“Sharp, stabbing pains internally.”
“Like an always tense pressure down there.”
“My entire lower half hurts badly, every day for so long that I can’t even tell you what hurts - because it all hurts.”
Sound like something you’d want to experience? Probably not. But this is the norm for women with pelvic floor disorders. Pelvic floor dysfunction is incredibly common, with an estimated 25% of women experiencing it at some point in their life – and around 16% of men.
Pelvic floor disorders – conditions caused by strain or damage to the pelvic region, a supportive “hammock” of muscles stretching from the tailbone to the pubic bone – can result from pregnancy and childbirth, obesity, excessive exercise, and other factors. These disorders occur when the pelvic muscles weaken, causing internal organs to sag or protrude.
It’s a problem as old as time: the use of pessaries to manage pelvic floor issues was documented in early Egyptian papyruses and later described by Greek physicians like Hippocrates.
When left untreated, pelvic floor disorders can lead to a cascade of symptoms including incontinence, difficulty urinating, painful intercourse, and chronic pelvic pain. Considering how common these disorders are – and how painful and life-limiting they can be – one might imagine that the treatment options to be varied and advanced as those for treating heart disease (which affects about 7% of the U.S. population).
In reality, the current gynecological prosthetics used to treat this disorder – vaginal pessaries – have remained largely unchanged for over 50 years. These soft, removable devices, designed to support the organs, come in just a few standard shapes and sizes. Fitting them often relies on trial and error. The ring pessary is used for most mild cases, while more complex devices like the Gellhorn pessary (disc and knob shaped) are used in more severe pelvic prolapse.
To understand how outdated they are, consider that modern pessaries were introduced around the same time computers were the size of rooms and cost the equivalent of $45,000 today (when adjusted for inflation). Most technologies, including medical devices, have seen radical transformation over the past several decades – but not pessaries.
Since the 1970s when those off-the-shelf vaginal pessaries were first introduced, 30% of patients on average experience fitting failure, 50% stop using the device within a year, and 56% develop complications as a result of the device. Those odds spell trouble for patients looking for relief from what progresses towards debilitating pain and discomfort.
Bringing new devices to market, particularly those affecting women’s health, can be an uphill battle, but the industry was ripe for innovation. And that’s when a call to Derek Sham pivoted his career journey from urological medical devices to an entrepreneurial one solving the problem of ill-fitting, off-the-shelf pessaries.
Cosm Medical’s Gynethotics™
A Personal Catalyst for Change
That innovation began with a phone call.
“I was in a board meeting one day – my mom was calling me on nonstop,” said Derek Sham, founder of Cosm Medical. “She told me my grandmother was in the bathroom and couldn’t get up.” Shortly after, she was diagnosed with late-stage pelvic organ prolapse, a severe condition where pelvic organs protrude into or outside the vaginal opening. However, her care team couldn’t find a pessary that fit her. Within a year, she was wheelchair bound.
“Looking at the different parts of the body where everything is now custom, the question that I couldn’t let go of is, ‘Why doesn’t this technology exist for gynecology?’” said Sham. At the time, he was already deeply immersed in urological (bladder-related) products, including having developed and commercialized the world’s most utilized urodynamics system. But his grandmother’s story inspired a new mission: bringing custom care to pelvic floor disorders.
From 100 Pessary Options to Millions
Enter Cosm Medical’s Gynethotics™ – customizable pessaries made possible through 3D printing and AI-powered software. Precision medicine had already transformed orthopedics, hearing aids, and dental work. Now Sham’s team was applying it to pelvic health.
“With pessary care specifically, a lot of patients struggle because the existing sizes are standardized with little variation,” explains Colleen McDermott, a Cosm advisor and Mount Sinai Urogynecologist.
An important part of Cosm’s breakthrough relies on AI-powered software and cloud-based diagnostics systems that intake patient-specific measurements and convert them into 3D-printed devices – delivered in an economically viable way.
“Measurements get put into our software, we can create the design, and then we leverage advanced manufacturing or 3D printing to make patient specific devices in an economically viable way,” explained Sham.
This level of customization means patients are no longer stuck from choosing from around 100 generic sizes. Instead, they can access over ten million configurations, ensuring a true fit. It’s like “Build-a-Bear” – but for pelvic care.
“Derek’s idea of 3D printed pessaries is brilliant because it can be very difficult to fit a pessary,” explains Cosm advisor Dr. Diane Newman, an incontinence nurse specialist and Adjunct Professor of Surgery at University of Pennsylvania’s Perelman School of Medicine. “It's almost like trying on dresses, figuring out what works and what fits. We have all these different types, all these different sizes, but once you get a woman who it fits for, I can't tell you the difference it makes in their lives. It’s really needed, but it’s not talked about a lot.”
A Shift in FemTech Funding Signals an Opportunity
So why has pelvic care lagged behind in innovation?
One reason, according to Dr. Jocelyn Fitzgerald, an Assistant Professor of Obstetrics, Gynecology, and Reproductive Sciences at the University of Pittsburgh School of Medicine, is embedded in the economics of medicine. In a 2024 study published in the Journal of Women’s Health, she found that procedures on female patients are reimbursed at an average of 25.6% less than similar procedures for men – making them less lucrative for providers.
“There is a systematic sexism in play here that makes it difficult for startups like us. It's infuriating, but it's also exciting because there is a shift,” noted Sham. “There’s more women's health startups getting funded.”
And the shift is real and measurable. According to Silicon Valley Bank, “Total VC dollars going to women’s health more than tripled between 2019 and 2024, outpacing healthcare as a whole.”
