Within Canada, the specialty of female pelvic medicine and reconstructive surgery stands on the brink. The needs of Canadian women for pelvic floor services are not presently met. There are inadequate academic programs to train surgeons, and the existing programs are inconsistent in scope. Consequently, the physicians who are interested in the field are drawn to the Board-accredited programs in the United States, and they frequently do not return to Canada. Those who do return will have trouble reversing this trend because of the absence of research and academic funding for urogynaecology in Canada. This will be accomplished only through the collaborative efforts of Canadian urogynaecologists to define the needs of the specialty and the support of health care administrators to build sustainable academic programs in urogynaecology.