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This article discusses the importance of physical activity (PA) for postpartum women and the need for support and guidance in engaging in PA after childbirth. The authors argue that PA is a human right and that access and education surrounding PA adaptation postpartum should be improved to support mothers' well-being. The article suggests strategies at the policy, community, interpersonal, and individual levels to support postpartum women's PA engagement, emphasizing the need for adequate maternity leave, healthcare guidelines, partnerships with healthcare providers, social support, and self-compassion. The authors conclude that achieving health equity for postpartum women requires input from all levels of society. [Extracted from the article]

OBJECTIVE: To develop evidence- and consensus-based clinical practice guidelines for management of high-tone pelvic floor dysfunction (HTPFD). High-tone pelvic floor dysfunction is a neuromuscular disorder of the pelvic floor characterized by non-relaxing pelvic floor muscles, resulting in lower urinary tract and defecatory symptoms, sexual dysfunction, and pelvic pain. Despite affecting 80% of women with chronic pelvic pain, there are no uniformly accepted guidelines to direct the management of these patients. METHODS: A Delphi method of consensus development was used, comprising three survey rounds administered anonymously via web-based platform (Qualtrics XM) to national experts in the field of HTPFD recruited through targeted invitation between September and December 2021. Eleven experts participated with backgrounds in urology, urogynecology, minimally invasive gynecology, and pelvic floor physical therapy (PFPT) participated. Panelists were asked to rate their agreement with rated evidence-based statements regarding HTPFD treatment. Statements reaching consensus were used to generate a consensus treatment algorithm. RESULTS: A total of 31 statements were reviewed by group members at the first Delphi round with 10 statements reaching consensus. 28 statements were reposed in the second round with 17 reaching consensus. The putative algorithm met clinical consensus in the third round. There was universal agreement for PFPT as first-line treatment for HTPFD. If satisfactory symptom improvement is reached with PFPT, the patient can be discharged with a home exercise program. If no improvement after PFPT, second-line options include trigger or tender point injections, vaginal muscle relaxants, and cognitive behavioral therapy, all of which can also be used in conjunction with PFPT. Onabotulinumtoxin A injections should be used as third line with symptom assessment after 2-4 weeks. There was universal agreement that sacral neuromodulation is fourth-line intervention. The largest identified barrier to care for these patients is access to PFPT. For patients who cannot access PFPT, experts recommend at-home, guided pelvic floor relaxation, self-massage with vaginal wands, and virtual PFPT visits. CONCLUSION: A stepwise approach to the treatment of HTPFD is recommended, with patients often necessitating multiple lines of treatment either sequentially or in conjunction. However, PFPT should be offered first line.

