Shifting Treatment Expectations in the Evolving Landscape of Female Pelvic Health

For too long, female pelvic health disorders have been shrouded in silence, dismissed as an inevitable result of aging or childbirth. Yet, 1 in 2 women will experience involuntary urine leakage, a frequent result of pelvic health disorders, at some point in their lives.¹

These disorders can diminish women’s quality of life, limit social engagement, and often lead to feelings of shame and isolation. As frontline providers in women’s health, obstetrician-gynecologists (OB-GYNs) are uniquely positioned to champion a new era of awareness, diagnosis, and effective treatment.

Stigma vs Empowerment: A “Tale of Two Cities”

The current state of female pelvic health, including disorders such as urinary incontinence (UI) and overactive bladder (OAB), can aptly be described as a “tale of two cities.” On the one hand, there’s still a pervasive belief among women that UI is “normal” after a certain age. This misconception can often be inadvertently reinforced by health care providers who recommend symptom management with absorbent pads or diapers rather than more definitive medical solutions. The numbers support this: In the US in 2023, the market for adult diapers was worth approximately $18.2 billion and is projected to grow to about $35.5 billion by 2033.²

However, a significant shift is underway. Patients are increasingly leveraging online resources to educate themselves and turning to social media to discuss their symptoms and treatment options. This rise in patient awareness and self-advocacy is driving a new wave of conversations with physicians and ultimately increasing the demand for more effective, comprehensive, and patient-centered care.

Adding to this momentum are recent changes in clinical guidelines. For example, in 2024, the American Urological Association updated its recommendations to promote patient-centered conversations and shared decision-making about treatment options for OAB.³ This empowers health care providers to meet patients where they are in their lives and facilitate more dynamic dialogues and personalized treatment journeys.

Understanding the Burden of UI

The impact of UI on quality of life is overwhelming. Women with UI report higher rates of depression, anxiety, and social isolation, often avoiding physical activity, travel, and intimate relationships.⁴ Likewise, pelvic health disorders, including OAB, can lead to feelings of shame, anxiety, and depression, which can result in social isolation.⁵ The financial burden of managing symptoms with pads, diapers, and other products can also be substantial. Addressing these conditions is not merely about physical relief; it is about restoring dignity, confidence, and overall well-being.

Barriers to Care and a Call for Integrated Solutions

Despite this considerable prevalence of pelvic health disorders and the availability of a broad range of safe, effective, and durable treatment options, significant barriers continue to hamper effective care.

• Lack of urgency. The belief that these disorders are, in some way, “normal” prevents women from developing a sense of urgency to seek help, including initiating conversations with their doctors. This underscores a broader societal issue where many women, and even some health care providers, remain uninformed about long-term effective solutions, limiting care to just symptom management.
• Fragmented referral pathways. Women often see primary care physicians who may not be equipped to diagnose or treat specific pelvic health conditions. This can often lead to patients swirling around in the health care system until they reach a specialist who can provide a more definitive diagnosis and work with them to develop a personalized treatment plan.
• Provider capacity and education. With many urologists and OB-GYNs retiring as patient demand increases, there is a growing capacity challenge.^6,7 Furthermore, continuous education for all providers is crucial to ensure they can accurately identify symptoms, make appropriate referrals to a specialist, and initiate screenings that can result in a definitive diagnosis and initiation of a treatment plan.

Advancing Therapeutic Solutions for Pelvic Health Care

Boston Scientific has been a pioneer in women’s health for more than 25 years, with a long-standing commitment to education, advocacy, and innovative medical solutions. We offer a robust portfolio of safe, clinically effective options for UI and OAB that help address women’s needs, life stage, and desired outcomes:

