#BePelvicHealthAware: Sharing clinical best practices on pelvic floor health through whiteboard animations, social media and a dedicated website


  • Sarah Cockell  
    Providence Health Care Heart Centre

Team members:

  • Manisha Tilak
  • Kim Vopni
  • Sarah Munro
  • Trish Gipson
  • Adrienne Sim
  • Terry Lee
    Centre for Health Evaluation and Outcome Sciences
  • Nicole Koenig
  • Melissa Nelson
  • Nicole Prestley Stuart
    UBC / Women's Health Research Institute

The pelvic floor is at the bottom of a woman’s belly and supports vagina, bladder, bowel and womb in their daily functions. It is made of muscles and strong surrounding tissues. Pregnancy, childbirth and the few months after are times of rapid change for the pelvic floor. A woman’s body naturally adapts to pregnancy and tissues are able to stretch, but the baby’s passage through the birth canal can sometimes cause lasting damage to the mother’s pelvic area. This can lead to urine, stool or gas leaking, vaginal bulging, poor body image, loss of vaginal sensation, pain and avoidance of sex. Fifty percent of aging women have pelvic symptoms, which may disappear gradually or last a long time. 

There is a lot of misinformation about this. Women often don’t talk about it because of embarrassment. Our team recently completed grant-funded studies showing that:

  1. Online information is often incorrect
  2. Pregnant women are poorly informed
  3. We can successfully enhance prevention through a workshop

We created animated videos and plan a dedicated website to inform women about how to best care for the pelvic floor in pregnancy and beyond. We aim to to raise awareness of pelvic floor health, prevention and treatment options.

The Canadians Seeking Solutions and Innovations to Overcome Chronic Kidney Disease (Can-SOLVE CKD) Network

MSFHR is providing matching funds to support the research of Dr. Adeera Levin, as part of the Canadians Seeking Solutions and Innovations to Overcome Chronic Kidney Disease (Can-SOLVE CKD) Network, one of five national chronic disease networks established through the Canadian Institutes of Health Research (CIHR) Strategy for Patient-Oriented Research (SPOR) Networks in Chronic Disease, connecting researchers, health professionals, policy-makers, and patients across the country.

Continue reading “The Canadians Seeking Solutions and Innovations to Overcome Chronic Kidney Disease (Can-SOLVE CKD) Network”

The role of Annexin II in airway epithelial wound repair and the effect of corticosteroids on the Annexin II regulated pathway

Asthma is an inflammatory condition of the lungs that affects a growing number of individuals in developed countries worldwide. Current research and therapies for asthma are aimed at relieving the symptoms associated with the disease rather than the underlying defect. In spite of the use of anti-inflammatory agents, asthmatics experience progressive changes in airway structure and cumulative damage to the cells that line the airways (epithelium). The accumulation of damage due to ineffective repair may in part explain the airway’s hyperresponsiveness in asthma and highlights the importance of effective epithelial repair. Ben Patchell seeks to identify molecules that normally contribute to the process of epithelial repair and apply these findings to diseases such as asthma. Specifically, he is studying glycosylation, a process in which certain molecules gain sugars to become fully functional. Glycosylation has previously been shown to be essential in the repair of normal airway cells and there are demonstrated differences between the cells of normal and asthmatic individuals. Ben has developed a method to identify the unknown protein molecules responsible for these differences. Annexin II has been identified as a novel mediator of epithelial repair and has been demonstrated on the surface of airway epithelial cells. Ben is exploring how Annexin II and its associated proteins are regulated and the mechanisms by which they regulate cellular events such as migration in both normal and asthmatic epithelium. He is also investigating the effect of steroids, the primary therapy for asthma, on each of the cellular events. This research could lead to new research strategies and new therapeutics for asthma.

