American Urogynecologic Society

Pelvic Floor Health: Your Guide to Pregnancy and Postpartum Care

 is now available in paperback and e-book!

This book will provide patients with answers to important pelvic floor-related questions, help prepare them for the expected and unexpected, and present a list of invaluable tips and resources. After reading, patients will become not only familiar with possible pelvic floor specific issues but also solutions to recovery (such as physical therapy exercises) for pelvic rehabilitation.

The topics below are discussed in Pelvic Floor Health: Your Guide to Pregnancy and Postpartum Care. Check out a 

Chapter 1: Common Questions About Pelvic Floor Problems

Chapter 2: Pelvic Floor Health During Pregnancy

Chapter 5: Postpartum Exercise With the Pelvic Floor in Mind

Chapter 7: Postpartum Pelvic, Bladder, and Bowel Symptoms

Chapter 8: Considerations for Future Childbirth

Writing Group Authors: Linda Brubaker, MD (Chair); Joan Blomquist, MD; Olivia Cardenas-Trowers, MD; Colleen Fitzgerald, MD; Yvette LaCoursiere, MD; Christina Lewicky-Gaupp, MD; Jessica McKinney, PT, DScPT, MS; Melanie Meister, MD; Kate Meriwether, MD; Ingrid Nygaard, MD; Megan Schimpf, MD; and Elisa Trowbridge, MD.

Thank you to these societies for their support!

International Urogynecological Association (

Mediterranean Incontinence and Pelvic Floor Society (

Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction (

Articles

The patient-focused book entitled Pelvic Floor Health: Your Guide to Pregnancy and Postpartum Care is now available in paperback and e-book.

Pelvic Floor Health Guide: Available in e-book & print! 

Abstract: The American Urogynecologic Society (AUGS) identified diversity, equity, and inclusion as the cornerstone of excellence in governance and operations. Although efforts to increase diversity of our membership have been ongoing for years, there had not previously been an adequate investment to ensure an inclusive climate that emphasizes equity across our volunteers and programs. In June 2020, the AUGS President, Dr Shawn Menefee, and Board of Directors called for a Presidential Task Force on Diversity, Equity, and Inclusion to study the current state of our society and make recommendations for future directions. The charge was intentionally broad. In review of the literature, there was little to inform the best means to proceed aside from administering climate surveys to gauge the current culture of inclusion and bias. The task force believed that the challenge was not only to describe the problem but also to articulate solutions. We ultimately moved to rewrite the Diversity and Inclusion and Code of Conduct Statements and develop an Action Plan that would accelerate the efforts of AUGS to foster inclusion and improve equity through the existing governance structure. In this document, we describe how the task force was organized and conducted the work to develop strategies that were aligned with the AUGS mission: “As the leader in female pelvic medicine and reconstructive surgery, AUGS drives excellence in care for women through education, research, advocacy, and interdisciplinary collaboration.”

In the summer of 2020, several racially motivated events in the United States became a catalyst for change, forcing everyone to examine this country’s past and current racial injustices. The American Urogynecologic Society (AUGS) struggled to confront how the honoring of past innovators in gynecology was alienating many of our current members. In June 2020, Dr Shawn Menefee emailed the AUGS membership his Presidential Perspective, which called for the AUGS community “to identify disparities and chart a path forward.”

 One month later, Dr Menefee commissioned the AUGS Presidential Task Force for Diversity, Equity, and Inclusion (DEI) and placed a call for volunteers.

 In August 2020, to highlight the history of racism in obstetrics and gynecology and acknowledge that racism persists today, the AUGS, in collaboration with ACOG and other women’s health care societies, published the “Joint Statement: Collective Action Addressing Racism.”

 The goals of the AUGS DEI Task Force (referred to as “task force” in this document) were to examine the organization’s history and mission and to assess its current state of diversity, equity, and inclusion. The task force sought to apply this knowledge to areas of membership, leadership, education, research, and patient care to devise an Action Plan to move the organization forward. The goal was to improve equity and inclusiveness for AUGS members, address the need for greater diversity in our research,

 and provide a useful roadmap for other health care societies as we collectively seek to improve diversity, equity, and inclusion. This report describes the process for how the task force was assembled, gathered data from the membership, and developed an action plan that was ultimately adopted by the AUGS Board of Directors (“Board”).

