Access to Pelvic Health Care in Rural Settings: Bridging Care Gaps
Authors: Rebecca Wytsma, B.Eng., Christine Goudie, Ph.D. (student)
Reviewed by: Crystal Northcott, N.P.
July 15, 2026
Access to pelvic health care should not be determined by geography. However, for individuals living in rural communities, it often does. A lack of pelvic health specialists in rural communities, paired with insufficient training opportunities for generalists, creates significant gaps in pelvic health care for rural patients.
Pelvic Floor Disorders – A Universal Issue
Pelvic floor disorders are common. Population-based studies estimate that nearly 1 in 4 individuals experience at least one pelvic floor disorder, including urinary incontinence, fecal incontinence, and pelvic organ prolapse (POP) [1][2]. By age 80, the lifetime risk of undergoing surgery for POP or urinary incontinence is approximately 20% of those who experience the condition [3]. Such POP conditions are prevalent, predictable, and often progressive.
Pelvic floor disorders do not spare rural populations – in fact, risk factors such as higher parity, limited postpartum follow-up, physically demanding work, and delayed specialist referral can worsen symptoms of pelvic floor disorders in rural patients. If specialized pelvic health care is not available in rural settings, certain conditions may be underscreened or underdiagnosed.
The Geography of Pelvic Health Care
In urban settings, patients experiencing pelvic health issues may have access to a variety of resources, including pelvic floor physiotherapists, urogynecologists, specialized imaging, and multidisciplinary pelvic health clinics. In rural and remote regions, those resources may be hours away, if they even exist at all.
Rural regions consistently have fewer specialists per capita compared to urban centres. In Canada, approximately 18% of the population lives in rural communities, yet only 8% of physicians practice there [4]. The Canadian Physiotherapy Association has specifically identified geographic barriers as a key driver of inequitable access to pelvic floor physiotherapy in Canada, calling on the federal government to prioritize policies that increase the availability of pelvic and perineal physiotherapy services in rural and remote communities [5].
A 2024 study that assessed the accessibility of pelvic health care for patients in Quebec found that less than 10% of the pelvic floor physiotherapists surveyed practiced in rural settings [6]. In Ontario, the provincial health authority has acknowledged that access to pelvic floor physiotherapists is unequal across the province and has recommended eHealth interventions specifically for patients where in-person care is not available or accessible [7] – a direct recognition of the rural access gap.
As a result, the burden of pelvic health care in rural communities frequently falls to generalists, such as family physicians, nurse practitioners, and general physiotherapists. Though these practitioners are highly skilled, not all of them will have received comprehensive hands-on pelvic health training during their education. Conditions like POP, stress urinary incontinence, and levator ani muscle avulsion require skilled assessment, often via palpation, a skill that cannot be learned from theory alone.
The Rural Training Reality
In large academic centres, trainees and practitioners benefit from supervised repetition, case variety, repeated exposure, and access to high-fidelity simulation labs. In rural practice, training resources may be limited. Without realistic training opportunities, assessment skills can be difficult to build and even harder to maintain in low-volume settings.
Research across multiple areas of healthcare has consistently demonstrated that simulation-based training improves procedural confidence and clinical performance, particularly when real-world exposure is limited. Anatomically accurate pelvic health models, especially when used in combination with virtual training courses, can:
- Allow rural clinicians to repeatedly practice pelvic health techniques, without having to travel to urban centers
- Build tactile familiarity with normal vs abnormal findings
- Increase confidence before assessing real patients
Evidence from randomised studies further supports the use of anatomical pelvic models as a teaching tool, demonstrating that model-based instruction can meaningfully enhance learners' assessment of pelvic floor musculature [8] [9]. Simulation tools enable repeated practice, anatomical familiarity, and refinement of skills, which can be translated directly into clinical care.
Supporting Patient Education
Anatomical models can also improve patient education in rural settings. By making internal anatomy and pelvic floor conditions easier to visualize, anatomical models help patients better understand their diagnosis and treatment options. Better patient education has been associated with greater confidence, improved engagement in care, and more informed decision-making. This is especially important in rural communities, where access to specialists and follow-up appointments may be limited, making effective education during the initial visit even more critical.
Bridging the Gap with Anatomy Models
Investing in pelvic health anatomical models is not simply an investment in education, but in the broader healthcare system:
- Supporting frontline providers
- Strengthening rural healthcare systems
- Ensuring that individuals receive competent, confident care – regardless of where they live
Geography should not determine the quality of pelvic health care an individual receives. Pelvic health anatomical models also offer a practical solution to a structural problem. They allow rural clinicians to build and maintain assessment competence, which can lead to earlier detection and improved care for rural patients with pelvic floor disorders. Using anatomical models, particularly in combination with virtual workshops, is one concrete step toward closing gaps in rural pelvic health care. When pelvic health care is made more accessible in rural communities, we move one step closer to true equity in pelvic health and reproductive health care.
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Granville Biomedical was founded in 2019 to address the lack of anatomically accurate, affordable, and hands-on training tools available in pelvic health education. Designed with lifelike anatomical detail and realistic tactile properties, Granville Biomedical® models enable healthcare professionals to build procedural confidence and refine clinical skills in a safe, simulated environment. The product line also supports patient education by helping individuals better understand their bodies and participate more confidently in their care.
Granville Biomedical has commercialized a growing portfolio of innovative educational models, including the Venus™ Pelvic Health Educational Model, Iris™ Pessary & Device Demonstration Model, Lily™ Pelvic Floor Levator Ani Muscle Model, Atlas™ Men's Health Anatomy Model, Astra™ IUS Skills Training Model, and the Celeste™ Cervical Assessment Model, scheduled for release later this year.
References
[1] Wu, J.M. et al. (2014). Prevalence and Trends of Symptomatic Pelvic Floor Disorders in U.S. Women. Obstet. Gynecol., 123(1),141-148.
[2] Nygaard, I., et al. (2008). Prevalence of symptomatic pelvic floor disorders in U.S. women. JAMA, 300(11), 1311–1316.
[3] Wu, J. M., et al. (2014). Lifetime risk of stress urinary incontinence or pelvic organ prolapse surgery. Obstet. Gynecol., 123(6), 1201–1206.
[4] Rush, K.L. et al. (2025). The healthcare experiences of rural-living Canadians with and without a primary care provider: a qualitative analysis of open-ended cross-sectional survey responses. Prim. Health Care Res. Dev.
[5] Canadian Physiotherapy Association. (2025). Written submission for pre-budget consultation in advance of the 2026 budget.
[6] Berre M.L., Dumoulin C. (2024). Accessibility of Pelvic Floor Physiotherapy for Treating Urinary Incontinence in Older Women in Quebec: An Online Survey. Physiother Can., 76(1), 86-94.
[7] Charette, M. and McLean, L. (2024). Geographic Accessibility to Pelvic Health Physiotherapy Services Across Ontario: A Geographic Information System Analysis. Physiother Can., 77(2), 174-185.
[8] Wood, N. et al. (2024). Resident education in urogynecologic procedures through stepwise simulation: puerperium to prolapse. J. Surg. Simul., 11, 25-34.
[9] Giroux, M. et al. (2020). A randomized comparison of training programs using a pelvic model designed to enhance pelvic floor examination in patients presenting with chronic pelvic pain. Int. Urogynecol. J., 32(2), 423-431.