This proposal seeks to improve care for the women who suffer the priority health conditions of pelvic floor dysfunction; problems that arise due to women's unique role in giving birth. It addresses the sex disparities that exist in these problems. Each year 3 million women deliver babies and 300,000 women need surgery for pelvic floor dysfunction. A lack of basic understanding of the mechanisms of birth-related injury and recovery during reproductive years and mechanisms of prolapse later in life block efforts to prevent damage, improve recovery, or improve treatment. We seek continued support for a broadly interdisciplinary group of researchers from 4 schools and 2 institutes to that has expedited development of new knowledge needed to improve treatment and prevention. Project 1: 'Birth Biomechanics' will test hypotheses concerning basic mechanisms of pelvic floor injury during vaginal birth; the single largest factor in causing pelvic floor dysfunction to identify specific situations may increase or decrease injury risk. Project 2: 'Injury Recovery' will identify risk factors associated with levator injury, test the hypothesis that these injuries are, in fact, related to vaginal delivery and determine early predictors of eventual recovery. Project 3, 'Mechanisms of Posterior Vaginal Prolapse' will use advanced imaging and deformation analysis to test hypotheses concerning the basic disease mechanisms responsible for posterior vaginal wall prolapse, one of the most common and strongly birth-associated pelvic floor dysfunction. Core A: Administrative / Human Subjects / Biostatistics core provides project support by recruiting subjects, compiling and analyzing data and protecting subject safety. In Core A, two study groups will be formed concerning 1) Gender Impact and 2) Basic Science Futures to discuss expanding the issues raised by this research. Core B: Measurement and Imaging core will provide technical support for the projects along with integrated analysis for 2 and 3 dimensional spatial data gathered across projects. This research will produce insights to address the women's health problem of pelvic floor dysfunction
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