• Bulking agents: A urethral bulking agent for women with stress urinary incontinence (SUI) can offer significant symptom improvement, particularly for those patients seeking an alternative to a sling or who may not be candidates for more extensive surgery. The Bulkamid™ Urethral Bulking System, for instance, can provide long-lasting relief but is less invasive than other SUI treatments. In a long-term study, 67% of women reported symptom improvement at 7 years following Bulkamid injection.⁸
• Midurethral slings: For SUI, Boston Scientific offers a full portfolio of midurethral slings to suit a variety of physician and patient needs. One of these is the Solyx™ Single Incision Sling System, which utilizes polypropylene mesh. Polypropylene mesh devices have been a mainstay in medical procedures for more than 50 years. In a prospective study, 94% of women who received Solyx reported improvement in SUI at 3 years, measured by a negative cough stress test.⁹
• Sacral neuromodulation devices: For conditions like OAB, sacral neuromodulation devices offer a reversible and adjustable treatment option by delivering mild electrical pulses to the sacral nerve that may restore communication between the brain and the bladder.¹⁰ Boston Scientific’s Axonics™ Sacral Neuromodulation System can be programmed and adjusted post implant to improve patient outcomes and provide ongoing support. In a clinical study, 93% of patients who completed 2-year follow-up experienced at least 50% reduction in urge incontinence with the Axonics System. In this study, the Axonics System was shown to deliver a clinically meaningful improvement in quality of life with no serious device-related adverse events.¹¹

Holistic Support for Providers and Patients

Successful patient outcomes require a holistic approach that integrates products, people, and programs. That is why Boston Scientific is also exploring advanced patient education tools that enable physicians to send personalized updates and educational content to patients via their cell phones. This helps patients receive clear, consistent information throughout their care journey. For implantable devices like sacral neuromodulation, Boston Scientific also provides postimplant support, assisting with needs like device programming and troubleshooting.

The vision for optimal patient outcomes also hinges on an integrated care ecosystem where primary care providers, OB-GYNs, urogynecologists, and urologists collaborate effectively. When this ecosystem works well, patient needs are less likely to fall through the cracks.

OB-GYNs specifically play a pivotal role in this ecosystem, as they are often the first point of contact for women experiencing pelvic health symptoms. By recognizing the diverse types of UI and the range of effective short- and long-term solutions, OB-GYNs can foster more proactive conversations, ultimately leading to timely referrals to urogynecologists and urologists for specialized care.​

The future of women’s pelvic health care is bright, marked by increased awareness, continued innovation in minimally invasive techniques, and a growing emphasis on integrated, patient-centered care. Boston Scientific strives to be a trusted partner in pelvic health, with a collaborative approach designed to empower both patients and providers. We are committed to forging a future where women are no longer suffering through pelvic health disorders in silence and, instead, have a clear path to comprehensive, effective care.

Learn more about Boston Scientific’s pelvic health solutions.

CAUTION: US federal law restricts this device to sale by or on the order of a physician.

To review the Indications, Safety, and Warnings for the Axonics SNM System, please visit www.bostonscientific.com/AxonicsSNMSystem-brief-summary.

Potential Risks Associated With Boston Scientific Midurethral Sling Products:

The following adverse events and known risks have been reported due to suburethral (beneath the urethra) mesh sling placement, any of which may be ongoing but are not limited to: abscess (swollen area within the body tissue, containing a buildup of pus); allergic reaction to the implant; apareunia (inability to perform sexual intercourse); bleeding from the vagina; hematoma formation (bruising); complete failure of the procedure/failure to resolve a patient’s stress urinary incontinence; dehiscence of vaginal incision (opening of the incision after surgery); de novo detrusor instability (involuntary contraction of the bladder wall leading to an urge to urinate); dyspareunia (pain during sexual intercourse); edema and erythema at the surgical site (swelling and redness); fistula formation (a hole/passage that develops through the wall of the organs) that may be acute or chronic; foreign body reaction (body’s response to the implant) that may be acute or chronic; infection or inflammation that may be acute or chronic (redness, heat, pain or swelling at the surgical site as a result of the surgery); irritation (redness or pain) at surgical site; leg weakness (muscle weakness); mesh contracture (mesh shrinkage); erosion into the following organs: urethra, bladder, or other surrounding tissues and exposure/extrusion into the vagina (when the mesh goes through the vagina into other organs or surrounding tissue); pain or discomfort to the patient’s partner during intercourse; pain/ongoing pain/severe/chronic pain in the pelvis, vagina, groin/thigh, and suprapubic area that may be acute or chronic (pain or ongoing pain just above the pubic bone, pelvis, vagina, groin/thigh area that may be severe and could last for a long time); pain with intercourse that may not resolve; perforation or laceration of vessels, nerves, bladder, urethra or bowel (a hole in or damage to these or other tissues that may happen during placement); scarring, scar contracture (tightening of the scar); stone formation (as a result of mesh erosion/exposure/extrusion in the urethra or bladder where the mesh is exposed to urine, mineral deposits may form along the mesh, also known as stones); tissue contracture (tightening of the tissue); voiding dysfunction: incontinence, temporary or permanent lower urinary tract obstruction, difficulty urinating, pain with urination, overactive bladder, and retention (involuntary leakage of urine or reduced or complete inability to empty the bladder from the mesh being implanted too tightly beneath the urethra). The following additional adverse events have been reported for the Solyx SIS System: dysuria (painful/difficult urination) and hematuria (blood in the urine). The occurrence of these events may require surgical intervention and possible removal of the entire mesh. In some instances, these events may be permanent after surgery or other treatments. Removal of mesh or correction of mesh-related complications may involve multiple surgeries. Complete removal of mesh may not be possible, and additional surgeries may not always fully correct the complications.

