xml: <clinical_study>
    <!-- This xml conforms to an XML Schema at:
      https://clinicaltrials.gov/ct2/html/images/info/public.xsd -->
    <required_header>
      <download_date>ClinicalTrials.gov processed this data on September 20, 2023</download_date>
      <link_text>Link to the current ClinicalTrials.gov record.</link_text>
      <url>https://clinicaltrials.gov/ct2/show/NCT06014021</url>
    </required_header>
    <id_info>
      <org_study_id>124CER19_</org_study_id>
      <nct_id>NCT06014021</nct_id>
    </id_info>
    <brief_title>Tele-rehabilitation for Female Athletes With Pelvic Floor Dysfunctions</brief_title>
    <acronym>ACTITUD2</acronym>
    <official_title>Treatment of Urinary Incontinence and Other Pelvic Floor Dysfunctions in Female Athletes</official_title>
    <sponsors>
      <lead_sponsor>
        <agency>University of the Balearic Islands</agency>
        <agency_class>Other</agency_class>
      </lead_sponsor>
      <collaborator>
        <agency>Fundació d'investigació Sanitària de les Illes Balears</agency>
        <agency_class>Other</agency_class>
      </collaborator>
      <collaborator>
        <agency>Consejo Superior de Deportes</agency>
        <agency_class>Other</agency_class>
      </collaborator>
    </sponsors>
    <source>University of the Balearic Islands</source>
    <oversight_info>
      <has_dmc>No</has_dmc>
      <is_fda_regulated_drug>No</is_fda_regulated_drug>
      <is_fda_regulated_device>No</is_fda_regulated_device>
    </oversight_info>
    <brief_summary>
      <textblock>
        Pelvic floor dysfunctions (PFD) are especially prevalent among females. As conservative&#xD;
        management, strengthening pelvic floor (PF) musculature under health supervision, regard an&#xD;
        important research line. However, embarrassment of female athletes limits healthcare demands.&#xD;
        New technologies could facilitate an autonomous but supervised tele-rehabilitation programs.&#xD;
  &#xD;
        This study will evaluate the effects of a 6-weeks strengthening PF program by using&#xD;
        tele-rehabilitation, with or without intracavitary biofeedback, in the PF anatomo-functional&#xD;
        characteristics, quality of life and sports performance of female athletes with PFD.&#xD;
  &#xD;
        To this end, 45 female athletes with self-reported PFD who train and compete in athletic in&#xD;
        Spain will be recruited and randomly distributed in three groups of the experimental study.&#xD;
        During 6 weeks, all participants will use an specifically developed Smartphone application&#xD;
        (named ACTITUD): the control group (CG) will have access to information about PF and direct&#xD;
        communication with healthcare team; experimental group 1 (EG1) will have access to the same&#xD;
        information and communication, and will perform a strengthening program for PF, which will be&#xD;
        instructed by 3D avatars, while using an intracavitary biofeedback device that will inform&#xD;
        about vaginal pressure; the experimental group 2 (EG2) will be similar to EG1, but they will&#xD;
        not use the intracavitary biofeedback device.&#xD;
  &#xD;
        Before and after these 6 weeks, anatomo-functional PF characteristics, quality of life, PFD&#xD;
        symptoms and sports performance of all participants will be evaluated. As an additional&#xD;
        outcome, the level of engagement of the athletes from experimental groups to complete the&#xD;
        training program will be registered.&#xD;
      </textblock>
    </brief_summary>
    <detailed_description>
      <textblock>
        Female athletes from EG1 and EG2 will complete the strengthening program for PF three times&#xD;
        per week, during six weeks. Each session will last about 20 minutes and exercises will be&#xD;
        modified every two weeks to meet the principle of training progression and avoid athletes&#xD;
        become bored.&#xD;
      </textblock>
    </detailed_description>
    <overall_status>Not yet recruiting</overall_status>
    <start_date type="Anticipated">September 15, 2023</start_date>
    <completion_date type="Anticipated">November 20, 2023</completion_date>
    <primary_completion_date type="Anticipated">October 5, 2023</primary_completion_date>
    <phase>N/A</phase>
    <study_type>Interventional</study_type>
    <has_expanded_access>No</has_expanded_access>
    <study_design_info>
      <allocation>Randomized</allocation>
      <intervention_model>Parallel Assignment</intervention_model>
      <primary_purpose>Treatment</primary_purpose>
      <masking>Double (Investigator, Outcomes Assessor)</masking>