This document serves to inform AUGS members of the task force’s deliberate process to evaluate the society’s current state of diversity, equity, and inclusion and develop a strategy to strengthen the existing societal paradigm. Notably, the task force administered a climate survey, created a Diversity and Inclusion Position Statement, updated the Member Code of Conduct, and developed an Action Plan. The governance committee could incorporate recommendations within the action plan to ensure DEI permeates all AUGS-sponsored initiatives. When embarking on the mission, the task force noted a paucity of literature available for guidance. Many society membership surveys assess the needs, opinions, and even diversity of its members, but few deeply examine issues with equity and inclusion beyond characterizing the current climate and calling for change.

 The task force was challenged to develop our own process and procedure to enact DEI culture and programmatic change. In addition to this procedural roadmap the task force developed, other lessons were harder to quantify. Three lessons learned are worth mentioning. First, we learned that diversity and inclusion mean different things to different constituent groups. Although we plan to present the findings of the climate survey separately, we noted that our members had many ideas about improving the culture of inclusion. Importantly, we found that although these ideas focused on different groups, they were not mutually exclusive or in opposition to other groups. Therefore, the task force needed to generate recommendations that would, ultimately, benefit all members and patients. Second, we learned that to make any substantive improvements in DEI, we must be prepared to participate in uncomfortable conversations where we acknowledge how each of us may have contributed to a culture of exclusion and racism. This was especially hard given that everyone is not always ready to admit the role they have played in perpetuating harm against marginalized groups. Third, we learned that organizational change will not happen without involving key leaders (eg, the AUGS Board and CEO) in the process from the start. Inclusion of the AUGS CEO not only helped us develop recommendations that could be easily integrated within the existing governance but would also help with buy-in from the various constituent groups throughout the society. The current task force report adds to the literature by providing a guide to help groups create a comprehensive action plan aligned with their mission and a specific process toward a solution. Although limited by a 24% response rate, the AUGS climate survey represented voices from individuals of not only different races, ethnicities, nationalities, gender identities, and sexual orientation but also different ages, abilities, educational backgrounds, and practice settings. The responses also demonstrated that a broad consideration of needs and perspectives must include the full diversity of the membership. The AUGS members include allied health professionals, physicians, medical students, trainees, and researchers. By using the AUGS survey responses to inform the revised Diversity and Inclusion Position Statement, Code of Conduct, and DEI Action Plan, the task force underscores that inclusion and equity require a more intentional strategy to incorporate all perspectives. The survey findings emphasize the wisdom that when the needs of the most vulnerable are addressed, everyone will benefit. The task force endeavored to ensure that the resulting product fully aligned with the AUGS mission “to drive excellence in the care of women.” These recommendations were designed to enhance member experience, education, research, and patient care. Through sharing our work and process, the task force hopes to provide a transparent way forward for our society; in addition, this report may benefit others who endeavor to improve their own DEI culture. One of the most important accomplishments is the newly established AUGS Diversity Equity and Inclusion Committee. This permanent committee will be charged with setting strategies to ensure equity across all groups, monitoring AUGS’ progress in the areas of diversity and inclusion, and disseminating results to members. Finally, it is important to acknowledge the difference between equality and equity. Equality overlooks systems of bias and injustice. Equity recognizes that special efforts are required to ensure representation and participation from groups who have been affected by historic and systemic injustices. If the events of 2020 served as a catalyst to examine and change longstanding inequities, this subspecialty’s celebration of the annual J. Marion Sims lectureship exemplified one of many symptoms of present day systemic racism born out of our collective history. It is an example of how past abuses live beyond their time and continue to perpetuate harm. Therefore, the task force concludes by acknowledging the past and recognizing the importance of remembering it, even when unfavorable, so that our collective future may be brighter, fairer, and more inclusive for all.