Introduction: The pelvic floor is exposed to differing stresses and trauma depending on the mode of birth. At the same time, the pelvic floor plays a crucial role in female sexual functioning (FSF). Whereby FSF encompasses different dimensions, from subjective satisfaction to physiological aspects, such as lack of pain and orgasm ability. The aim of the study presented here is to assess FSF in relationship to postpartum pelvic floor disorder based on the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire, IUGA‐Revised (PISQ‐IR), in a large convenience sample and to identify whether there is an association between mode of birth as well as perineal injuries and FSF of women up to 24 months postpartum. Material and Methods: We conducted a cross‐sectional online survey and recruited via social media women up to 24 months after birth of their last child. FSF was surveyed using the PISQ‐IR. Details were also collected on all previous births and birth‐related perineal trauma, as well as current breastfeeding, obesity, and socio‐demographics. Multivariate models were then calculated to determine a possible association between FSF and birth mode. Results: The data basis is the responses of 2106 survey participants within the first 24 months postpartum. Even 12–24 months postpartum, 21% of respondents are not sexually active, which burdens almost 44% of these women. With regard to mode of delivery, differences in FSF are only evident in individual dimensions of the PISQ‐IR. The dimensions "Condition Impact" and "Condition Specific" were significantly associated with more impairments in sexually active respondents up to 12 months postpartum whose last mode of delivery was forceps or vacuum extraction. If a perineal tear had occurred during last birth, this was significantly associated with a lower PISQ‐IR subscore in the "Condition Impact," "Condition‐Specific," "Global Quality," "Partner‐Related," and "Arousal" models. The low variance explanation shows that further relevant factors on female sexuality may exist. Conclusions: The issue of impairments in FSF following childbirth, persisting for an extended period of time, is a significant postpartum concern. Due to the very different dimensions of FSF, the influence of the mode of delivery must be considered in a differentiated way. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this study was to determine the prevalence of pelvic floor disorders (PFDs) and associated risk factors among parous Ugandan women. Methods: We performed a cross‐sectional study of parous Ugandan women. Demographics and assessment for PFD were obtained. The presence of PFD was defined by participant symptom report, standardized questionnaires, and standard physical examination (pelvic organ prolapse quantification [POP‐Q] and cough stress test [CST]). Results: A total of 159 women were enrolled in the study between June 2022 and June 2023. The median age was 35 years and median parity was 4. Forty‐four (28%) women in the cohort reported symptoms of urinary incontinence. No women reported symptoms of pelvic organ prolapse or anal incontinence. Seventy‐two (46%) participants had a positive CST and 93 (58.3%) had stage II or greater prolapse based on the POP‐Q. Cesarean section was found to have a protective effect for the development of PFD (odds ratio [OR] 0.22, 95% confidence interval [CI] 0.07–0.59, P = 0.004). Conclusion: PFDs are prevalent among parous Ugandan women at rates similar to cohorts in other low‐ and middle‐income countries. Cesarean section seems to be a protective factor against developing PFDs. Synopsis: Pelvic floor disorders are prevalent among parous Ugandan women. Cesarean delivery seems to be protective for the development of these disorders. [ABSTRACT FROM AUTHOR]

Introduction: Surgeries for pelvic organ prolapse (POP) and stress urinary incontinence (SUI) are commonly performed in older adults, many of whom are also frail. A surgical risk calculator for older adults undergoing POP/SUI surgeries that incorporates frailty, a factor known to increase the risk of surgical complications, would be helpful for preoperative counseling but currently does not exist. Materials and Methods: Medicare Carrier, Outpatient, and MedPAR files were examined for beneficiaries undergoing POP and SUI surgery between 2014 and 2016. A total of 15 POP/SUI categories were examined. The Claims‐Based Frailty Index (CFI), a validated measure of frailty in Medicare data, and Charlson Comorbidity Index were deconstructed into their individual variables, and individual variables were entered into stepwise logistic regression models to determine which variables were most highly predictive of 30‐day complications and 1‐year mortality. To verify the prognostic accuracy for each model for surgical complications of interest, calibration curves and tests of model fit, including C‐statistic, Brier scores, and Spiegelhalter p values, were determined. Results: In total, 108 479 beneficiaries were included. Among these, 4.7% had CFI scores consistent with mild to severe frailty (CFI≥0.25). A total of 13 prognostic variable categories were found to be most highly predictive of postoperative complications. Calibration curves for each outcome of interest showed models were well‐fit. Most models demonstrated high c‐statistic values (≥0.7) and high Spiegelhalter p values (≥0.9), indicating good model calibration and excellent discrimination, and low Brier scores (<0.02), indicating high model accuracy. Conclusions: Urologic surgery for older Adults Risk Calculator serves as a novel surgical risk calculator that is readily accessible to both patients and clinicians that specifically factors in components of frailty. Furthermore, this calculator accounts for the heterogeneity of an aging population and can assist in individualized surgical decision‐making for these common procedures. [ABSTRACT FROM AUTHOR]

