The pelvic floor muscles maintain a sustained resting tone and several contractions and relaxation activities for continence, urination, defecation and sexual function. Examination of the pelvic floor muscles is essential for treatment and rehabilitation planning. However, healthcare students' training is still a challenge, considering the evaluation of power, speed, endurance, and ability to relax the pelvic floor muscles. This study aims to construct and validate a female haptic pelvis for the practical training of undergraduate students in Women's Health. The device is intended to simulate the functional assessment of the pelvic floor, incorporating dynamic graduated strength to mimic muscle contractions.

An integrative literature review investigated the mechanical and neural aspects of pelvic floor muscle contraction and various instruments for measuring this contraction. This review identified several key parameters related to pelvic floor muscle function, including location, thickness, muscle torque, pressure, and velocity. These parameters provided essential physiological characteristics of the pelvic floor muscles and supported the development of a device for simulating pelvic floor muscle function across four levels, as outlined by Brink et al (1989)[1]  (Table 1). This measure uses concepts of pressure (rated 1 to 4), time and displacement. These parameters are assessed using the index and middle fingers positioned in the antero-posterior orientation, with the index finger resting atop the middle finger, inserted 4 cm to 6 cm into the vaginal canal.
         The device uses an Arduino board as a central processing unit. The Arduino board has input and output data control circuits, allowing it to interface with various components (servo motors to mimic muscles) and resistive sensors (adjust actuators force). An Integrated Development Environment (IDE) that supports C/C++ programming language provides an interface for writing, compiling, and uploading code to the Arduino. Thus, it enables the Arduino to control each actuator individually as an individual pelvic muscle according to the predefined information raised in the review of the pelvic floor muscles physiology.
	The servo motor (MG946R, 5VDC, 19mm x 40.7mm x 42.9mm, 55 grams) to simulate the contraction of pelvic floor muscles has metal gears to ensure greater torque, ranging between 10.5 Kg/cm and 13 Kg/cm, and has an operating speed ranging from 0.20 seconds per 60 degrees to 0.17 seconds per 60 degrees. Each servo motor pulls silicone-coated nylon bands to shorten the length (contraction). These bands are designed with a similar width and length to the pelvic floor muscles and are fixed according to their origin and insertion. The coordination of servo motors, including strength, speed, time, and location, is based on physiological parameters extracted from the integrative literature review.
	A 3D-printed pelvic bone supports the artificial muscles and the vaginal canal made of silicone rubber. This setup allows for bidigital palpation of the pelvic floor muscles and their contraction. The synthetic pelvis provides a realistic texture and feel, enabling students to practice palpation techniques and assess muscle function effectively (Arduino based contraction simulation). 
	As part of the proof of concept, the device's ability to simulate pelvic floor muscle contraction and pressure will be compared with a commercial quantitative assessment method known as a perineometer. The comparison will be based on the Brink et al (1989) scale1, which provides a standardized framework for evaluating pelvic floor muscle function across four levels.
	The activation patterns of the servo motors, which simulate pelvic floor muscle contraction, will play a crucial role in the configurations for student training and evaluation. These patterns will be programmed into the device to replicate various scenarios of pelvic floor muscle function, allowing students to practice assessment techniques.

Several silicone rubbers were tested and were selected the silicone rubber extra soft to simulate the fibromuscular vaginal wall (silicone rubber 00-10, platinum cure, tensile strength 120psi, elongation break 800%, ~3mm thickness with several transverse folds - rugae) and the tube (~10cm length with anterior wall 7.5cm and posterior wall 10cm, diameter ~4.3cm). The silicone rubber 00-50 (platinum cure, extra-soft, tensile strength 315 psi, elongation break 980%) was selected to reproduce the cervix (2.5cm diameter and 3cm depth). These data were based on Pendergrass et al (1996) [2].
       Furthermore, the servo motors are being tested in a static model to improve tactile perception of the best torques corresponding to the force scale (Figure 1).

The construction of the pelvic simulation device represents a significant technological innovation with a primary focus on enhancing teaching and learning practices in higher education. By providing simulated training through haptic reality, this device offers a unique opportunity for students in physiotherapy and medicine courses to develop essential skills in the functional assessment of the pelvic floor.
        Students can engage in hands-on learning experiences that closely resemble clinical practice through realistic simulation. The device's ability to replicate the tactile sensations and feedback associated with pelvic floor assessment allows students to gain valuable practical experience in a controlled environment. This immersive approach to learning fosters greater understanding and retention of complex concepts related to women's health and pelvic floor dysfunction.

The based Arduino female pelvis has a significant potential to improve students pelvic muscle examination training. Thus, critical thinking and problem-solving skills can be stimulated while performing clinical practice promoting a deeper understanding of women's health. Through the theory and practice integration in simulated training, the based Arduino female pelvis enhances the overall educational experience for undergraduate healthcare students who will make a meaningful difference in the lives of women´s health.

Brink CA, Sampselle CM, Wells TJ, Diokno AC, Gillis GL. A digital test for pelvic muscle strength in older women with urinary incontinence. Nurs Res. 1989 Jul-Aug;38(4):196-9. PMID: 2748352.
Pendergrass, P. B., Reeves, C. A., Belovicz, M. W., Molter, D. J., & White, J. H. (1996). The shape and dimensions of the human vagina as seen in three-dimensional vinyl polysiloxane casts. Gynecologic and obstetric investigation, 42(3), 178–182. https://doi.org/10.1159/000291946.