References

1. Patel UJ, Godecker AL, Giles DL, Brown HW. Updated prevalence of urinary incontinence in women: 2015-2018 national population-based survey data. Female Pelvic Med Reconstr Surg. 2022;28(4):181-187. doi:10.1097/SPV.0000000000001127
2. Market.US. Global Adult Diapers Market Report by Type (Underwear and Brief, Pads and Guards, Drip Collector and Bed Protectors), by Distribution Channel (Institutional Sales, Retail Stores, Online Channels), by Region and Companies — Industry Segment Outlook, Market Assessment, Competition Scenario, Trends and Forecast 2024-2033. Market.US. October 2024. Accessed October 2025. https://tinyurl.com/2kpfperh
3. Cameron AP, Chung DE, Dielubanza EJ, et al. The AUA/SUFU guideline on the diagnosis and treatment of idiopathic overactive bladder. J Urol. 2024;212(1):11-20. doi:10.1097/JU.0000000000003985
4. Lee H, Rhee Y, Choi KS. Urinary incontinence and the association with depression, stress, and self-esteem in older Korean Women. Sci Rep. 2021;11(1):9054. doi:10.1038/s41598-021-88740-4
5. Melotti IGR, Juliato CRT, Coelho SCA, Lima M, Riccetto CLZ. Is there any difference between depression and anxiety in overactive bladder according to sex? a systematic review and meta-analysis. Int Neurourol J. 2017;21(3):204-211. doi:10.5213/inj.1734890.445
6. Scarborough N. 8 things to know about the urologist shortage. Healthgrades. Updated June 21, 2023. Accessed October 2025. https://tinyurl.com/mrx58sse
7. Weiner S. The fallout of Dobbs on the field of OB-GYN. Association of Medical Colleges. August 23, 2023. Accessed October 2025. https://tinyurl.com/bdetkm8a
8. Brosche T, Kuhn A, Lobodasch K, Sokol ER. Seven-year efficacy and safety outcomes of Bulkamid for the treatment of stress urinary incontinence. Neurourol Urodyn. 2021;40(1):502-508. doi:10.1002/nau.24589
9. White AB, Kahn BS, Gonzalez RR, et al. Prospective study of a single-incision sling versus a transobturator sling in women with stress urinary incontinence: 3-year results. Am J Obstet Gynecol. 2020;223(4):545.e1-545.e11. doi:10.1016/j.ajog.2020.03.008
10. Sacral neuromodulation: a guide for women. International Urogynecological Association. Accessed January 2026. https://www.yourpelvicfloor.org/media/Sacral_Neuromodulation_RV2-2.pdf
11. Pezzella A, McCrery R, Lane F, et al. Two-year outcomes of the ARTISAN-SNM study for the treatment of urinary urgency incontinence using the Axonics rechargeable sacral neuromodulation system. Neurourol Urodyn. 2021;40(2):714-721. doi:10.1002/nau.24615