      <masking_description>The design of this study does not allow to mask participants or care providers. Investigators or outcomes assessors will not know which group athletes belong.</masking_description>
    </study_design_info>
    <primary_outcome>
      <measure>Functional characteristics of pelvic floor musculature with perineometer</measure>
      <time_frame>6 weeks</time_frame>
      <description>Change in the maximal voluntary contraction (MVC) according to the values of pressure collected by a perineometer (in mmHg) after the intervention period and compared to the athletes from the rest of groups. To assess it, participants will perform a maximal contraction of pelvic floor musculature during 3 seconds (three trials with 60 seconds apart). The best trial (the highest pressure) will be collected, as well as the rest vaginal pressure before the first trial of MVC.</description>
    </primary_outcome>
    <primary_outcome>
      <measure>Anatomical characteristics of pelvic floor structures with ultrasound I</measure>
      <time_frame>6 weeks</time_frame>
      <description>Change in the levator hiatus length (in mm) after the intervention period and compared to the athletes from the rest of groups. This variable will be assessed by using transperineal approach with transducer in longitudinal orientation, at three different functional situations: at rest, while participants perform a maximal voluntary contraction (MVC) of the pelvic floor musculature, and also at straining.</description>
    </primary_outcome>
    <primary_outcome>
      <measure>Anatomical characteristics of pelvic floor structures with ultrasound II</measure>
      <time_frame>6 weeks</time_frame>
      <description>Change in the anorectal angle (in degrees) and pubourethral angle (in degrees) after the intervention period and compared to the athletes from the rest of groups. These variables will be assessed by using transperineal approach with transducer in longitudinal orientation, at three different functional situations: at rest, while participants perform a maximal voluntary contraction (MVC) of the pelvic floor musculature, and also at straining.</description>
    </primary_outcome>
    <primary_outcome>
      <measure>Anatomical characteristics of pelvic floor structures with ultrasound III</measure>
      <time_frame>6 weeks</time_frame>
      <description>Change in the symmetry of the bladder base (in mm) at rest and bladder base displacement (in mm) while participants perform a MVC of the pelvic floor musculature (PFM) and also during straining, after the intervention period and compared to the athletes from the rest of groups. These variables will be assessed by using a transabdominal approach with transducer, in transverse orientation.</description>
    </primary_outcome>
    <primary_outcome>
      <measure>Sports performance through maximal vertical jump</measure>
      <time_frame>6 weeks</time_frame>
      <description>Change in the maximal height that athletes reach with a vertical jump (in meters) after the intervention period and compared to the athletes from the rest of groups. To assess it, participants will perform a maximal countermovement jump (three trials with 30 seconds apart). It will be collected the average of the three trials.</description>
    </primary_outcome>
    <primary_outcome>
      <measure>Presence of pelvic floor disorders symptomatology</measure>
      <time_frame>6 weeks</time_frame>
      <description>Change in self-reported PFD symptoms through the PFD-SENTINEL questionnaire, after the intervention period and compared to the athletes from the rest of groups. To this end, athletes will reply the proposed PFD-SENTINEL tool consisting of 5 symptoms (urinary incontinence, anal incontinence, pelvic pain, pelvic organ prolapse, and overactive bladder syndrome) and 28 items. The responses to each item are categorized in yes or no. One point will be assigned for the affirmative response to each item. It will be considered the symptom score (presence or not of PFD symptoms),and total score (from 0 to 28 points).</description>
    </primary_outcome>
    <primary_outcome>
      <measure>Frequency of pelvic floor disorders symptomatology</measure>
      <time_frame>6 weeks</time_frame>
      <description>In case of affirmative response to the presence of one or more PFD symptoms, it will be explore the frequency of the existing symptom. The responses will be graded on a 4-point scale indicating how often women have each symptom (1 = rarely, 2 = sometimes, 3 = often, and 4 = always). It will be explored the change after the intervention period and compared to the athletes from the rest of groups.</description>
