Three Canadian urogynecologists are among the 16 lead authors of the first global International Urogynecological Association (IUGA) guideline on obstetric anal sphincter injuries (OASIs): Dr. Maria Giroux (University of Saskatchewan), Dr. May Alarab (University of Toronto), and Dr. Geoffrey Cundiff (University of British Columbia). Led by Mr. Abdul Sultan and published in the International Urogynecology Journal in July 2026, the guideline addresses prevention, diagnosis, repair, complications and follow-up across diverse healthcare settings.
The Society of Obstetricians and Gynaecologists of Canada (SOGC) has updated the OASIs care guidelines. Dr. Dobrochna Globerman (University of Manitoba) is the lead author of Part I: Prevention, Recognition, and Immediate Management (No. 457, December 2024). Dr. Maria Giroux (University of Saskatchewan) is the lead author of Part II: Long-Term Management and Counselling Regarding Subsequent Mode of Delivery (No. 465, January 2026). Canadian co-authors of both parts include Dr. Dante Pascali (University of Ottawa), Dr. Alison Carter Ramirez (University of Calgary), Dr. Maryse Larouche (University of British Columbia), and a pelvic health physiotherapist Dr. Sinéad Dufour (McMaster University).
Part I provides practical recommendations on perineal protection, diagnosis, primary repair and immediate postpartum management, supporting prevention, prompt recognition and early recovery. Part II focuses on long-term recovery through dedicated follow-up clinics, pelvic health physiotherapy, assessment of anal sphincter complex structure and function using endoanal ultrasound and anorectal manometry, and counselling regarding mode of subsequent delivery. The IUGA guideline also incorporates the Canadian algorithms developed for SOGC Part II to support individualized counselling and shared decision-making about future births in centres with and without access to specialized investigations.
CSPM members can apply this guidance to local assessment, referral and follow-up, keeping women’s bowel function, pain, sexual health, and emotional wellbeing central to individualized care.
Understanding Postpartum Dyspareunia After OASIs: MSc Research Presented at IPPS
Postpartum dyspareunia can affect intimacy, emotional wellbeing, and quality of life. At the 29th International Pelvic Pain Society (IPPS) Annual Scientific Meeting in Rochester, Minnesota, in October 2026, CSPM member Dr. Maria Giroux presented her MSc dissertation research examining the role of pelvic health physiotherapy in its management, with a particular focus on women following obstetric anal sphincter injuries (OASIs).
Dr. Giroux, a urogynecologist and Clinical Assistant Professor at the University of Saskatchewan, graduated with an MSc in Pain Management from Cardiff University (Cardiff, UK). She completed her dissertation under the supervision of Sharon E. Norman.
The evidence-based review included 15 studies involving 1,452 women. Pelvic health physiotherapy demonstrated potential benefit for some women, particularly those with pelvic floor hypertonicity or scar tissue tenderness. However, treatment protocols and outcome measures varied, improvements in sexual function were inconsistent, and women with OASIs were underrepresented. These findings highlight the need for individualized assessment and stronger evidence to determine which physiotherapy approaches are most helpful for different pain phenotypes after OASIs.
The dissertation informed a proposal for a randomized controlled trial evaluating a multidisciplinary Persistent Postpartum Pain pathway incorporating pelvic health physiotherapy for women following OASIs. The proposed approach would tailor treatment to each woman’s pain phenotype while addressing the physical, psychological, and social dimensions of persistent postpartum pain.
Beyond Six Weeks Postpartum: A Canadian Contribution to Global Maternal Pelvic Health Advocacy
Pelvic floor disorders can emerge or persist months or years after childbirth, affecting women’s health, relationships, and quality of life. An international white paper calls for these lasting consequences to be recognized as a maternal health priority, with care extending beyond the traditional six-week postpartum period.
CSPM member Dr. Maria Giroux, a urogynecologist and Clinical Assistant Professor at the University of Saskatchewan, is a Canadian co-author of Chronic Maternal Pelvic Morbidity: A Neglected Tragedy, published in the International Urogynecology Journal in 2026. Led by Dr. Aparna Hegde, the paper was developed by eight international authors on behalf of the Foundation for International Urogynecological Assistance (FIUGA) Board.
The paper addresses pelvic organ prolapse, urinary and fecal incontinence, perineal trauma and sexual dysfunction. It examines how stigma, limited awareness and fragmented services can leave these conditions unrecognized or untreated, with lasting consequences for women’s quality of life.
The authors call for prevention, screening, timely referral and treatment to be integrated into existing maternal and reproductive health programs. Priorities include training healthcare providers, improving access to affordable services, strengthening research and measuring chronic maternal morbidity more consistently.
The publication supports the global call to action championed by the International Urogynecological Association (IUGA) and FIUGA. For CSPM members, it connects clinical practice with advocacy for accessible, coordinated services that support women’s long-term pelvic health.
Canadian Leadership in Mode of Subsequent Delivery After OASIs
Planning another delivery after an obstetric anal sphincter injury (OASI) can raise concerns about recurrent OASI, anorectal symptoms, and long-term pelvic health. A clinical opinion from the International Urogynecological Association (IUGA) offers a structured approach to counselling that places women’s clinical needs and preferences at the centre of birth planning.
Dr. May Alarab (University of Toronto) is the lead author of Mode of Subsequent Delivery After Obstetric Anal Sphincter Injuries (OASIs), published in the International Urogynecology Journal in 2026. Dr. Maria Giroux (University of Saskatchewan) is the paper’s other Canadian co-author. Developed through IUGA’s Innovation, Research, and Development Committee, the paper addresses a central clinical challenge: supporting informed decisions about mode of subsequent delivery when high-quality evidence remains limited. For CSPM members, the paper offers a practical resource for assessment and counselling, helping translate clinical findings into birth plans that reflect each woman’s individualized priorities.
