Dr. Alexandra Dubinskaya | The Hidden Impact of Obstetric Anal Sphincter Injuries (OASIS)
Show Notes:
Many obstetric anal sphincter injuries (OASIS) are missed immediately after birth, leaving women to unknowingly compensate for years until hormonal changes, aging, or menopause expose underlying dysfunction. In this eye-opening conversation, Lynn Schulte sits down with urogynecologist and pelvic floor surgeon Dr. Alexandra Dubinskaya to discuss obstetric anal sphincter injuries (OASIS), why they are often missed, and the lifelong consequences they can create for women.
From the realities of birth trauma to missed diagnoses to pudendal nerve injuries, this episode dives into the complex factors influencing bowel control, pelvic floor function, hormonal shifts and postpartum recovery. Dr. Dubinskaya also shares treatment options that many practitioners may not be familiar with, including neuromodulation and surgical interventions.
This conversation will provide pelvic health practitioners with practical insights to better recognize, educate, and support clients in postpartum and throughout their lifespan
Clinical Takeaways from this Episode
- What qualifies as an obstetric anal sphincter injury (OASIS) and how third and fourth-degree tears are classified.
- Why sphincter injuries are frequently underdiagnosed or missed immediately after birth.
- The critical role of the pudendal nerve in bowel control, sensation, and pelvic floor function.
- The differences between neuromodulation and sphincteroplasty as treatment options.
- Common postpartum symptoms that may indicate an undiagnosed sphincter injury.
- Why menopause frequently exposes previously compensated pelvic floor injuries.
- How pelvic health therapists can help restore function and improve quality of life after birth trauma.
- The patient education you can offer your clients to improve birth outcomes and postpartum recovery.
Frequently Asked Questions
What is an obstetric anal sphincter injury (OASIS)?
OASIS refers to third- and fourth-degree perineal tears involving the anal sphincter muscles, with fourth-degree tears extending into the rectal mucosa.
Why are OASIS injuries often missed?
Diagnosis can be difficult because birth occurs in a dynamic environment with tissue swelling, bleeding, variable anesthesia, limited visualization, and urgent clinical priorities.
What symptoms may suggest a missed sphincter injury?
Practitioners should be alert for fecal urgency, bowel leakage, decreased anal sensation, difficulty controlling bowel movements, urinary symptoms, and persistent pelvic floor dysfunction.
Why do symptoms sometimes appear years later?
Women often compensate for mild injuries for years. Hormonal changes during menopause, age-related muscle loss, and reduced tissue resilience may uncover previously compensated dysfunction.
How can pelvic floor physical therapy help?
Pelvic floor rehabilitation can improve muscle coordination, restore neuromuscular awareness, optimize bowel mechanics, reduce muscular guarding, address scar tissue, and improve quality of life while helping determine when additional medical referral is appropriate.
About Today’s Guest
Dr. Alexandra Dubinskaya is a nationally and internationally recognized Urogynecologist and Sexual Medicine specialist based in Beverly Hills. Her innovative, whole-person approach blends cutting-edge science with deeply compassionate care, empowering women to reclaim their bodies, confidence, and pleasure at every age. Born and raised in Russia, Dr. Dubinskaya moved to the United States with a singular goal: to transform women’s health. Today, she is a rising voice in the field, serving as Chair of the Communication Committee for the International Society for Sexual Medicine (ISSM), where she leads global efforts to elevate sexual health literacy and dismantle the silence surrounding conditions women have been told to “just live with.” Dr. Dubinskaya’s expertise spans urinary and pelvic floor disorders, sexual pain, libido concerns, menopause care, and the modern science of pleasure. Her research is featured in top medical journals and textbooks, and her growing social media platforms are reframing long-ignored conversations with evidence, empathy, and a touch of humor.
She is sought after for her ability to translate medical knowledge into compelling, relatable storytelling—whether on stage, on camera, or behind a microphone. Fiercely dedicated to women’s wellbeing, she is on a mission to rewrite the cultural narrative around pelvic, sexual, and menopausal health, empowering women everywhere to feel seen, validated, and in control of their bodies.
YouTube: Drurogyn
Instagram: Drurogyn Alexdubinskaya
Why This Episode Matters
Birth recovery doesn’t end at six weeks postpartum, and neither should our clinical thinking. Obstetric anal sphincter injuries remind us that the effects of childbirth can extend across decades, influencing continence, function, confidence, and quality of life long after delivery. Through earlier recognition, collaborative care, patient education, and skilled rehabilitation, pelvic health practitioners have the opportunity to change outcomes – not only in the postpartum period, but throughout every stage of a client’s life.
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Love Dr. Rachael! She is such a gem in the Metro Detroit area. She was my pelvic floor PT during my first pregnancy and postpartum and inspired me to pursue pelvic health certification (coming from an Ortho PT clinic). I’m now working through Holistic Treatment of the Pregnant and Postpartum Body.
Thank you so much for this presentation…I am an osteopath and also trained in SER (love love Upledger!)…the piece about ‘freeze’ related to transgenerational trauma was very informative and a reminder to look further…I have had a client who lost a baby and when I treated her she felt she needed to give birth to this child…and then went back several lives and saw that she had also lost a baby many lives prior! This relieved her of some stress…so every piece of the puzzle counts…keep the nuggets coming, so appreciative! Best, Judith
Great interview, Lynn and Susanne, for pushing us beyond “hands on, hands in”, confirming our need as therapists, for wide, grounded personal presence for our clients to feel safe and then willing to bring forth those physical/emotional/transgenerational, traumas/beliefs that lead to more complete healing and return to function. Appreciate the shout out, and listened delightfully to two of my favorite teachers and mentors. All of this was gold!