An examination of injection drug use sites: the influence of social and physical context on drug-related harms and public health interventions

Injection drug use may result in severe health consequences including increased risk of viral infections such as HIV and hepatitis C, soft tissue infections, and drug overdose. Recently, with increasing attention being paid to the impact of environment on individual and public health, intervention efforts for injection drug users (IDUs) have moved beyond the modification of individual behaviour and focused on modifying the environments in which people use injection drugs. One recent and controversial example of this involves medically supervised injection facilities, where IDUs can inject pre-obtained illicit drugs under the supervision of health care professionals. William Small is studying and comparing three types of injecting settings in the Downtown Eastside: private injecting spaces (such as homes), public injecting spaces (such as alleys), and Vancouver’s supervised injecting facility. He is examining how the social and physical context of each setting influences the ability of injection drug users to employ HIV-prevention measures and safer injection practices. The findings of this research will build important knowledge about the health and HIV vulnerabilities of IDUs in the Downtown Eastside. Also, this research will provide information on the impact of current interventions, which may inform future interventions for addressing injection drug use.

Genetic determinants of the host response to infection in critically ill adults with systemic inflammatory response syndrome

Each year in Canada about 100,000 people develop sepsis—a severe illness caused by the presence of bacteria in the bloodstream. The condition causes blood pressure to drop, resulting in shock and may lead to multiple organ dysfunction and eventually death. With a mortality rate of 30 and 65 per cent respectively, sepsis and septic shock cause more deaths annually than heart attacks. Inflammation and immune response to infection varies greatly between patients. Some inflammation is a normal defense against infection. However, if inflammation is excessive, white blood cells and other cells can spill into the circulatory system and damage healthy organs. Continuing her previous MSFHR-funded research, Ainsley Sutherland is studying whether the genes that recognize bacteria and viruses play a role in determining which patients will develop the excessive inflammation that can lead to sepsis. This understanding could lead to the development of drug therapies for patients at higher risk of sepsis, and the avoidance of unnecessary drug side effects in patients who are not at risk.

To Each Her Own: Sex Work Typologies, Intimate Relationships, and their Impact on HIV Risk for Female Sex Workers in Vancouver's Downtown Eastside

The estimated 1,000 female sex workers in Vancouver’s Downtown Eastside (DTES) live in Canada’s poorest neighbourhood, characterized by deplorable housing conditions and high rates of hepatitis C and HIV infections. HIV prevalence is an alarming 26 per cent, according to a recent study of 198 female sex workers in the DTES. Although violence, poverty and social marginalization have been identified as putting these women at risk, we know very little about two of the defining issues that characterize sex work and make these women vulnerable to HIV: types of sex workers, and the intimate relationships women form with boyfriends and regular clients. Treena Orchard is exploring whether there is a link between a particular type of sex worker and relationship structure that places certain groups of women at greater risk for HIV infection. Her hypothesis is that women with an established sex work status are more likely to form lasting relationships and avoid high-risk sexual practices. Treena’s research is examining how different types of sex workers are identified and organized, and how these women construct and attach meaning to their intimate relationships, especially in relation to the issues of sexuality, health and trust. This study will use individual interviews, focus groups and social mapping to determine the broader social processes and health determinants that structure the HIV risk of these female sex workers. Examining the social organization of sex work and relationships in this context is critical to improving the women’s health status and developing HIV prevention programs that are population and gender-specific. As one of the few qualitative studies to address these issues among Canadian sex workers, this research will be relevant to other researchers, health authorities and – through their participation – the women themselves.

Examining the complex role of social, environmental and structural factors as barriers and facilitators for HIV risk and prevention among substance-using women in survival sex work.

Women engaged in survival sex work in Vancouver’s Downtown Eastside (DTES) face multiple vulnerabilities that directly enhance their risk of HIV transmission, including entrenched poverty, homelessness, repeated episodes of violence and assault, substance abuse, and social marginalization. In addition, the illegal, clandestine and largely unregulated nature of sex trade work in Canadian cities increasingly pushes street-entrenched women to the outskirts of society, limiting their means to protect themselves and access to supportive health services. Despite increasing evidence of gender differentials in new HIV infections facing women – particularly youth and women of Aboriginal ancestry – and extensive harm reduction and public health efforts focusing on illicit drug use in this community, little information exists about the complex social, environmental and structural factors that facilitate prevention, harm reduction practices, and access to care. Kate Shannon’s research will use participatory-action research methodologies to explore the social and environmental barriers and facilitators to HIV prevention among survival sex workers. While several individual factors have been shown to elevate HIV and STI (sexually transmitted infection) risk among female substance users in this setting, far less attention has been paid to the role of social and structural violence and power relations in facilitating HIV risk through both sexual and drug use pathways. Using social mapping, focus group discussions and interview-questionnaires, Kate’s research will aim to demonstrate the social and environmental factors that mitigate the HIV risk environment of survival sex workers, and in particular, the role of violence and power relations in the negotiation of HIV prevention behaviours among drug-addicted women and their intimate and working partners This research will provide valuable information about a population that has remained largely on the periphery of public health and harm reduction strategies and services. It is anticipated that the research will also foster capacity building among survival sex workers and help inform evidence-based policy and practice tailored to this population.

