The ‘Invisalign for pelvic health’: how Cosm is bringing personalized pessaries and tissue-remodeling to gynaecology
Replacing the trial-and-error of pessary fitting and supporting gynaecological recovery too
Pessaries - the small silicone devices used to support the pelvic floor - have barely changed in decades. They’re still fitted manually, using finger measurements and trial-and-error. Many women cycle through multiple shapes and sizes before finding one that works; many simply give up. With more than half of all women experiencing a pelvic floor disorder at some point in their lives, the limits of this system are felt widely across gynaecology and postnatal care.
Cosm Medical, a Canadian healthtech company, believes precision is the missing piece. Its personalized pessaries allow clinicians to adjust the device’s dimensions and softness based on a patient’s anatomy and symptoms - a shift founder and CEO Derek Sham describes as “bringing precision into this field”. The workflow is built around existing care pathways: pelvic floor physiotherapists, OB/GYNs and urogynecologists can order the device through a simple online platform without changing clinic infrastructure.
With almost 10 million possible shape combinations on Cosm’s 3D printing platform, the aim is to make pessary fitting as tailored as glasses or orthotics.
“If a patient finds their pessary slightly uncomfortable, a clinician can adjust the dimensions of the device and order it from us online - whether it’s the material, a softer material versus the current one, or adjusting the length, width, thickness of the device,” he says.
From custom fitting to tissue remodeling
But the personalized pessary is only the starting point. The ambition of Sham’s team and network of expert clinicians is to do for pelvic health what Invisalign did for dentistry.
“Invisalign remodels teeth and bone with a mechanical device,” he explains.
“We are now in clinical studies for the first applications of tissue remodeling with a mechanical gynaecological device to help women recover from surgery and childbirth.”
The idea is simple but has potential for large-scale impact: precision-made devices that can both support the tissue and also help guide healing after childbirth trauma, prolapse surgery or pelvic floor injury. It’s much like how casts, prosthetic sockets or orthodontic aligners reshape soft tissue and bone.
Fixing one problem shouldn’t cause another
Sham argues that current pessaries often create unintended trade-offs.
“The challenge with off-the-shelf pessaries is that you fix one problem, you can cause another,” he says. A device that supports prolapse may worsen urinary symptoms; one that helps with incontinence may create discomfort elsewhere.
Cosm’s precision devices are designed to optimize three interconnected domains: vaginal health (such as prolapse and sexual function), urinary function (incontinence and obstruction) and colorectal function (constipation and faecal incontinence).
“Half of women with prolapse also have some form of urinary issue,” Sham notes. “These conditions are correlated.”
By matching design to anatomy, the company hopes to avoid the compromises women have long been expected to tolerate.
Why this matters: quality of life, mental health and long-term outcomes
For many women, pelvic floor issues can be life-altering. Sham is open about how personal the problem became when even the best clinicians he knew couldn’t fully help his grandmother. “She deserved better,” he says.
He points to the broad consequences when pelvic trauma after childbirth isn’t addressed — from reduced mobility to the emotional toll. “There’s a strong association of postpartum depression with the pelvic floor being damanged,” he says.
Addressing the root causes early, he argues, reduces later healthcare costs and improves long-term well-being. With ageing populations and rising postnatal complexity, the pressure on urogynaecology services continues to grow; personalized non-surgical options are increasingly seen as essential to closing gaps in care.
Commercial progress and next steps
Cosm’s personalized pessaries are already reimbursed by almost all major employer health plans in Canada and are eligible for HSA/FSA spending in the US.
The company has secured significant non-dilutive funding from provincial and federal Canadian programs in Q3 2025, adding to their Seed+ first close in Q2 2025 - and is currently raising additional funds to further expand.
As part of its upcoming expansion, Sham is meeting UK companies, consultant urogynecologists and consultant nurses across the UK to explore research and commercial partnerships. Early conversations are also underway in Europe, where ageing populations and surgical backlogs create strong demand for conservative pelvic health solutions.
“Our goal is to build a transformational precision care platform across childbirth, surgery and older age,” he says.
A long-ignored corner of healthcare finally moves forward
Despite affecting millions, pelvic floor disorders remain one of the least modernized areas of women’s health and it is still so stigmatised that many women suffer in silence. Cosm’s belief is that precision engineering — long established in dentistry, hearing, prosthetics and orthopaedics — now has a place here too and can help with normalizing this area of health too.
“We’re essentially bringing precision into this field,” Sham says. “First with personalized pessaries — and then by unlocking tissue remodeling to help women recover from surgery and childbirth.”
Cosm Medical is one of nine startups selected for the 2025 Canadian Technology Accelerator (CTA) FemTech program organised by the Government of Canada. This program is free for the selected participants, and it provides access to mentors, a peer network, masterclasses delivered by subject matter experts on topics like the market landscape, IP considerations, fund raising, regulatory issues, public relations, and more, and a dedicated visit to the UK and France to connect founders with potential partners and customers. This article is part of a partnership with the High Commission Canada in the UK.