The past decade has seen increased interest in products and services addressing women’s health (femtech). The market is moving beyond knee-jerk dismissal of femtech, and investors are wising up to the untapped potential of this industry. Women, too, are no longer taking a backseat to their own health journey. Social media has played a part, helping normalize conversations once shrouded in stigma.
“There are a lot of conditions that women have lived with, mostly because of stigmatization around women’s health issues but I do think it's changing,” observed Newman. “Take incontinence: Chrissy Teigen talked about wearing diapers after childbirth. Women are smarter about their health now, probably due to social media. And they they're not going to put up with this anymore.”
Cosm Medical founder Derek Sham
Nurses, Not Just Doctors, Drive Innovation
Sham also understood something many health tech startups miss: in clinical settings, engage with the actual users of their product. All too often, founders will default to seeking the expertise of doctors, despite the reality that the people interacting with the devices in a hospital/healthcare setting are often nurses, not physicians. Nurses are often the ones fitting, managing, and educating patients about pessaries.
“I have to commend Derek,” said Diane, who is a Doctor of Nursing Practice (DNP). “He asked me to join his advisory team early on. Most advisory teams are filled with doctors, but in practice, Women's Health nurses practice in gynecology and primary care and they are at the frontline of pessary care and more.”
Scaling and Reimbursement
So how does Cosm make money from pelvic floor dysfunction treatment?
“We’re working through the same business model as custom orthotics, dental and hearing, which is a B2B, B2C revenue share,” Sham explained. “We sell to providers, providers sell to patients.”
That may not be the case forever, though. “We are driving towards novel reimbursement,” he said. “So we're working with the different medical societies to create codes, similar to custom orthopedics, which is typically done through the standard healthcare purchasing.”
If this happens, it will be easier to get insurance to cover their products.
A Place for Capitalization – and Connections
The Science Center and Cosm first intersected when Sham connected with Eli Velasquez – he then went on to participate in Cohort 7 of the Capital Readiness Program (CRP) in March 2025. Along with nine other medtech, digital health, and therapeutics startups, Sham arrived in Philadelphia for five days packed with stress tests, tangible advice, and investor feedback.
As Cosm is a Toronto-based company, CRP was an important steppingstone of their expansion plan for the U.S. healthcare market. The Canadian and American healthcare markets differ widely – Canada using a single-payer, publicly funded system while the U.S. uses a complex multi-payer, public and private insurance system.
The U.S., however, represents a vastly wider market – with 340 million people potentially interacting with the healthcare market versus Canada’s 40 million. So despite the U.S. market’s complexity, health tech companies are willing to jump through the required hoops to sell here – and improve hundreds of thousands of lives in the process. Some would argue that they also need to, to attract the capital necessary to build products leveraging advanced technologies that change the standard of care across the world.
Although CRP doesn’t promise any funding from the Investors-in-Residence who are there to provide critical guidance and support to the assembled startups, it’s not surprising that sometimes, the conversations and connections that happen at CRP lead to enduring relationships in the industry. Maren Nelson, Co-Chair of the Life Science Screening Committee for Alliance of Angels, was one of the Investors-in-Residence on hand that week.
“[CRP] definitely helped expand our network,” said Sham about the program. In addition to his network, Sham was able to expand his cap table too. In September 2025, Cosm Medical closed its Seed+ financing round with the Alliance of Angels among the investors.
This is a huge feather in Cosm’s cap: Alliance of Angels is a 180-member strong investment group based out of Seattle, Washington. “The Alliance of Angels invested in Cosm because we liked their product and their strategy for U.S. market entry and expansion,” Nelson explained. “We are also excited about Cosm’s commitment improving women’s health and to create an environment that supports women using their products.”
The CRP connections don’t end there. Sham was introduced to another international startup and CRP alum, Calla Lily Clinical Care. The two have something in common: two Asian-Canadian male co-founders deeply involved in women’s health. And like Cosm, Calla Lily is approaching an essential aspect of women’s health with a new and more customizable design – so the startups could learn a thing or two from each other.
Derek Sham, founder of Cosm Medical, with Investor-in-Residence Maren Nelson, Co-Chair of the Life Science Screening Committee for Alliance of Angels
On the Horizon: An International Launch
So what’s next for Cosm? Although their product is already on market in Canada, their next goal is to launch in the U.S. – a goal they expect to reach this fall while continuing to expand their digital platform’s capabilities across new designs, workflows and indications.
“We're really excited. We've completed our first clinical studies, which demonstrated improved patient symptoms with personalized pessaries of current designs,” said Sham.
Beyond pessaries, following more advanced medical device markets such as orthopedics, Cosm is the first in the field to pursue tissue remodeling (ie. think casts, slings, and sockets after surgery). They have completed recruitment for their first tissue remodeling study on post-surgical recovery, with additional data coming from four other clinical studies to advance care from obstetrics to surgery to menopause to elderly care. And with future versions of Gynethotics™ designed to incorporate AI-driven improvements based on aggregated patient data, the personalization will only deepen. Not to mention, they’ll be joining the Science Center pavilion at HLTH in Las Vegas this October.
Cosm’s approach to pelvic floor dysfunction treatment will make a difference in the lives of millions of patients: Derek Sham’s drive to create a better solution for people like his grandmother has helped him survive the startup gauntlet. But the advice he would give his past self – and budding entrepreneurs – is surprisingly simple:
“Be kind – to yourself and your team. We're all in this together.”
