National Urogynecology Research Agenda: A Path Forward for Advancing the Treatment and Management of Pelvic Floor Disorders

Developed by the AUGS Scientific Committee and Research Agenda Writing Group

Women's health research is woefully underfunded. A 2021 study found that in disease states that unequally affect one gender, a disproportionate amount of funding from the National Institutes of Health (NIH) went to male-dominated areas. The authors found that in approximately 75% of cases, the funding was provided to male-dominated diseases.1 In addition to the disproportionately smaller amount of NIH research funding that is allocated to women's health, the majority goes to research involving reproductive-aged women and is often allocated specifically to pregnancy and maternity issues.2 The Office of Research of Women's Health noted that of the proportion of the overall NIH research spending by disease, condition, and special initiative from fiscal year 2017 to 2019, only 10% was allocated to women's health research; however, in that same year, the proportion of that money spent on contraception and pregnancy was 78.6% of the total, despite the fact that women spend the minority of their lives bearing children.2 Women's health care should encompass the full life span of women, including conditions affecting postreproductive and geriatric women, the fastest-growing segment of the U.S. population. Pelvic floor disorders (PFDs) are common conditions that can significantly affect a woman's quality of life. Approximately 25% of women experience at least 1 PFD, and this percentage is likely higher in women older than 65 years, as it is well established that all PFDs increase after menopause.3,4

PURPOSE

The American Urogynecologic Society (AUGS) recognizes the importance of evaluating the conditions women face throughout their lives, including conditions that become more prevalent in the post-reproductive years. Furthermore, the mission of AUGS is to drive excellence in comprehensive care for women with PFDs. Aligning the mission of AUGS with the need to increase the amount of research funding directed toward women's health beyond maternity and reproductive care identified an opportunity to develop a National Urogynecology Research Agenda focused on research funding for PFDs.

At the direction of the AUGS Board of Directors, the AUGS Scientific Committee was charged with the task of creating a Research Agenda that would serve the urogynecology research community by synthesizing and presenting key gaps and research priorities for a variety of PFDs. Six conditions were prioritized for inclusion in the Research Agenda, including pelvic organ prolapse (POP), lower urinary tract symptoms, recurrent urinary tract infections (rUTIs), bladder pain syndrome/interstitial cystitis (BPS/IC) and myofascial pelvic pain (MFPP), female sexual health, and fecal incontinence (FI). Once the working group generated a manuscript and the internal revisions were complete, the Research Agenda was reviewed and edited by 9 external reviewers and then subsequently by the AUGS Publications Committee and the AUGS Board of Directors. Edits were considered, and revisions made accordingly to create the final Research Agenda (https://www.augs.org/researchagenda/).

There are extensive areas to be explored in women's health research, especially for conditions women face throughout their lives, including conditions such as PFDs that become more prevalent in the post-reproductive years. The main goal of the Research Agenda is to synthesize and present key gaps and research priorities for a variety of PFDs. There is a clear need to increase funding to investigate these crucial topics. The intention is that this agenda will serve as a living document to be updated as knowledge advances and research priorities evolve. This document will also help to guide researchers when putting forth funding applications and should be used by PFD advocates when championing research dollars that can be directed toward women's health care beyond reproduction.

REFERENCES

1. Mirin AA. Gender disparity in the funding of diseases by the U.S. National Institutes of Health [published online November 27, 2020]. J Womens Health (Larchmt). 2021;30(7):956–963. doi:10.1089/jwh. 2020.8682.

2. National Institutes of Health. Report of the Advisory Committee on Research on Women's Health: Fiscal Years 2019-2020. Office of Research on Women's Health and NIH Support for Research on Women's Health. Available at: https://orwh.od.nih.gov/sites/orwh/files/ docs/ORWH_BiennialReport2019_20_508.pdf.

3. Nygaard I, Barber MD, Burgio KL, et al, Pelvic Floor Disorders Network. Prevalence of symptomatic pelvic floor disorders in US women. JAMA. 2008;300(11):1311–1316. doi:10.1001/jama.300. 11.1311.

4. Dieter AA, Wilkins MF, Wu JM. Epidemiological trends and future care needs for pelvic floor disorders. Curr Opin Obstet Gynecol. 2015; 27(5):380–384. doi:10.1097/GCO.0000000000000200.

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