Raffaella De Vita
Virginia Tech College of Engineering
In 2010, roughly one-third or 28 million American women suffered from pelvic floor disorder, including urinary and/or fecal incontinence, and pelvic organ prolapse, or the literal collapse of the uterus into and inside the walls of the vagina.
The direct costs for pelvic organ prolapse alone costs a staggering $1 billion, not counting costs associated with lost productivity or decreased quality of life. Women who suffer the disorder experience great pain and discomfort and bladder infections. Not much is known about pelvic floor disorder or prolapse because it is not talked about as openly as, say, breast cancer, in the general population.
Raffaella De Vita, an assistant professor in the Department of Engineering Science Mechanics at Virginia Tech, is now leading a national study on the disorder, including seeking out new treatments and providing new ways to prevent prolapse. “These are issues that many women have, we as engineers should not feel embarrassed to talk about them,” she said.
Director of Virginia Tech’s Mechanics of Soft Biological Systems Laboratory, De Vita is using a five-year $473,000 National Science Foundation Faculty Early Career Development (CAREER) Award to lead this research. Her collaborative research partners include Walter Reed Army Medical Center’s Department of Obstetrics and Gynecology in Washington, D.C., and the Biophysics Collaborative Access Team at the Argonne National Laboratory near Chicago.
Problems related to and the cost of treatment of pelvic floor disorders, including pelvic organ prolapse, are expected to increase as the population continues to simultaneously age and grow. An estimated 44 million women are expected to suffer from some form of pelvic floor disorder in the year 2050. Men also can get the disorder, but are far less likely than woman to do so.
Most cases of pelvis floor disorders are caused by stretched pelvic organs, their supporting muscles and connective tissues during pregnancy, vaginal delivery, as well as aging. In the case of vaginal delivery, ligaments and muscles are stretched beyond their original shape, or a strained organ can weigh on a ligament, causing it to stretch out and weaken as would a rubber band stretched too far.
De Vita’s research will focus on the elastic and viscoelastic properties of two major ligaments supporting the uterus and vagina: the uterosacral ligaments and cardinal ligaments. Mechanical testing will be coupled with synchrotron X-ray diffraction imaging to reveal the collagenous micro-structure of USLs and CLs with unprecedented details. She will obtain the ligaments from swine that are used in other research projects. Although not an exact match to human, simply with the structure of the body and gravity load on two legs, human, versus four legs, pig, the organs are close enough in design and shape.
De Vita likens these ligaments of the pelvic organs to the ropes of a boat in a dock. If the pelvic floor muscles, or water level, in the dock becomes low, the weight of the pelvic organs, the boat, becomes greater on the ligaments, or ropes in the analogy, and can cause them to stretch, and/or break. In aging, ligaments and internal organs can start to lose their strength and sag, similar to aging, sagging skin.
With new modeling of uterosacral ligaments and cardinal ligaments, De Vita will seek new scientific-based medical treatment options. For now surgeons correct stretched ligaments using mesh material around the tissue, or snipping the middle of the tissue out, thus shortening the length of the stretched ligament. In both cases, medical problems have occurred post-surgery: Corrosion of the mesh against the tissue, and the snipped ligament again weakening losing its tension, said De Vita. These treatments have resulted in lawsuits, and are not scientifically based.
Possible treatment scenarios include creating replacement, artificial ligaments that have the same exact elasticity and structural makeup of the original tissues, De Vita said.
Additionally, she will seek preventative measures for pelvic floor disorder, including the option of exercises or stretches women can use leading up to a natural, vaginal birth. She likens giving birth, and having previously un-stretched muscles traumatized to a jogger starting off at a dead, fast run, without stretching during warm up exercises. The muscles are suddenly stressed and, in many cases, damaged.
In addition to the medical research efforts for new treatments and preventative measurements, De Vita will use her CAREER award to develop a new graduate course on nonlinear mechanics of biological systems and revise a similar undergraduate course she teaches to include laboratory hours in experimental biomechanics. She also will spearhead community outreach education efforts, including women’s groups, on pelvic floor disorder and prolapse.
The CAREER grant is the National Science Foundation’s most prestigious award, given to creative junior faculty considered to become academic leaders of the future.
De Vita has previously worked on National Science Foundation grants, including a $300,000 study of knee ligament sprains at the micro-mechanical level in 2009. She earned a laurea degree in mathematics from University of Naples II in 2000, and masters and doctoral degrees in mechanical engineering from the University of Pittsburgh in 2003 and 2005, respectively.