How better pelvic floor care can prevent debilitating long-term consequences
Ivilina Pandeva is a consultant sub-specialist urogynaecologist and a robotic pelvic floor reconstructive surgeon at Cambridge University Hospitals NHS Foundation Trust (CUH). She is also passionate about global health and the importance of listening to and prioritising women’s health needs. This International Women’s Day she tells us what she loves about her job and why she’s supporting a project to improve the prevention and management of severe perineal trauma in childbirth for women in Kenya.
Can you explain what you do in ten words or less?
I help women with prolapse and incontinence feel normal again.
What does this mean in practice?
My work focuses on diagnosing and treating women with pelvic floor disorders such as incontinence, prolapse and complications from childbirth. This ranges from conservative measures to advanced surgical laparoscopic and robotic techniques. The goal of what I do is to restore function, to improve women’s quality of life and to empower women to gain confidence in their own health.
What do you enjoy the most about your role?
Many of my patients suffer in silence with pelvic floor conditions. It affects their confidence, their relationships and their daily activities. For me, seeing the transformation after treatment – whether it’s conservative measures, surgery or purely lifestyle changes – is one of the most fulfilling parts of my job.
For example, I regularly see women who struggle with basic activities like walking due to severe prolapse, or women in their 30s and 40s being unable to play with their young children due to incontinence. Sometime just understanding the issue, receiving the right education and even simple conservative measures can bring immediate relief.
Beyond patient care, I love mentoring and training others. I find it rewarding sharing my knowledge with the next generations of specialists and seeing them continue what they’ve learned to further improve care for women.
What does International Women’s Day and this year’s theme of ‘accelerate action’ mean to you?
International Women’s Day is a powerful reminder of the progress we’ve made in advocating for women’s and girls’ rights, but it’s also a reminder of what else we need to do. For me this day is about hearing women’s voices and ensuring that their health needs are heard and prioritised, because we need to drive change to improve outcomes for women globally.
Accelerate action means moving beyond the conversation and making a real difference by taking steps to improve access to healthcare, to education, and to research in women’s health. In my field that means having a focus on prevention and access to treatment options but also overcoming the stigma around prolapse and incontinence. It’s about ensuring that more women get the care that they need and training more specialists worldwide.
Why did you get involved in global health?
Getting involved in global health is what makes my job even more interesting and rewarding. I truly believe that access to good healthcare should not be a privilege: it’s a basic human right. I’ve seen first-hand how the lack of access to essential maternal pelvic floor care can have devastating long-term consequences. In a lot of settings, women are suffering from preventable conditions simply because of lack of training, understanding, resources and knowledge. This is what drove me and what continues drives me to get involved. I want to make sure that women, no matter where they live, no matter their background, receive the care they deserve.
Tell us more about the work you’ve been involved in and the benefit it will have to women.
I was recently involved in a project with Cambridge Global Health Partnerships delivering a Quality Improvement (QI) fundamentals and coaching programme in Kenya with a focus on maternal health services. The project combined online and face-to-face training to give clinicians the tools to develop sustainable solutions for their healthcare settings. Through education, mentorship, and practical training the project aims to create long-term improvements by empowering local healthcare providers to implement the changes in their own practice.
What are you working on next?
After I came back from the project in Kenya, I felt that there was a real need to focus on fistula prevention and the long-term health consequences women can develop as a result.
I’m now fundraising to deliver a project with Cambridge Global Health Partnerships in sub-Saharan Africa focused on reducing the incidence of fistula – a debilitating condition where a connection forms between the birth canal and the bowel due to severe perineal trauma. This initiative will focus on the prevention and management of perineal trauma, specifically obstetrical anal sphincter injuries, often referred to as OASIs.
The project aims to provide collaborative and sustainable training to midwives and obstetricians in low-resource settings on techniques to reduce the risk of severe perineal trauma at the time of childbirth. I’m working on developing a structured postnatal pelvic health pathway in these settings to ensure that if women do sustain such injuries, they receive the correct diagnosis and the correct treatment early on. This will directly improve their long-term well-being and prevent long-term complications such as fistula, incontinence or prolapse.
I believe that prevention is the best cure and that we can work together to be proactive rather than reactive in perineal health.
How can people get involved or support this project?
The easiest way to support the project is to donate via the JustGiving page. Every contribution helps train more healthcare workers, enable knowledge exchange between healthcare institutions, and expand access to specialist care. Spreading awareness by talking about pelvic health also helps because it breaks the stigma and encourages more women to seek care.
In collaboration with CMR Surgical and CUH colleagues, Ivilina is running a highly-specialised Urogynaecology Robotics Course on 28 March 2025, with course payment waived in lieu of a suggested donation to support the obstetric fistula project with CGHP.
Interested in participating in global health but not sure where to begin? Find out about the support, advice and funding CGHP offers you or email us at info@cghp.org.uk.
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