Background/Objectives: The postpartum period is marked by numerous physical changes, often leading to pelvic floor disorders (PFD) such as urinary incontinence (UI) and diastasis recti abdominis (DRA). This study aimed to assess the occurrence of UI and DRA in postpartum women and evaluate the effectiveness of physiotherapy in managing UI and DRA. Methods: A total of 396 women, between the 3rd and 5th postpartum day, were randomized into three groups: control (GrCon), online exercise group (GrOnl), and supervised group (GrSup). GrCon received only education, whereas GrOnl and GrSup had three sessions with exercises with physiotherapist—online or supervised. Data were collected through questionnaires, ICIQ FLUTS, body posture assessments, and DRA measurements. Results: The results showed a significant reduction in UI and DRA symptoms across all groups, with the GrSup group showing the greatest improvement. UI symptoms decreased from 49% during pregnancy to 36.9% postpartum, with GrSup women reporting fewer urological complaints compared to the GrOnl and GrCon groups (p < 0.001). DRA incidence dropped from 76.2% in the early postpartum days to 23.4% at six weeks, with GrSup showing the lowest rates (9.8%). Notably, supervised physiotherapy resulted in a higher frequency (94.7%) and correct performance of PFME (72.2%) compared to the online and control groups. Conclusions: The study concludes that supervised physiotherapy is more effective than online sessions in managing postpartum UI and DRA, emphasizing the importance of guided exercise for better outcomes. [ABSTRACT FROM AUTHOR]

Objective Methods Results Conclusion The primary aim was to adapt the Body Image in the Pelvic Organ Prolapse Questionnaire (BIPOP‐Q) to Turkish culture and evaluate its reliability and validity. The secondary aim was to examine how body image is affected by partner status and the presence of pelvic organ prolapse (POP) symptoms.The study included 150 women with POP stage ≥2. The reliability of the BIPOP‐Q was evaluated by internal consistency and test–retest analyses. To assess the criterion validity of BIPOP‐Q, genital image and POP questionnaires were administered. Correlation coefficients were determined by Spearman correlation analysis. To evaluate the construct validity of the BIPOP‐Q, confirmatory factor analysis was conducted. The Mann–Whitney U test was used to compare independent groups.The internal consistency of the BIPOP‐Q (Cronbach α = 0.918) was found to be high, and the test–retest reliability of the scale items (r = 0.538–0.828) ranged from moderate to excellent. Correlations between the BIPOP‐Q and criterion scale scores were found to be low to moderate (r = −0.450 to 0.377, P < 0.05). The two‐factor construct validity of the BIPOP‐Q was confirmed. Women without a partner or with symptomatic POP exhibited lower body image scores than women with a partner or with asymptomatic POP (P < 0.05).The Turkish BIPOP‐Q is a reliable and valid scale for assessing POP‐specific body image. Turkish women without a partner or with symptomatic POP appear to have more impaired body image. Further studies are needed to examine the responsiveness of the BIPOP‐Q to interventions. [ABSTRACT FROM AUTHOR]

Featured Application: The proposed smartphone application guides female track and field athletes to perform an effective exercise program to improve pelvic floor symptoms and strength, while they are supervised by health professionals. Despite the high prevalence of pelvic floor (PF) dysfunctions in female athletes, help-seeking is low due to embarrassment and disinformation. This study evaluated the effects of a 6-week exercise program guided by a specific app, with and without intravaginal biofeedback on the PF symptoms, strength, and sonographic measures of female athletes. Compliance with the program was evaluated. Thirty-nine athletes with PF symptoms used the app with different functionalities: experimental group 1 (n = 13) (EG1: exercises, PF information, and physiotherapists contact); experimental group 2 (n = 14) (EG2: exercises with biofeedback, PF information, and physiotherapists contact); and the control group (n = 12) (CG: PF information, and physiotherapists contact). Before and after the 6 weeks, PF symptoms, strength with the Oxford scale, and sonographic measures were evaluated. EG1 and EG2 improved strength (p = 0.028 and p = 0.001, respectively) and incontinence urinary symptoms (p = 0.041 and p = 0.002, respectively) over the baseline, without between-group differences (p > 0.05). No significant differences were observed in sonography (p > 0.05). Regarding compliance, 84.6 and 71.4% of athletes from EG1 and EG2 completed the program twice per week or more. A 6-week PF exercise program guided by the app improved PF symptoms and strength of female athletes and ensured high compliance with the program but was insufficient to improve sonography. [ABSTRACT FROM AUTHOR]