    </primary_outcome>
    <primary_outcome>
      <measure>Sexual dysfunction symptomatology</measure>
      <time_frame>6 weeks</time_frame>
      <description>Change in self-reported sexual dysfunction symptoms through The Female Sexual Function Index (FSFI), after the intervention period and compared to the athletes from the rest of groups. This scale consists of 19 items that assess sexual function over the past 4 weeks and yield domain scores in six areas: sexual desire, arousal, lubrication, orgasm, satisfaction, and pain. The responses to each item are graded as follows: 1 = never or very low, 2 = rarely or low, 3 = sometimes or moderate, 4 = often or high, 5 = always or very high. It will be consider individual score for each area (max 6 points) and total score (max 36 points).</description>
    </primary_outcome>
    <primary_outcome>
      <measure>Level of quality of life</measure>
      <time_frame>6 weeks</time_frame>
      <description>It will be explore the change in quality of life due to the pelvic floor disorders symptoms (according to a scale from 0, no affection, to 10, maximal affection) after the intervention period and compared to the athletes from the rest of groups.</description>
    </primary_outcome>
    <secondary_outcome>
      <measure>Engagement to training program</measure>
      <time_frame>6 weeks</time_frame>
      <description>Percentage of training program sessions that athletes from experimental groups completed during the six weeks of intervention, according to the number of proposed sessions (three times per week).</description>
    </secondary_outcome>
    <number_of_arms>3</number_of_arms>
    <enrollment type="Anticipated">45</enrollment>
    <condition>Pelvic Floor Disorders</condition>
    <arm_group>
      <arm_group_label>Experimental group 1</arm_group_label>
      <arm_group_type>Experimental</arm_group_type>
      <description>All participants will use an Smartphone application with access to information about pelvic floor and communication with healthcare team, and a strengthening program for PF, while using an intracavitary biofeedback device.</description>
    </arm_group>
    <arm_group>
      <arm_group_label>Experimental group 2</arm_group_label>
      <arm_group_type>Active Comparator</arm_group_type>
      <description>All participants will use an Smartphone application with access to information about pelvic floor and communication with healthcare team, and a strengthening program for PF.</description>
    </arm_group>
    <arm_group>
      <arm_group_label>Control group</arm_group_label>
      <arm_group_type>Active Comparator</arm_group_type>
      <description>All participants will use an Smartphone application with access to information about pelvic floor and communication with healthcare team.</description>
    </arm_group>
    <intervention>
      <intervention_type>Behavioral</intervention_type>
      <intervention_name>Pelvic floor muscle training with biofeedback device</intervention_name>
      <description>Use of the Smartphone application to perform a strengthening program for pelvic floor musculature, while using an intracavitary biofeedback device that will inform about vaginal pressure.</description>
      <arm_group_label>Experimental group 1</arm_group_label>
    </intervention>
    <intervention>
      <intervention_type>Behavioral</intervention_type>
      <intervention_name>Pelvic floor muscle training</intervention_name>
      <description>Use of the Smartphone application to perform a strengthening program for pelvic floor musculature.</description>
      <arm_group_label>Experimental group 2</arm_group_label>
    </intervention>
    <intervention>
      <intervention_type>Behavioral</intervention_type>
      <intervention_name>Information about pelvic floor and communication with health professionals</intervention_name>
      <description>Use of the Smartphone application with access to information about pelvic floor and direct communication with healthcare team.</description>
      <arm_group_label>Control group</arm_group_label>
      <arm_group_label>Experimental group 1</arm_group_label>
      <arm_group_label>Experimental group 2</arm_group_label>
    </intervention>
    <eligibility>
      <criteria>
        <textblock>
          Inclusion Criteria:&#xD;
  &#xD;
            -  To train and compete in any of the Track and Field modalities&#xD;
  &#xD;
            -  To have sports license from regional or national Track and Field Federation in the&#xD;
               season when study starts.&#xD;
  &#xD;
