesn’t work, she offers minimally invasive surgery that solves the pain while sparing her patients’ fertility.

Dr. Danielle Luciano

Dr. Danielle Luciano cares for women throughout their lifespans.

“As an OB/GYN, I take care of my patients throughout their lifespan. I might remove their endometriosis when they are young,” and help them in menopause too. As a fellow woman, she can relate to her patients and perhaps give them more convincing advice than a male doctor might.

“I’ve had some babies, and I’ve had to have some things fixed afterwards, so I know where they’re coming from,” Luciano says. “I can say, ‘Look, I know you’re going to go home and try to do 1,000 things. But I need you to take it easy for just one week.’”

Fibroids and endometriosis affect a lot of women, around 10 percent. Oftentimes these conditions run in families, and a mom may normalize it when her daughter suffers, explaining the same thing happened to her. But if a woman has miserable periods with such heavy bleeding, terrible pain, or gastrointestinal symptoms that she can’t work or go to school, there could be something wrong that Luciano can help with.

Professions sometimes run in families, too. Luciano’s father, Dr. Anthony Luciano, is also an OB/GYN at UConn Health, specializing in reproductive endocrinology and minimally invasive surgery.

“Initially I didn’t want to do anything he did — but the more I learned, the more I wanted to have that skill and expertise,” Luciano says.

She and he now work together; he is a member of the Center of Excellence for Minimally Invasive Gynecologic Surgery at UConn Health. She is the director.

Breastfeeding

If lactation is a superpower, nursing is an art.

If lactation is like a superpower — a woman makes milk, and it’s perfectly nourishing, antibacterial, immunity-boosting, and always exactly the right temperature — then nursing is more of an art, a skill women learn by observation or instruction.

But fairly often in the U.S., women have trouble with it, and end up pumping or formula feeding even if they’d rather nurse.

“Whenever we talk about breastfeeding it becomes a very hot and emotional conversation,” UConn nurse-scientist Ruth Lucas, Ph.D., RN, says. She wants to cool that conversation off with data.

Lucas spent 20 years working as a nurse and lactation specialist, “supporting mom in whatever way she can feed her baby and feel good about herself.” But the more she saw, the more she wondered why for so many women breastfeeding just didn’t work. So she turned to research, and her first project has zeroed in on pain during nursing. Why does it happen, and how can we help women who want to nurse but find it agonizing?

She’s finishing up a pilot study that tracked women who initiated breastfeeding, their experiences, and their gene variants that might be linked with pain. And that’s just the start. She’s also interested in the baby side of the equation: different babies approach breastfeeding differently. Does this affect mom’s pain? Does the pain change the breastmilk? Does that affect the babies?

“We all want to grow and nurture our children,” Lucas says. She wants to nurture the women, too.

Pelvic Health

Cultural taboos prevent patients from admitting that they have issues.

Lauren Brennan and Cathy Trahiotis want you to talk to your patients about peeing. And sex. Also bowel movements. Like, how often does your patient poop?

“If they say ‘once a week,' you know there’s a problem,” Brennan says, laughing. She’s a family nurse practitioner who works in the urology practice at UConn Health. Trahiotis is a physical therapist who specializes in women’s pelvic health. And they’re on a mission to educate people — and alleviate people’s fears — about incontinence and other pelvic problems.

Recent studies have found that almost half of adult women experience either stress incontinence — involuntary urination when coughing or exercising — or urge incontinence, when they feel the urge to urinate but can’t get to a toilet in time.

“But it’s not normal to have incontinence! We can treat it,” says Trahiotis.

Dr. Cathy Trahiotis and Dr. Lauren Brennan

Cathy Trahiotis and Lauren Brennan want docs to talk to patients about peeing. And sex.

She notes that for some women, pregnancy can be the start of pelvic issues. The heavy, swelling uterus presses on nerves in the pelvis, stretches ligaments, and separates the abdominal muscles (a condition called diastasis recti). After birth, if the abdominals don’t knit back together, it leads to weakness that can force the pelvic muscles to compensate, stressing them and potentially causing pubic pain or incontinence.