Background: Estrogen deficiency during menopause, aging, reproductive history, and factors increasing intra-abdominal pressure may lead to structural and functional failure in the pelvic floor. Lifestyle choices, such as eating behavior, may contribute to pelvic floor disorders. Objectives: The objective of the study was to investigate associations of eating behavior with symptoms of pelvic floor disorders, that is, stress urinary incontinence, urgency urinary incontinence, fecal incontinence, and constipation or defecation difficulties among middle-aged women. Design: A cross-sectional, observational study was performed using a population sample of 1098 Finnish women aged 47–55 years. Methods: Eating behavior, food consumption frequency, demographical, gynecological, and physical activity variables were assessed using self-report questionnaires. Logistic regression models were used to assess the associations of eating behavior, food frequency, and symptoms of pelvic floor disorders. Models were adjusted with demographical, gynecological, and physical activity variables. Results: In adjusted models, middle-aged women with disordered eating style were more likely to experience the symptoms of stress urinary incontinence (odds ratio (OR) 1.5, p = 0.002), and constipation or defecation difficulties (OR 1.4, p = 0.041). Adding body mass index into the models abolished associations. Of the studied food items, more frequent consumption of ready-made, highly processed foods (OR 1.5, p = 0.001), and fast foods (OR 1.5, p = 0.005) were independently associated with symptoms of stress urinary incontinence regardless of eating style, whereas consuming ready-made foods (OR 1.4, p = 0.048) was associated with symptoms of urgency urinary incontinence. Daily consumption of fruits (OR 0.8, p = 0.034) was independently associated with symptoms of stress urinary incontinence. Furthermore, we observed that daily consumption of porridge was associated with symptoms of constipation or defecation difficulties (OR 1.7, p = 0.010) independently of eating style. Alcohol consumption (OR 0.9, p = 0.015) was inversely associated with constipation and defecation difficulties. Women with overall higher quality diet had lower odds for stress urinary incontinence (OR 0.9, p = 0.002). Conclusion: This study provides proof-of-concept evidence to the hypothesis that eating behavior and consuming certain food items are associated with perceived pelvic floor disorders. As a preventive action, eating behavior of women with the risk of these symptoms should be assessed, and guidance toward healthy eating patterns should be provided. [ABSTRACT FROM AUTHOR]

