Hypothesis / aims of study
Introduction
Urogynecology, a subspecialty addressing pelvic floor disorders (PFDs) such as urinary incontinence, pelvic organ prolapse, and fecal incontinence, is gaining recognition worldwide. However, in India, awareness and structured training opportunities in this field remain limited among healthcare professionals (HCPs)
Aims and Objectives
This study aims to evaluate the current level of awareness, knowledge, and perception of urogynecology among healthcare professionals in India. Specific objectives include:
1. To assess familiarity with urogynecology and confidence in managing pelvic floor disorders across various healthcare roles.
2. To identify the frequency and context in which HCPs encounter PFD cases in clinical practice.
3. To explore perceived barriers in the diagnosis, referral, and treatment of PFDs.
4. To analyze training preferences and awareness of existing urogynecology programs.
5. To identify priority areas for research and opportunities for educational enhancement in urogynecology.
Study design, materials and methods
Methods
A cross-sectional survey was conducted among 370 healthcare professionals, including gynecologists, urologists, urogynecologists, physicians, and general surgeons. Participant distribution was: 153 gynecologists, 29 urologists, 18 urogynecologists, 123 physicians, and 47 surgeons. Respondents rated their confidence in managing pelvic organ prolapse, stress urinary incontinence, overactive bladder, and fecal incontinence using a 5-point Likert scale. An average confidence score was computed, and participants were categorized as “Confident” (≥3.5) or “Not Confident” (<3.5). Chi-square tests were used to assess differences by role.
Results
1. Quantitative Findings
- Profession-wise Distribution: Among 370 respondents, gynecologists formed the largest group (41.4%), followed by physicians (33.2%), surgeons (12.7%), urologists (7.8%), and urogynecologists (4.9%).
- Awareness Levels: 62% were “very familiar” and 29% “somewhat familiar” with urogynecology. Awareness significantly varied by role (χ² = 320.54, p < 0.001), with specialists more familiar than generalists.
- Confidence in Managing PFDs: The average score was 3.1/5. Specialists averaged 3.8/5, while non-specialists scored 2.7/5 (χ² = 210.87, p < 0.001). Gynecologists had only 11 confident vs. 142 not; urologists had 16 confident vs. 13 not; 16 of 18 urogynecologists were confident (χ² = 84.06, p < 0.001).
- Clinical Exposure: 45% of respondents encountered over 20 PFD cases annually. Exposure was significantly higher among specialists (χ² = 185.62, p < 0.001).
2. Perceived Barriers, Preferences, and Research Needs
- Barriers to Care: Lack of patient awareness (66%), limited access to urogynecology specialists (58%), and poor referral pathways (45%) were the most common barriers.
- Training Preferences & Referral Patterns: 75% preferred hands-on training. Higher awareness was strongly associated with appropriate referral practices (χ² = 198.41, p < 0.001).
- Research Priorities: Participants prioritized research on PFD epidemiology, cultural factors, and cost barriers. 92% advocated for curricular integration of urogynecology at both undergraduate and postgraduate levels.
Interpretation of results
The findings underscore significant gaps in urogynecology awareness and confidence, particularly among non-specialists such as physicians and surgeons. Clinical exposure was a strong predictor of confidence, reinforcing the value of hands-on training. Patient-level and systemic barriers, including limited specialist access and referral ambiguity, require institutional and policy-level attention. The results reflect readiness among professionals for education reform and support the integration of urogynecology into mainstream medical training in India.