            -  To have a self-reported pelvic floor disorder (urinary incontinence, fecal&#xD;
               incontinence, sexual dysfunction or pelvic organ prolapse).&#xD;
  &#xD;
          Exclusion Criteria:&#xD;
  &#xD;
            -  To have pelvic pain during the last three months.&#xD;
  &#xD;
            -  To have recurrent infections of urinary tract during the last three months.&#xD;
  &#xD;
            -  To be receiving physiotherapy treatment due to any pelvic floor disorder at the moment&#xD;
               of the start of the study.&#xD;
  &#xD;
            -  To have been pregnant during the year prior to the start of the study.&#xD;
        </textblock>
      </criteria>
      <gender>Female</gender>
      <minimum_age>18 Years</minimum_age>
      <maximum_age>45 Years</maximum_age>
      <healthy_volunteers>No</healthy_volunteers>
    </eligibility>
    <overall_official>
      <last_name>Natalia Romero-Franco</last_name>
      <role>Principal Investigator</role>
      <affiliation>University of the Balearic Islands</affiliation>
    </overall_official>
    <overall_contact>
      <last_name>Natalia Romero-Franco, PhD</last_name>
      <phone>971172916</phone>
      <phone_ext>2916</phone_ext>
      <email>natalia.romero@uib.es</email>
    </overall_contact>
    <overall_contact_backup>
      <last_name>Juan Carlos Fernández-Domínguez, PhD</last_name>
      <phone>971259513</phone>
      <phone_ext>9513</phone_ext>
      <email>jcarlos.fernandez@uib.es</email>
    </overall_contact_backup>
    <location>
      <facility>
        <name>University of the Balearic Islands</name>
        <address>
          <city>Palma De Mallorca</city>
          <state>Balearic Islands</state>
          <zip>07122</zip>
          <country>Spain</country>
        </address>
      </facility>
    </location>
    <location_countries>
      <country>Spain</country>
    </location_countries>
    <results_reference>
      <citation>Rodriguez-Lopez ES, Acevedo-Gomez MB, Romero-Franco N, Basas-Garcia A, Ramirez-Parenteau C, Calvo-Moreno SO, Fernandez-Dominguez JC. Urinary Incontinence Among Elite Track and Field Athletes According to Their Event Specialization: A Cross-Sectional Study. Sports Med Open. 2022 Jun 15;8(1):78. doi: 10.1186/s40798-022-00468-1.</citation>
      <PMID>35704136</PMID>
    </results_reference>
    <results_reference>
      <citation>Romero-Franco N, Molina-Mula J, Bosch-Donate E, Casado A. Therapeutic exercise to improve pelvic floor muscle function in a female sporting population: a systematic review and meta-analysis. Physiotherapy. 2021 Dec;113:44-52. doi: 10.1016/j.physio.2021.04.006. Epub 2021 Apr 29.</citation>
      <PMID>34555673</PMID>
    </results_reference>
    <verification_date>August 2023</verification_date>
    <study_first_submitted>August 22, 2023</study_first_submitted>
    <study_first_submitted_qc>August 22, 2023</study_first_submitted_qc>
    <study_first_posted type="Actual">August 28, 2023</study_first_posted>
    <last_update_submitted>August 29, 2023</last_update_submitted>
    <last_update_submitted_qc>August 29, 2023</last_update_submitted_qc>
    <last_update_posted type="Actual">September 1, 2023</last_update_posted>
    <responsible_party>
      <responsible_party_type>Sponsor</responsible_party_type>
    </responsible_party>
    <keyword>Female</keyword>
    <keyword>Athletes</keyword>
    <keyword>Track and Field</keyword>
    <keyword>Tele-rehabilitation</keyword>
    <keyword>Strengthening</keyword>
    <condition_browse>
      <!-- CAUTION:  The following MeSH terms are assigned with an imperfect algorithm            -->
      <mesh_term>Pelvic Floor Disorders</mesh_term>
    </condition_browse>
    <patient_data>
      <sharing_ipd>No</sharing_ipd>
    </patient_data>
    <!-- Results have not yet been posted for this study                                          -->
  </clinical_study>
  
  
text: download date: ClinicalTrials.gov processed this data on September 20, 2023
  link text: Link to the current ClinicalTrials.gov record.
  url: https://clinicaltrials.gov/ct2/show/NCT06014021
  org study id: 124CER19_
  nct id: NCT06014021
  lead sponsor: 
  collaborator: 
  collaborator: 
  has dmc: No
  is fda regulated drug: No
  is fda regulated device: No
  Pelvic floor dysfunctions (PFD) are especially prevalent among females. As conservative
        management, strengthening pelvic floor (PF) musculature under health supervision, regard an
        important research line. However, embarrassment of female athletes limits healthcare demands.
        New technologies could facilitate an autonomous but supervised tele-rehabilitation programs.