Northington GM, Acevedo-Alvarez MG, Willis-Gray MG, et al. 

. 2022;28(3):127-130. doi: 10.1097/SPV.0000000000001169

1. American Urogynecologic Society. News: a message to the AUGS community on racial equality. 2020. Available at: https://www.augs.org/a-message-to-theaugs-community-on-racial-equity/. Accessed December 9, 2021.

2. American Urogynecologic Society. News: AUGS Diversity and Inclusion Task Force call for volunteers. 2020. Available at: https://www.augs.org/ augs-diversity-and-inclusion-task-force-call-for-volunteers/. Accessed December 9, 2021.

3. American Urogynecologic Society. Joint Statement: collective action addressing racism. 2020. Available at: https://www.acog.org/news/newsarticles/2020/08/joint-statement-obstetrics-and-gynecology-collectiveaction-addressing-racism. Accessed December 9, 2021.

4. Grimes CL, Clare CA, Meriwether KV, et al. Inadequacy and underreporting of study subjects’ race and ethnicity in federally funded pelvic floor research. Am J Obstet Gynecol 2021;225(5):562.e1–56

5 Hammond CB. A survey of the practices and opinions of the domestic members of the American Society for Reproductive Medicine. Fertil Steril 2004;82(3):547–548. doi:10.1016/j.fertnstert.2004.01.051.

6. Beitsch PD, Lerner AG, Laidley AL, et al. Who are we and what do we think? Am J Surg 2003;186(4):321–323. doi:10.1016/s0002-9610(03)00270-8

7. Lightner DJ, Terris MK, Tsao AK, et al. Status of women in urology: based on a report to the Society of University Urologists. J Urol 2005;173(2): 560–563. doi:10.1097/01.ju.0000149739.51103.d3.

"Although efforts to increase diversity of our membership have been ongoing for years, there had not previously been an adequate investment to ensure an inclusive climate that emphasizes equity across our volunteers and programs."

The American Urogynecologic Society Action Plan on Diversity, Equity, and Inclusion

 is the year’s largest venue for those in the field of urogynecology and Female Pelvic Medicine and Reconstructive Surgery to come together for education and networking.

Present your latest findings and best practices, attend inspiring presentations and interactive workshops, engage in formal and informal dialogue, and establish or reinforce the bonds that will help you achieve the most important work of your career in 

Portland, Oregon or virtually on October 3-7, 2023!

November 21—Call for abstract and video reviewers opens

December 30—Abstract and video reviewer submission deadline

January 10—Call for abstracts, workshops, and roundtables opens

February 23—Workshop and roundtable submissions deadline

The American Urogynecologic Society's Pelvic Floor Disorders (PFD) Week 2023 is the year’s largest venue for those in the field of urogynecology and Female Pelvic Medicine and Reconstructive Surgery to come together for education and networking.

AUGS Pelvic Floor Disorders (PFD) Week 2023 Important Dates

Enhanced recovery after surgery (ERAS) evidence-based protocols for perioperative care can lead to improvements in clinical outcomes and cost savings. This article aims to present consensus recommendations for the optimal perioperative management of patients undergoing urogynecological surgery.

A review of meta-analyses, randomized clinical trials, large nonrandomized studies, and review articles was conducted via PubMed and other databases for ERAS and urogynecological surgery. ERAS protocol components were established, and then quality of the evidence was both graded and used to form consensus recommendations for each topic. These recommendations were developed and endorsed by the writing group, which is comprised of the American Urogynecologic Society and the International Urogynecological Association members.

 All recommendations on ERAS protocol items are based on best available evidence. The level of evidence for each item is presented accordingly. The components of ERAS with a high level of evidence to support their use include fasting for 6 h and taking clear fluids up to 2 h preoperatively, euvolemia, normothermia, surgical site preparation, antibiotic and antithrombotic prophylaxis, strong antiemetics and dexamethasone to reduce postoperative nausea and vomiting, multimodal analgesia and restrictive use of opiates, use of chewing gum to reduce ileus, removal of catheter as soon as feasible after surgery and avoiding systematic use of drains/vaginal packs.

