The MAHSC (Manchester Academic Health Science Centre) inaugural lecture series celebrates the remarkable contributions of our honorary MAHSC clinical chairs. These prestigious honors, awarded by the University of Manchester’s Faculty of Biology, Medicine, and Health, recognise distinguished individuals across Greater Manchester who have demonstrated excellence in research, education, and clinical practice.

Health Innovation Manchester was delighted to host Dr Fiona Reid, Consultant Urogynaecologist at Manchester University NHS Foundation Trust, for her MAHSC inaugural seminar: “Listening to Women: Pain, Surgery, and Outcomes That Matter – Reporting from the Basement of Women’s Health.” The session shone a powerful light on the history, science, and lived realities of pelvic health – and why Manchester is uniquely placed to lead the future of this field.

Dr Reid opened with characteristic humour and honesty, describing her clinical world as “the basement of medicine – anatomically downstairs, politically downstairs, and a very underfunded downstairs.” Yet, as she made clear throughout her lecture, the pelvic floor is far from a minor concern. It is, as she put it, “an engine, a biological wonder,” essential to mobility, continence, sexual function, dignity, and everyday wellbeing for half the population.

A Hidden Epidemic Rooted in History

Dr Reid took the audience back to Manchester’s Industrial Revolution – an era celebrated for engineering triumphs but one that also left a quieter legacy written in women’s bodies. Working long hours in cotton mills, lifting heavy loads, breathing poor air, giving birth repeatedly with no contraceptive autonomy, and returning to work without rest, women experienced widespread prolapse and pelvic floor injury.

Two Manchester surgeons – Donald and Fothergill – pioneered what became known as the Manchester Repair in the 1890s, a prolapse surgery still performed today. But despite isolated breakthroughs, women’s health research remained underfunded and overlooked.

This historic neglect echoes loudly into the present. As Dr Reid highlighted, the women’s health gap is stark: women spend 25% more of their lives than men in poor health, not because they live longer, but because they live longer unwell. Closing this gap could unlock enormous improvements in wellbeing and economic productivity.

Bias in Research and Diagnostics: A Systemic Problem

Modern medicine continues to treat the male body as the default. From crash-test dummies designed on male physiques to decades of cardiology research excluding women, the result is delayed diagnoses, atypical labelling of symptoms, and poorer outcomes for female patients. Dr Reid illustrated this powerfully: fewer than 5% of “heart attack” images online depict women, even though heart disease affects men and women equally.

If such bias exists in high-profile conditions, she argued, it is unsurprising – though unacceptable – that pelvic floor disorders remain poorly understood, poorly funded, and often trivialised.

This “normalisation of suffering” was another major theme. Everyday products used to manage incontinence or menstrual bleeding rarely provide health information that could prompt women to seek help.

When Women Aren’t Listened To: Lessons from the Cumberlege Review

Dr Reid revisited the events surrounding the use of synthetic mid‑urethral slings -procedures that were life‑changing for many women, but which caused serious complications for some. The Cumberlege Review (2020) captured harrowing testimonies from women who felt dismissed, unheard, and even gaslit when raising concerns.

“The lesson is not that surgery is inherently wrong,” Dr Reid explained. “It’s about strengthening science, improving surveillance, and restoring trust.”

Redefining ‘Cure’: Putting Women’s Lived Experience at the Centre

One of Dr Reid’s most influential research contributions has been challenging the traditional definition of “cure” in pelvic floor surgery.

Her qualitative and psychometric studies showed that anatomical success does not always align with women’s own perceptions of cure. Factors like coping strategies, activity levels, pad use, fluid restriction, and lifestyle adaptation all shape how women evaluate outcomes. Measuring the wrong construct risks misclassifying both success and failure.

As she emphasised:
“Cure is not a fixed surgical endpoint – it is an outcome mediated by a woman’s own context.”

Her hope: that modern AI and machine learning might help define more meaningful, patient‑centred outcome measures in the future.

Why Health Literacy Matters

A 2021 study led by Dr Reid’s team revealed that fewer than 10% of patients could correctly label major external genital structures, and many could not identify the primary symptom of prolapse. Very few recognised physiotherapy as a treatment option.

This lack of health literacy has profound implications: delayed care, fragile consent, limited shared decision-making, and poorer outcomes. “Women deserve to understand their own bodies,” she emphasised.

Manchester’s Leading Role in Pelvic Health

Dr Reid highlighted the scale and impact of the Warrell Unit, now the largest urogynaecology unit in the UK. It provides care across four Manchester hospitals, offers tertiary and super‑regional services, and treats patients from across the North West and even internationally.

The unit’s multidisciplinary approach spans consultants, specialist nurses, clinical scientists, and research fellows – several of whom contributed elevator‑pitch videos during the seminar. Their projects span biomechanics, surgical outcomes, and improving diagnostic pathways, reflecting the unit’s scientific ambition and collaborative spirit.

A Vision for the Future: The Manchester Institute of Pelvic Health

Dr Reid closed with a compelling call to action: to establish Manchester as home to a new Institute of Pelvic Health.

Grounded in the city’s history of innovation, energised by scientific potential, and powered by a commitment to truly listening to women, such an institute could transform research, care, and public understanding on a national and global scale.

As she put it:
“When something affects half the population, it’s not a special interest – it’s mainstream medicine.”