Background: Burnout disproportionately affects professionals who spend much of their time in direct patient care. The physical and emotional demands of pelvic floor therapists, coupled with identity-based stressors, may place Black women pelvic floor therapists at an increased risk for experiencing burnout. Objective: The purpose of this study was to explore the experiences of burnout among Black women pelvic floor therapists in the United States. Design: This is a short-form qualitative study with data collected from an online survey. Methods: We recruited Black women pelvic floor therapists from November 2023 to February 2024 to complete an online survey comprised of open-ended questions about their experiences of burnout. The coding team analyzed the short-form qualitative data using inductive structural tabular thematic analysis. Results: Of the 59 participants in the total sample, 37 reported experiencing professional burnout. Main themes were: (1) contributors to burnout, (2) signs of burnout, and (3) consequences of burnout. Notably, contributors to burnout were predominantly structural and included workplace factors, such as unrealistic productivity standards and experiences of discrimination and microaggressions. Signs of burnout were primarily emotional. Consequences of burnout included leaving the current work setting, a strong desire to transition to a different setting, or taking a break from the profession overall. Conclusion: This study revealed that it is not only the intensity of Black women pelvic floor therapists' workload but also the nature of their tasks and the contexts within which they operate that contribute to burnout. Plain language summary: Why is this study important? Pelvic floor therapy (PFT) is an increasingly popular medical treatment for genito-pelvic pain/penetration disorder (GPPPD). Black women pelvic floor therapists' are at a high risk of experiencing professional burnout due to the limited number of PFTs in general and the desire for Black women patients to have Black doctors. The current study sought to understand Black pelvic floor therapists' experiences of burnout. What did the researchers do? The research team surveyed Black women pelvic floor therapists and anticipated that these women would report burnout from the demands of their jobs, being overworked, and experiencing gendered racism within their workplaces. What did the researchers find? Out of a total of 59 Black women PFTs, 37 reported professional burnout. The main sources of burnout for participants were structural issues within the workplace, such as inadequate time for administrative duties, limited support for patients, unrealistic workloads and productivity standards, and workplace discrimination. Burnout manifested for participants through a lack of motivation and passion towards their work, emotional disengagement, and fatigue. As a result, some participants left their jobs or experienced health issues. Healthcare fields should consider ways to promote wellness and work–life balance, especially for Black women with physically and emotionally demanding roles. [ABSTRACT FROM AUTHOR]

ABSTRACT Objective Design Setting Population or Sample Methods Main Outcome Measures Results Conclusions First, to assess whether levator ani deficiency (LAD) is associated with pelvic floor dysfunction 1 year postpartum, including urinary, vaginal and bowel symptoms; and second, to explore at what cut‐off of LAD score such pelvic floor dysfunction arises.Nested case–control study.Örebro University Hospital, Örebro, Sweden.Primiparous women 1 year after vaginal birth.Three‐dimensional endovaginal ultrasound assessment of the levator ani muscle; LAD score based on this ultrasound, and validated questions about pelvic floor dysfunction. Logistic regression models were used.Symptoms of pelvic floor dysfunction associated with LAD.Altogether 190 women were included, 103 of whom were symptomatic cases and 87 asymptomatic controls. 53% in the case group, and 58% in the control group had a LAD score of 0. A greater LAD score was significantly associated with urinary incontinence (adjusted odds ratio [aOR] 1.11, 95% confidence interval [CI] 1.00–1.22) and vaginal laxity (aOR 1.14, 95% CI 1.03–1.25). The risk of urinary incontinence was increased when the LAD cut‐off score was set between ≥ 1 point and ≥ 4 points. The risk of vaginal laxity was increased when the cut‐off was set between ≥ 8 and ≥ 14 points.LAD was associated with both urinary incontinence and vaginal laxity. The risk of urinary incontinence increased already with minor LAD and defects of the most medial levator ani muscle portions normally supporting the midurethra may explain this increase. [ABSTRACT FROM AUTHOR]

Painful conditions of the pelvic floor include a set of disorders of the pelvic region, discreetly prevalent in the female population, in which pain emerges as the predominant symptom. Such disorders have a significant impact on quality of life as they impair couple relationships and promote states of anxiety and irascibility in affected individuals. Although numerous treatment approaches have been proposed for the management of such disorders, there is a need to identify strategies to promote muscle relaxation, counter pelvic pain, and reduce inflammation. The endocannabinoid system (ECS) represents a complex system spread throughout the body and is involved in the regulation of numerous physiological processes representing a potential therapeutic target for mood and anxiety disorders as well as pain management. Cannabidiol (CBD), acting on the ECS, can promote relief from hyperalgesia and allodynia typical of disorders affecting the pelvic floor and promote muscle relaxation by restoring balance to this delicate anatomical region. However, its use is currently limited due to a lack of evidence supporting its efficacy and harmlessness, and the mechanism of action on the ECS remains partially unexplored to this day. This comprehensive review of the literature examines the impact of pain disorders affecting the pelvic floor and major treatment approaches and brings together the main evidence supporting CBD in the management of such disorders. [ABSTRACT FROM AUTHOR]

