Doctor Rich

Doctor Rich Doctor Rich He is a certified Center of Excellence surgeon and one of only 25 da Vinci Epicenter program directors in the United States.

Texas Urogynecology & Laser Surgery Center provides expert and compassionate gynecology care to women in all stages of their lives and offers comprehensive diagnostic and treatment services for pelvic floor disorders. Dr. Farnam is board certified in both Obstetrics & Gynecology and Female Pelvic Medicine & Reconstructive Surgery (Urogynecology) and is a leader in the field of Minimally Invasive Gynecology and Laser Surgery.

09/03/2026

Who Should NEVER Get Vaginal Laser 🤔

Is steroid cream your only option for va**nal atrophy? 🤔 Not necessarily. I sat down with urogynecologist to talk about laser treatment (like MonaLisa Touch) as a way to give patients a "holiday" from chronic high-potency steroids. 💊✨

We cover:
✅ How laser treatment for urogenital atrophy actually works — it's superficial, nothing permanent
✅ Who should NOT get it — including women with a history of pelvic radiation (cervical/anal cancer survivors) due to permanent vessel damage
✅ Why poor skin quality or open sores may mean it's not the right fit
✅ How it can help break the cycle of chronic yeast infections and bacterial vaginosis by resetting va**nal pH
✅ Why constant antibiotics/antifungals can wreck your gut flora long-term
This is exactly the kind of honest, patient-first conversation every woman deserves to have with her doctor. Whether it's menopause-related dryness, recurrent infections, or just wanting more info before committing to a treatment plan — this one's for you. 🙌

Have you tried laser treatment for va**nal atrophy or chronic infections? Tell me about your experience in the comments — if you're thinking it, a thousand other people are too. 💬

08/29/2026

Fighting the Good Fight...

08/28/2026

Do I really need a hysterectomy with my sacrocolpopexy? 🤔 It's one of the top questions I get — and surgeons genuinely don't always agree.

In this episode I sit down with fellow urogynecologist Dr. Erin Myers to break down why some surgeons remove a healthy uterus during prolapse surgery, while others offer a uterus-sparing hysteropexy instead.

Dr. Myers shares, from her own surgical experience:
🔹 Why a "healthy" uterus can still carry future risk
🔹 Why removing it can make the mesh repair technically safer
🔹 What happens when the uterus blocks access to the repair
🔹 The complications a hysteropexy can create down the road

There's no universal right answer here — it depends on your anatomy, your goals, and your surgeon's approach. That's exactly why it's worth understanding both sides before you decide. 💬

If you're thinking it, a thousand other people are too. Drop your questions below 👇

08/26/2026

Where does s***m go after a hysterectomy? 👀 This is one of THE most common questions I get, so let's clear it up once and for all.

Here's the truth: even with a fully intact uterus and cervix, only a tiny fraction of s***m ever make it past the cervix — we're talking a few thousand out of hundreds of millions. Over 99% stay right in the va**na, where they're broken down naturally. This is completely normal and has been happening your whole reproductive life. 🩺

After a hysterectomy? Almost nothing changes. The va**na simply ends at the va**nal cuff (sutured closed at the top), so instead of 99% staying in the va**na... it's now 100%. Same process. Same safe outcome. Nothing gets trapped, nothing lingers. Your body still knows exactly what to do. 💚

If you're nervous about a hysterectomy or recovering from one, I hope this eases your mind a little. Got a question you're embarrassed to ask? Drop it below — if you're thinking it, so are thousands of others. ✨

🛍️

08/22/2026

I apologize on behalf of myself… 🫶

08/20/2026

I sat down with , and she shared something deeply personal: watching her own mother suffer from severe fibroids — bleeding so heavy she would pass out. She told me this was part of why she was called to medicine. Now, when she sits with a patient in pain, she sees her mother in her.

Dr. Crable wrote a book on patient stories because the #1 thing she wants women with fibroids to hear is: you are not alone. So many patients walk in thinking their case is the worst one — the only one who's lost a baby, the only one who's suffered like this. You're not. 🙏

Some of the stories she shares:
✨ Women who lost pregnancies to fibroids, had them removed, and carried healthy babies to term afterward
✨ Women whose "routine" fibroid surgery came back as cancer (rare — under 1% — but it happens, and it's why workups matter)
✨ Women with post-menopausal bleeding who'd never had a proper evaluation

If you've been told "it's just fibroids, deal with it" — this conversation is for you. You have more options than you think. 💪

👇 What question do you wish someone would just answer honestly about fibroids? Drop it below.

🛍️ Wearing because comfort matters when you're on your feet all day. 🏥

08/18/2026

Prostate cancer screening does NOT start with the exam most men dread. It starts with a simple PSA blood test. 🩸

According to the American Urological Association, PSA is the primary screening tool — and their guidelines say don't rely on the re**al exam alone. There isn't even strong evidence that adding it improves screening accuracy.

😬 The fear of the re**al exam is the #1 reason so many men skip screening entirely. That fear may be based on outdated info.

To be fair — the exam isn't gone completely. It still matters for staging once cancer is found, or as a tiebreaker when PSA results are borderline.

⚠️ Honest caveat: PSA testing isn't perfect either. False alarms happen. That's why the real first step is a conversation with your doctor about your age, family history, and risk.

📊 Prostate cancer affects 1 in 8 men. Don't let fear of an outdated exam keep you from getting screened.

Tag a man in your life who needs to see this. 👇

08/15/2026

Thank you Anesthesia for all you do 😬

08/13/2026

Had a hysterectomy but your bladder still feels like it's falling? 😳 You're not imagining it.

😔 "My surgeon said they didn't want to make it worse." Sound familiar?

Here's what most patients never get told: when the uterus is removed, the top of the va**na loses its natural support. That support needs its own repair — an apical suspension (often a uterosacral suspension). Whether it's done at the same time as your hysterectomy depends a lot on your surgeon's training. 🎓

📊 The data: general OB/GYNs are statistically less likely to perform apical suspension during hysterectomy vs. urogynecologists — and skipping it means more women coming back for a second surgery.

⚖️ To be fair, a surgeon saying "I'm not comfortable doing this" isn't wrong. That's actually a good thing — no one wants a surgeon working outside their training.

🚩 But here's the rule: if they're not doing the repair, they owe you TWO things —
1️⃣ A referral to a specialist
2️⃣ A clear reason why

No referral + no reason = time for a second opinion. 👀

💬 Has this happened to you? Tell me in the comments — I read every one. 👇

🔴 Follow for more real talk on pelvic health, prolapse, and what your surgeon might not be telling you.

08/11/2026

Women’s health care shouldn't be filled with shame, guilt, or embarrassment! 🛑🩺 So many women deal with intimate concerns regarding bladder function, sexual health, and physical comfort, but feel too intimidated to speak up. 🤫💬

Dr. Richard Farnam is breaking down the stigma behind common treatments—like in-office procedures under local anesthesia—and reminding everyone that getting older doesn't mean you just have to live with leaks or discomfort. 💧✨ Quality of life matters at every stage! 💖

👇 Let’s chat in the comments: Have you ever felt hesitant talking to a doctor about your intimate health?

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