  
        This study will evaluate the effects of a 6-weeks strengthening PF program by using
        tele-rehabilitation, with or without intracavitary biofeedback, in the PF anatomo-functional
        characteristics, quality of life and sports performance of female athletes with PFD.
  
        To this end, 45 female athletes with self-reported PFD who train and compete in athletic in
        Spain will be recruited and randomly distributed in three groups of the experimental study.
        During 6 weeks, all participants will use an specifically developed Smartphone application
        (named ACTITUD): the control group (CG) will have access to information about PF and direct
        communication with healthcare team; experimental group 1 (EG1) will have access to the same
        information and communication, and will perform a strengthening program for PF, which will be
        instructed by 3D avatars, while using an intracavitary biofeedback device that will inform
        about vaginal pressure; the experimental group 2 (EG2) will be similar to EG1, but they will
        not use the intracavitary biofeedback device.
  
        Before and after these 6 weeks, anatomo-functional PF characteristics, quality of life, PFD
        symptoms and sports performance of all participants will be evaluated. As an additional
        outcome, the level of engagement of the athletes from experimental groups to complete the
        training program will be registered.
  Female athletes from EG1 and EG2 will complete the strengthening program for PF three times
        per week, during six weeks. Each session will last about 20 minutes and exercises will be
        modified every two weeks to meet the principle of training progression and avoid athletes
        become bored.
  allocation: Randomized
  intervention model: Parallel Assignment
  primary purpose: Treatment
  masking: Double (Investigator, Outcomes Assessor)
  masking description: The design of this study does not allow to mask participants or care providers. Investigators or outcomes assessors will not know which group athletes belong.
  measure: Functional characteristics of pelvic floor musculature with perineometer
  time frame: 6 weeks
  description: Change in the maximal voluntary contraction (MVC) according to the values of pressure collected by a perineometer (in mmHg) after the intervention period and compared to the athletes from the rest of groups. To assess it, participants will perform a maximal contraction of pelvic floor musculature during 3 seconds (three trials with 60 seconds apart). The best trial (the highest pressure) will be collected, as well as the rest vaginal pressure before the first trial of MVC.
  measure: Anatomical characteristics of pelvic floor structures with ultrasound I
  time frame: 6 weeks
  description: Change in the levator hiatus length (in mm) after the intervention period and compared to the athletes from the rest of groups. This variable will be assessed by using transperineal approach with transducer in longitudinal orientation, at three different functional situations: at rest, while participants perform a maximal voluntary contraction (MVC) of the pelvic floor musculature, and also at straining.
  measure: Anatomical characteristics of pelvic floor structures with ultrasound II
  time frame: 6 weeks
  description: Change in the anorectal angle (in degrees) and pubourethral angle (in degrees) after the intervention period and compared to the athletes from the rest of groups. These variables will be assessed by using transperineal approach with transducer in longitudinal orientation, at three different functional situations: at rest, while participants perform a maximal voluntary contraction (MVC) of the pelvic floor musculature, and also at straining.
  measure: Anatomical characteristics of pelvic floor structures with ultrasound III
  time frame: 6 weeks
  description: Change in the symmetry of the bladder base (in mm) at rest and bladder base displacement (in mm) while participants perform a MVC of the pelvic floor musculature (PFM) and also during straining, after the intervention period and compared to the athletes from the rest of groups. These variables will be assessed by using a transabdominal approach with transducer, in transverse orientation.
  measure: Sports performance through maximal vertical jump
  time frame: 6 weeks
  description: Change in the maximal height that athletes reach with a vertical jump (in meters) after the intervention period and compared to the athletes from the rest of groups. To assess it, participants will perform a maximal countermovement jump (three trials with 30 seconds apart). It will be collected the average of the three trials.
  measure: Presence of pelvic floor disorders symptomatology
  time frame: 6 weeks
  description: Change in self-reported PFD symptoms through the PFD-SENTINEL questionnaire, after the intervention period and compared to the athletes from the rest of groups. To this end, athletes will reply the proposed PFD-SENTINEL tool consisting of 5 symptoms (urinary incontinence, anal incontinence, pelvic pain, pelvic organ prolapse, and overactive bladder syndrome) and 28 items. The responses to each item are categorized in yes or no. One point will be assigned for the affirmative response to each item. It will be considered the symptom score (presence or not of PFD symptoms),and total score (from 0 to 28 points).