Life at the Margins: Understanding Social Determinants of HIV/AIDS on Women's Health Through Multidisciplinary Translational Research

Vancouver’s Downtown Eastside community has the highest rates of HIV infection and the poorest health outcomes in Canada. Female sex workers in the community are among those at highest risk of infection. The limited success of public health programs and harm reduction interventions in this population reflect the multiple barriers that compromise their access to care. This includes socioeconomic factors such as poverty and unstable housing, the stigma associated with sex work, multiple addictions, and limited autonomy and personal choice. Disease control and harm reduction measures typically focus on individual responsibility, and often do not accommodate for the influences that can increase HIV risk and diminish autonomy among women in the downtown eastside. Susan Berkhout is utilizing an alternative framework developed from contemporary feminist and bioethics literature on ”relational autonomy” in order to more accurately characterize HIV risk behavior, and to produce more effective prevention and treatment strategies aimed at reducing HIV risk among female sex workers. This model considers the socioeconomic and cultural influences, and relationships involved in sex work and injection drug use. The findings should contribute to new harm reduction strategies tailored for this population, provide ethical guidance for researchers working with members of vulnerable populations, and help health care providers enhance autonomy in female sex workers.

Structure-function relationship in smooth muscle contraction

Hollow organs such as the intestines, bladder, uterus, blood vessels, and the airways that make up lungs are lined with smooth muscle cells. Normal functioning of these organs depends on the ability of these cells to contract and relax – processes that control the volume and shape of the organs and enable them to perform their various functions. When an individual has asthma, excessive contraction of the airway smooth muscle results in airway narrowing, compromising the individual’s ability to breathe. In asthmatics, airway smooth muscle has a tendency to generate more force and shorten more extensively than in individuals without asthma. This condition is further exacerbated by the fact that the muscle cells adapt to this shorter length, making it difficult for asthmatic airways to open after an attack has occurred. Leslie Chin is studying the role airway smooth muscle plays in the development of asthma. Generally, asthma research focuses on relaxing the smooth muscle cells which is typically accomplished by using an inhaler; however, it is also important to focus on preventing these muscle cells from adapting to shorter lengths. Leslie is investigating how this adaptation occurs in asthmatics and how this adaptation is prevented in healthy people. Understanding how both the mechanics of airway smooth muscle in asthma and the alterations are altered could lead to new treatments for the disease.

Investigation of the impact of HLA genetic diversity on HIV sequence evolution and clinical correlates of HIV disease

One of the major challenges facing HIV treatment and vaccine design is the virus’ capacity to mutate extremely rapidly in response to a changing environment. The course of HIV infection within a given individual is characterized by a constant, dynamic evolution of the virus. It is now appreciated that a wide range of host genetic factors influences the course of HIV infection and disease progression. The proposed research project seeks to investigate the effects of genetic variation within specific genes of the human immune system (called the “”Major Histocompatibility Complex”” or “”MHC”” genes) on the clinical course of HIV infection. The results of this project will help us gain a more detailed understanding of the multiple genetic factors that affect the course of HIV infection, and help bring us closer to the potential incorporation of human genetic information into the clinical management and treatment of this disease. In addition, this research will be of relevance in the continuing efforts to develop a vaccine against HIV. Research such as this will help us develop and implement strategies for clinical management of HIV/AIDS and will therefore ultimately be of benefit to individuals living with HIV.