Objective: To assess the prevalence and the characteristics of pelvic floor dysfunction (PFD) in women with endometriosis. Methods: This is a methodological paper that describes the 'Endometriosis and Pelvic Floor Dysfunction' (EndoPFD) multicenter study protocol. It involves three sites: the University Hospital of Pisa, the San Raffaele Hospital of Milan and the Vanvitelli University Hospital of Naples. Women are recruited through web links and are asked whether they want to participate to the clinical evaluation or only to the web survey. The web survey gathers personal history, endometriosis history and symptoms, and performs a subjective evaluation of PFD through questionnaires: Urinary Distress Inventory 6, Colorectal-Anal Distress Inventory 8, Wexner Scale for Fecal Incontinence, Wexner Constipation Scoring System, and Female Sexual Function Index. Those interested in the clinical evaluation will add to the questionnaires the following exams: gynecological and proctological exam, pelvic ultrasound, urodynamic test, and anorectal manometry. Preliminary results: Recruitment for the web survey was completed. A total of 1,149 women signed the electronic consent, 329 were excluded due to inclusion/exclusion criteria; hence, 525 completed all the questionnaires (response rate of 64.02%). Recruitment for the clinical evaluation is ongoing. Discussion: This study protocol offers the possibility to define the prevalence of PFD in endometriosis patients with a subjective and an objective assessment of signs and symptoms. This may pave the way for changing the approach to patients with endometriosis. Moreover, it demonstrates the validity of the method used (online survey and recruitment) to reach a high number of patients. [ABSTRACT FROM AUTHOR]

Purpose: Investigate the relationship between female pelvic floor muscle (PFM) function and body composition. Methods: Cross-sectional study—participants answered sociodemographic and urogynecological questions. The amount of fat mass was measured by dual-emission X-ray densitometry (DXA), and subcutaneous fat thickness was assessed by abdominal ultrasound. PFM assessment was performed using the Modified Oxford Scale and vaginal manometry. Descriptive analysis, independent t test, spearman correlation, and univariate regression were performed. Results: Ninety-nine women were included. All body composition variables evaluated, except subcutaneous fat thickness, indicated that women with a higher concentration of fat in the pelvic, android, and visceral region have lower maximum voluntary PFM contraction strength assessed by Modified Oxford Scale and manometry. The univariate model pointed out that the fat concentration increases the chances of reduced PFM strength in the entire body (0.6%), android (5.4%), visceral region (25.3%), and pelvic (89.9%). There was a correlation between the concentration of total, pelvic, and android fat with MVC/average peak. Conclusion: The accumulation of "total", "pelvic", "android", and "visceral" fat mass is correlated with reduction in PFM strength, and there is an association between MVC and the variables of total and segmented fat. However, pelvic fat concentration is predictive in 89.9% of cases. [ABSTRACT FROM AUTHOR]

Background/Objectives: Anal incontinence is linked to pelvic floor dysfunction. Diagnosis involves assessing both the function and structure of the anorectal unit. Although transperineal ultrasound has gained attention as a less invasive option, its effectiveness as a diagnostic tool for evaluating the relationship between structure and function is still debated. This study aimed to explore the relationship between quantitative measurements of anal sphincter and pelvic floor structures as well as the subjective symptoms and objective assessments of sphincter function regarding anal incontinence. Methods: 50 women with pelvic floor dysfunction were recruited for the study. The severity of anal incontinence was assessed using the CACP score. Ultrasound imaging was employed to measure anal sphincter area, while sphincter pressures were evaluated through manometry. The relationships between variables were analyzed using Pearson's and Spearman's correlation tests. Results: The mean anal sphincter area was 5.51 cm2 at rest and 4.06 cm2 during maximal contraction. Resting anal sphincter pressure had an average of 46.29 mmHg, and contraction pressure averaged 103.25 mmHg. No significant correlation was found between the anal sphincter area and pressure at rest (r = 0.018) or during contraction (r = −0.210). However, a moderate correlation was observed between the change in sphincter pressure and area during contraction (r = 0.312). The CACP score showed no significant correlation with the sphincter area at rest (r = −0.084) but was weakly correlated during contraction (r = −0.270). Conclusions: Conventional diagnostic tools for evaluating anal incontinence can be uncomfortable and are not always readily available. Perineal sonography presents a promising, less invasive alternative for dynamic assessment of the anal sphincter. [ABSTRACT FROM AUTHOR]