Fortunately diastasis recti can usually be cured with physical therapy. Other issues involving the pelvic muscles can be similarly healed through specific exercise, stretching, and diet.

In her urology practice, Brennan often sees patients with dyspareunia, or painful sex. It can often be treated. But it’s almost never the reason the patient made the appointment, Brennan notes. She always has to ask.

Both Brennan and Trahiotis say cultural taboos against discussing bodily functions prevent patients from admitting to their doctor that they have issues. So doctors should bring it up first. Ask patients directly: “How’s sex for you? Is it comfortable? Do you have any issues you’d like to talk about?” Ask about peeing and bowel movements. Or if your patients are super shy about discussing it, perhaps a written questionnaire would be better.

No matter how you do it, Trahiotis and Brennan say, the bottom line is “know about it, talk about it, don’t be afraid! And fix it without surgery!”

Dermatology

Sometimes she’ll point out something I can’t see. That’s when I reassure her.

The trick to drawing out a patient’s concerns about her skin is to hand her a mirror, says UConn Health dermatologist Dr. Mona Shahriari.
“Sometimes she’ll point out something I can’t see. That’s when I reassure her. I’m a trained dermatologist, and if I can’t see it, the world probably can’t, either.”

Dr. Mona Shahriari

Dr. Mona Shahriari wants women to feel like at least once, they're being taken care of.

Shahriari has seen a lot. The year before she entered medical school, she volunteered to work with individuals exposed to radiation and chemicals during the Iran-Iraq War. They had a tendency to grow bizarre forms of skin cancer. Many of them would try to hide the growth and ignore it. And now, even though she’s practicing medicine on the other side of the planet with an entirely different population, some of her female patients have a similar problem.

“They’re so busy caring for their families they forget to care for themselves. Women often show up with undiagnosed skin diseases” they’ve been ignoring, says Shariari. When they finally do make it to her office, she gives them the time they need. Most of the time her women patients come to her with concerns about skin cancer, but there’s usually another underlying worry: aging.

“Society makes women very self-conscious about their appearance,” says Shahriari. And their skin is readily visible to the world. So she listens, and helps them. Ultimately, a patient may need bloodwork, a biopsy, laser treatment, or reassurance. But no matter what, “I make them feel like at least once, they’re being taking care of. Their concerns are the priority.”

Gynecologic Oncology

Some women say “I just can’t do this anymore.” But we have lots of options to help.

The patients keep her going. Many of the women are overweight. A lot of them have diabetes and high blood pressure. They don’t heal well; they’re greater surgical risks; they’re medically fragile. And yet, they keep going. And so does she.

“I love my patients,” says gynecologic oncologist Dr. Molly Brewer, chair of UConn Health’s Department of Obstetrics and Gynecology. “They endure so many incredibly hard treatments. They’re an inspiration.”

Dr. Molly Brewer

Dr. Molly Brewer says getting cancer patients healthy and back to their lives makes the challenges of her job worth it.

Typically, the women are referred to her by primary care physicians, gynecologists, or emergency room doctors when the women show up with a suspicious lump in their abdomen, cervix, or vulva. Such patients are usually urgent, and Brewer always gets them into her office within a week or less. If they don’t have cancer, she sends them back to their regular doctor. But if they do have cancer, she cares for them from the beginning to the end, performing surgery to remove the mass, treating it with anti-cancer drugs, and helping them through into remission. She also cares for certain breast cancer patients who suffer from unique gynecological issues. Certain drugs used to prevent a recurrence of the cancer can cause vaginal atrophy because they suppress estrogen, for example.

“Vaginal atrophy makes sex really painful. Some women say ‘I just can’t do this anymore.’ But we have lots of options” to help, Brewer says.

Her research centers on ovarian cancer and new technologies to diagnose it. She and her partner, newly arrived gynecologic oncologist Dr. Bradford Whitcomb*, are currently enrolling patients for an ovarian cancer vaccine study.

She chose gynecologic oncology because she loves it, and she loves it because of the patients. The challenge of taking care of women with difficult cancers, and the inspiration of watching them make
it through.

“When we get them into remission, they’re healthier, they feel better, they’re able to go back to their life. And that makes it all worth it.”