Purpose/Hypothesis: The purpose of this study was to compare conventional electrical muscle stimulation (EMS) using a vaginal sensor with a novel external stimulator in the treatment of those with stress urinary incontinence (SUI). Number of Subjects: Eighteen female participants aged from 36 to 46 years with a diagnosis of stress urinary incontinence and a body mass index (BMI) of less than 30 (kg/m2)were randomly assigned to one of two groups for an eight week treatment protocol. The duration of their symptoms spanned 7 - 19 years. Materials/Methods: All subjects completed a bladder diary and a quality of life questionnaire. Each subject had a digital examination of their PFM which was scored as per the Modified Oxford Scale. The amount of urine lost during a cough test and 4 jumping jacks was assessed via pad weight. Each participant completed a bladder filling protocol to allow for delineation of the bladder from the pelvic floor fascia and associated PFM. Real Time Ultrasound (RTUS) imaging with color doppler was used for assessment of PFM contraction, vascularity and to establish bladder volume. Participants in the experimental group wore external electrodes and participants in the control group wore a vaginal electrode. The treatment protocol for both groups was 30 minutes of stimulation at least 4 times per week at home. Subjects were blinded to sonography and were not instructed regarding pelvic floor contractions. Results: At week one and four all subjects in the experimental group could perform appropriate volitional contractions of their PFM in standing but more importantly all reported a diminution in leakage. Changes in the control group were not as significant and only two participants could volitionally perform a PFM in standing when compared to the experimental group. The study is still ongoing. Conclusions: The externally applied EMS proved superior than vaginally delivered EMS in eliciting a PFM contraction in standing. We believe this is a more functional position to train the PFM since symptoms are more evident in standing. All subjects in the experimental group reported a decrease in symptoms and pad use following week one and four of the protocol. The subjects in the control group reported minimal improvements at week one and four when compared with those in the experimental group. Clinical Relevance: Urinary incontinence is a world wide problem and its prevalence is difficult to assess. Research shows that SUI is the most prevalent type in women under 60 years of age. Although most people associate loss of control to old age, it is not a normal or natural part of aging. More importantly incontinence causes a significant social and psychological impact on the lives of women. The novel EMS device in this study was shown to be significantly better than conventional EMS devices in reducing or ablating the symptoms associated with stress urinary incontinence and in eliciting a PFM contraction in standing. More importantly the device is non invasive and can be used as a home treatment.