  measure: Frequency of pelvic floor disorders symptomatology
  time frame: 6 weeks
  description: In case of affirmative response to the presence of one or more PFD symptoms, it will be explore the frequency of the existing symptom. The responses will be graded on a 4-point scale indicating how often women have each symptom (1 = rarely, 2 = sometimes, 3 = often, and 4 = always). It will be explored the change after the intervention period and compared to the athletes from the rest of groups.
  measure: Sexual dysfunction symptomatology
  time frame: 6 weeks
  description: Change in self-reported sexual dysfunction symptoms through The Female Sexual Function Index (FSFI), after the intervention period and compared to the athletes from the rest of groups. This scale consists of 19 items that assess sexual function over the past 4 weeks and yield domain scores in six areas: sexual desire, arousal, lubrication, orgasm, satisfaction, and pain. The responses to each item are graded as follows: 1 = never or very low, 2 = rarely or low, 3 = sometimes or moderate, 4 = often or high, 5 = always or very high. It will be consider individual score for each area (max 6 points) and total score (max 36 points).
  measure: Level of quality of life
  time frame: 6 weeks
  description: It will be explore the change in quality of life due to the pelvic floor disorders symptoms (according to a scale from 0, no affection, to 10, maximal affection) after the intervention period and compared to the athletes from the rest of groups.
  measure: Engagement to training program
  time frame: 6 weeks
  description: Percentage of training program sessions that athletes from experimental groups completed during the six weeks of intervention, according to the number of proposed sessions (three times per week).
  arm group label: Experimental group 1
  arm group type: Experimental
  description: All participants will use an Smartphone application with access to information about pelvic floor and communication with healthcare team, and a strengthening program for PF, while using an intracavitary biofeedback device.
  arm group label: Experimental group 2
  arm group type: Active Comparator
  description: All participants will use an Smartphone application with access to information about pelvic floor and communication with healthcare team, and a strengthening program for PF.
  arm group label: Control group
  arm group type: Active Comparator
  description: All participants will use an Smartphone application with access to information about pelvic floor and communication with healthcare team.
  intervention type: Behavioral
  intervention name: Pelvic floor muscle training with biofeedback device
  description: Use of the Smartphone application to perform a strengthening program for pelvic floor musculature, while using an intracavitary biofeedback device that will inform about vaginal pressure.
  arm group label: Experimental group 1
  intervention type: Behavioral
  intervention name: Pelvic floor muscle training
  description: Use of the Smartphone application to perform a strengthening program for pelvic floor musculature.
  arm group label: Experimental group 2
  intervention type: Behavioral
  intervention name: Information about pelvic floor and communication with health professionals
  description: Use of the Smartphone application with access to information about pelvic floor and direct communication with healthcare team.
  arm group label: Control group
  arm group label: Experimental group 1
  arm group label: Experimental group 2
  criteria: 
  gender: Female
  minimum age: 18 Years
  maximum age: 45 Years
  healthy volunteers: No
  last name: Natalia Romero-Franco
  role: Principal Investigator
  affiliation: University of the Balearic Islands
  last name: Natalia Romero-Franco, PhD
  phone: 971172916
  phone ext: 2916
  email: natalia.romero@uib.es
  last name: Juan Carlos Fernández-Domínguez, PhD
  phone: 971259513
  phone ext: 9513
  email: jcarlos.fernandez@uib.es
  facility: 
  country: Spain
  citation: Rodriguez-Lopez ES, Acevedo-Gomez MB, Romero-Franco N, Basas-Garcia A, Ramirez-Parenteau C, Calvo-Moreno SO, Fernandez-Dominguez JC. Urinary Incontinence Among Elite Track and Field Athletes According to Their Event Specialization: A Cross-Sectional Study. Sports Med Open. 2022 Jun 15;8(1):78. doi: 10.1186/s40798-022-00468-1.
  PMID: 35704136
  citation: Romero-Franco N, Molina-Mula J, Bosch-Donate E, Casado A. Therapeutic exercise to improve pelvic floor muscle function in a female sporting population: a systematic review and meta-analysis. Physiotherapy. 2021 Dec;113:44-52. doi: 10.1016/j.physio.2021.04.006. Epub 2021 Apr 29.
  PMID: 34555673
  responsible party type: Sponsor
  mesh term: Pelvic Floor Disorders
  sharing ipd: No