The evidence base and recommendations for a urogynecology-relevant ERAS perioperative care pathway are presented in this consensus review. There are several elements of ERAS with strong evidence of benefit in urogynecological surgery.

In urogynecology/female pelvic medicine and reconstructive surgery (FPMRS), a field dedicated to the improvement in quality of life of women who suffer from pelvic floor disorders, there is an inherent drive to minimize risk and maximize efficacious treatments. There are local, regional, national, and international differences in the setting for surgery, number of days of hospitalization, duration of catheterization and vaginal packing, and postoperative analgesia utilized after pelvic floor surgery. It is well known that surgical stress induces a catabolic state that leads to increased cardiac demand, relative tissue hypoxia, increased insulin resistance, and altered pulmonary and gastrointestinal function. Enhanced recovery after surgery (ERAS) is an evidence-based paradigm shift in perioperative care, proven to reduce both recovery time and postoperative complication rates, while also being cost-effective.

 The goal of ERAS programs is to promote rapid recovery (by maintaining normal physiology in the perioperative period), as quantified by decreasing the length of hospital stay, complications, and cost of specific surgical interventions.

 ERAS is a multimodal, multidisciplinary approach to the care of the surgical patient. The process implementation involves a team consisting of surgeons, anesthetists, an ERAS coordinator (often a nurse or a physician assistant), and nursing staff from units that care for the surgical patient. ERAS pathways focus on counseling preoperatively, optimizing nutrition, standardizing analgesia and avoiding opioid use, minimizing electrolyte and fluid imbalance and using primarily minimally invasive surgical routes. After ERAS implementation, gynecological oncology patients experienced decreased length of admission, early return of bowel function and decreased narcotic use, resulting in high patient satisfaction.2 Adopting these protocols in urogynecology could benefit patients by reducing pain and hastening recovery

 —especially in the current climate of increased risk of hospital-acquired infections with prolonged hospitalization. The objective of this report is to evaluate the existing evidence in urogynecology and gynecology, and from other fields such as colorectal or general surgery, where specific evidence is unavailable regarding gynecological surgery on implementation of an ERAS pathway and develop recommendations for practice.

Latthe P, Panza J, Marquini GV, et al.Urogynecology. 2022 Nov 1;28(11):716-734. doi: 10.1097/SPV.0000000000001252

1. Perioperative Pathways: Enhanced Recovery After Surgery [Internet]. 2018 [cited 2020 Dec 12]. Available from: https://www.acog.org/ clinical/clinical-guidance/committee-opinion/articles/2018/09/ perioperative-pathways-enhanced-recovery-after-surgery

2. Nelson G, Bakkum-Gamez J, Kalogera E, et al. Guidelines for perioperative care in gynecologic/oncology: Enhanced Recovery After Surgery (ERAS) Society recommendations—2019 update. Int J Gynecol Cancer [Internet] 2019; [cited 2021 Feb 15];ijgc–2019– 000356. Available from: https://ijgc.bmj.com/content/early/2019/03/ 15/ijgc-2019-000356.

3. Smith TW, Wang X, Singer MA, et al. Enhanced recovery after surgery: A clinical review of implementation across multiple surgical subspecialties. 

4. Carter-Brooks CM, Du AL, Ruppert KM, et al. Implementation of a urogynecology-specific enhanced recovery after surgery (ERAS) pathway. Am J Obstet Gynecol [Internet] 2018 [cited 2020 Dec 12]; 219(5):495.e1–495.e10. Available from: https://www.ajog.org/ article/S0002-9378(18)30496-4/abstract.

There are several elements of ERAS with strong evidence of benefit in urogynecological surgery.

American Urogynecologic Society

Articles

Pelvic Floor Health Guide: Available in e-book & print!

The American Urogynecologic Society Action Plan on Diversity, Equity, and Inclusion

AUGS Pelvic Floor Disorders (PFD) Week 2023 Important Dates

AUGS-IUGA joint clinical consensus statement on enhanced recovery after urogynecologic surgery