Background: The prevalence of POP in women ranges from 30–40%, with 10–20% requiring surgical intervention. Annually, over 225,000 surgical procedures for POP are performed in the United States. The severity of prolapse is assessed using the four-stage POP-Q system, which facilitates clinical research by providing a standardized measure of defect severity. Surgical intervention is indicated for more severe cases, with various techniques available through vaginal or abdominal access. Synthetic meshes, primarily made of polypropylene (PP), are commonly used in POP surgeries due to their biocompatibility and mechanical support. This research aims to evaluate the effectiveness and safety of a non-resorbable, light polypropylene gynecological mesh (G-Mesh®, Tricomed S.A., Łódź, Poland) in the surgical treatment of pelvic floor prolapse in women. Methods: The meshes were implanted via laparoscopy (Dubuisson method) and laparotomy or transvaginally. A multicenter, retrospective study was conducted involving 81 patients aged 28–83. Results: The results collected at three follow-up visits indicated a high level of patient satisfaction, minimal discomfort, and no significant pain. Many patients emphasized significant improvement in quality of life and the lack of any adverse events associated with the presence of the implant. Conclusions: The G-Mesh® gynecological mesh has emerged as an effective and safe intervention for treating pelvic floor dysfunction in women, addressing conditions such as cystocele, rectocele, uterine prolapse, and ureterocele. [ABSTRACT FROM AUTHOR]

Women's rugby is experiencing unprecedented growth and professionalisation, yet the research underpinning player welfare and performance remains significantly underdeveloped. This special issue of the European Journal of Sport Science addresses the critical need for evidence‐based practices tailored to female rugby players. Current literature is predominantly male‐focused, despite known sex differences impacting training, injury mechanisms and health outcomes. In particular, the underrepresentation of female‐specific studies presents risks to player safety and performance optimisation. This issue presents cutting‐edge research, from world‐leading interdisciplinary experts and applied practitioners, on three main themes: female‐specific injury and illness surveillance and education, tackle safety and performance, and intersectional research agendas. Contributions include insights into female‐specific health domains, such as breast and pelvic floor health, emphasising the need for tailored care pathways and interventions. Additionally, the importance of gender‐responsive coaching and tackle skill acquisition is highlighted, advocating for progressive, context‐specific training frameworks. Moreover, an intersectional approach to research is proposed, to address the broader social and material contexts affecting marginalised women and girls in rugby. These findings aim to drive interdisciplinary, inclusive research, ensuring that the professionalisation of women's rugby is matched by advancements in scientific understanding and applied practice. This special issue not only celebrates the progress made, but also calls for ongoing efforts to bridge the knowledge gap, ensuring holistic support for female rugby players from participation, through to retirement and beyond. [ABSTRACT FROM AUTHOR]

