My main areas of research are related to pelvic floor dysfunction and in particular sexual function, female urinary incontinence and pelvic organ prolapse.

3.1.1 Sexual Function in Urogynaecology

3.1.1.1 MD Thesis: Association between urinary incontinence and sexual function in women. This thesis aimed to analyse the association between urinary incontinence and sexual function in women. The impact of different treatment modalities for urinary incontinence and their effect on sexual function was measured. The prevalence of sexual dysfunction is greater in women with pelvic floor disorders and the various interventions for urinary incontinence have a variable impact and this was presented in my thesis.
(http://etheses.whiterose.ac.uk/18525/1/MD%20with%20Appendix.pdf).

3.1.1.2 Because of my expertise in sexual medicine, I was invited by IUGA to lead one of the 5 UK sites that validated an international instrument for use in assessing sexual function in women with pelvic floor dysfunction (PISQ-IR).
(A new measure of sexual function in women with pelvic floor disorders (PFD): the Pelvic Organ Prolapse/Incontinence Sexual Questionnaire, IUGA-Revised (PISQ-IR). Int Urogynecol J. 2013;24:1091-1103)

3.1.2 Pelvic Floor Muscle Tone

3.1.2.1 Chief Investigator: RCT on physiotherapy with and without electrical stimulation for improving pelvic floor muscle tone (IPSU trial) (RfPB funded).
This study demonstrated no difference in electrical stimulation and standard physiotherapy for women with urinary incontinence and sexual dysfunction. This was in collaboration with the University of Sheffield (ScHARR)
(Impact of pelvic floor muscle training on sexual function of women with UI and a comparison of electrical stimulation versus standard treatment (IPSU trial): a randomised controlled trial. Physiotherapy. 2018;104:91-97)

3.1.2.2 Following on from this and in collaboration with the Auckland Engineering institute, I looked at pelvic floor muscle stiffness using vaginal elastometer in attendees of a postnatal perineal trauma clinic. I investigated the association of pelvic floor muscle stiffness values to demographics, labour characteristics, mode of vaginal delivery, clinical features and evidence of Levator Ani damage on MRI. This received Grant funding from INSIGNEO, University of Sheffield (Postnatal pelvic floor muscle stiffness measured by vaginal elastometry in women with obstetric anal sphincter injury: a pilot study. Int Urogynecol J. 2019 Dec 4).

3.1.2.3 Also, in collaboration with the Auckland Institute, I am currently investigating the changes in pelvic floor muscle pressure profile before and after pelvic organ prolapse surgery using the Intravaginal pressure sensor device (IVPSD). This has received
Grant funding from UKCS.

3.1.2.4 I have also analysed the Pelvic floor muscle tone in pregnancy using the IVPSD device. This study was commenced as a BMedSci project and has now recently concluded.

3.1.3 National Prolapse Surveys
Conducted three national UK surveys on prolapse management (2007, 2011, 2018).
Survey data has informed changes in surgical trends in the surgical management of pelvic organ prolapse (POP). It has also allowed major understanding into the use of mesh for both vaginal and abdominal surgery and the application of laparoscopic procedures for managing prolapse.

This is the most robust epidemiological data till date on the use of mesh for vaginal prolapse. These papers have a joint citation index of over 170: (National survey on the management of prolapse in the UK. Neurourol Urodyn.2007;26:325-331

The UK national prolapse survey: 5 years on. Int Urogyneco J. 2011;22:517-52
The UK National Prolapse Survey: 10 years on. Int Urogynecol J. 2018;29:795-801)
This survey has subsequently been used and repeated in other countries including Australia.

3.1.4 Cost Effectiveness of antibiotic usage for UTIs
In collaboration with ScHARR I undertook a study into the cost-effectiveness of the four
antibiotics currently recommended in England for treatment of uncomplicated UTI in adult
women.
A decision tree economic model of treatment for women over the age of 18 with signs and
symptoms of uncomplicated UTI in primary care treatment in England was undertaken.
This demonstrated that Trimethoprim is likely to be the most cost-effective first-line
treatment for uncomplicated UTI in women but where there is resistance a single 3g dose
of fosfomycin is likely to be the most cost-effective option for empirical treatment.
(Cost-effectiveness of antibiotic treatment of uncomplicated urinary tract infection in
women: a comparison of four antibiotics. BJGP Open. 2017 Oct 4;1[3])

3.1.5 Patient Decision Aids (PDA)

3.1.5.1 Developed tools (PDA) for shared decision-making in stress urinary incontinence
surgery.
I led the study and established the clinical utility of PDA. This tool facilitates a shared
decision-making allowing patients to make decisions about their healthcare that takes
into account their personal values and preferences.
(Utility of patient decision aids (PDA) in stress urinary incontinence surgery. Int
Urogynecol J.2019. 30 (9).1483-1486 )

3.1.5.2 Later, I co-authored the NICE PDA for stress urinary incontinence surgery on behalf of
BSUG. I have investigated how these function in clinical practice and patient
satisfaction to their use and have undertaken both qualitative and quantitative research
assessing their utility in practice using the research tool version of the Decision Conflict
scale.
(https://www.nice.org.uk/guidance/ng123/resources/surgery-for-stress-urinaryincontinence-
patient-decision-aid-pdf-6725286110)
This research was Awarded the Lindsay Stewart Memorial Award by the RCOG.

3.1.6 Vaginal Laser therapy in Breast Cancer patients
In collaboration with the UoS (collaborator Professor Lynda Wyld) I conducted a
Systematic Review and Meta-analysis of the impact of vaginal laser therapy in breast
cancer women where oestrogen is contraindicated
This is one of the studies used by NICE in their IPG on the use of vaginal laser for GSM.
(The impact of vaginal laser treatment for genitourinary syndrome of menopause in breast
cancer survivors: a systematic review and meta-analysis. Clinical Breast Cancer. 2019.
Vol. 19, No. 4, e556- 62.)