The pelvic floor and its associated disorders are a unique and often overlooked aspect of women's rugby. This review discusses relevant biopsychosocial considerations specific to the pelvic floor and rugby. Pelvic floor disorders can present at any time across the female lifespan but are more prevalent during pregnancy and postpartum. This is due to the substantial physiological and anatomical changes experienced during pregnancy and vaginal childbirth. Consequently, pelvic floor disorders can impact a player's ability to perform, maintain engagement with, or return to, rugby due to symptoms. Players need to be informed, supported, and guided through focused pelvic floor muscle training to condition the muscles and 'ready' them for the varied demands of rugby. Health and fitness professionals should understand the risk of pelvic floor disorders across the female lifespan and screen players for symptoms when supporting them to maintain or return to rugby. Rugby players who are symptomatic of pelvic floor disorders should be signposted to specialist services and/or resources to manage their symptoms. Once engaging in rugby training, ongoing evaluation of player load tolerance and implementation of individualized strategies to support managing rugby‐related loads to the pelvic floor should be considered. Finally, surveillance and research focusing specifically on rugby players and pelvic floor function are needed. Highlights: High force‐related activities, such as rugby, challenge the pelvic floor muscles (PFMs) and can increase a player's susceptibility to pelvic floor disorders (e.g., stress urinary incontinence, feeling a bulge inside or outside the vagina)Pelvic floor disorders can present at any time across the female lifespan, with pregnancy and childbirth being two commonly reported risk factors for such disordersPredisposing (genetics), inciting (pregnancy and vaginal childbirth) and intervening (lifestyle, aging) factors likely influence pelvic floor load tolerancePFM training has level 1 evidence to be a first line treatment for urinary incontinence and pelvic organ prolapse in the general female population. We encourage PFM training to be incorporated into rugby training programmes across all ages, levels and roles regardless of whether pelvic floor disorder symptoms are present or not [ABSTRACT FROM AUTHOR]

Objectives: This cross-sectional study aimed to compare the sexual function (SF) and pelvic floor function of men with systemic sclerosis (SSc) with age-matched healthy controls (HC) and to identify the implications of clinical features on SF. Material and method: Twenty SSc males and 20 HC aged 18–70 years completed eleven questionnaires assessing SF [International Index of Erectile Function (IIEF), Male Sexual Health Questionnaire (MSHQ)]; sexual quality of life: Sexual Quality of Life Questionnaire-Male (SQoL-M); pelvic floor function: Pelvic Floor Impact Questionnaire-Short Form 7 (PFIQ-7), fatigue, depression, physical fitness, functional disability, and quality of life. Clinical data were collected. Results: Significantly worse SF was observed in patients (median IIEF erectile function 12 in SSc versus 29 in HC, p < 0.001), with 70% reporting erectile dysfunction (ED) compared to 15% in HC. However, no significant difference was observed regarding pelvic floor function (median PFIQ7 8.8 in SSc versus 7.0 in HC, p = 0.141). Impaired SF was associated with higher disease activity, increased systemic inflammation, more pronounced fatigue, reduced physical fitness, severe depression, impaired overall quality of life, dyspepsia, and arthralgias (p < 0.05 for all). Conclusions: Sexual dysfunction is highly prevalent in our SSc patients, whereas pelvic floor dysfunction is unlikely to be associated with these problems. [ABSTRACT FROM AUTHOR]

Objective: To systematically review and synthesise what is known about the effectiveness of non‐pharmaceutical conservative interventions for the management of urinary incontinence (UI) experienced by women during physical exercise. Methods: A systematic search was performed in the following databases in September 2023: the Medical Literature Analysis and Retrieval System Online (MEDLINE), Cumulative Index to Nursing and Allied Health Literature (CINAHL), Excerpta Medica dataBASE (EMBASE), Scientific Electronic Library Online (SciELO), Latin American and Caribbean Health Sciences Literature (LILACS), and Physiotherapy Evidence Database (PEDro). Studies were deemed eligible if population consisted of females who reported symptoms of UI while participating in physical exercise, and the interventions involved any non‐pharmaceutical conservative treatment to manage symptoms during exercise. The primary outcome was severity of UI signs and symptoms. The protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO identifier: CRD42022379138). Results: Of the 3429 abstracts screened, 19 studies were retained. Pelvic floor muscle training (PFMT) and intravaginal devices were the most commonly investigated modalities. Only two randomised controlled trials (RCTs), both among volleyball players, compared PFMT with no PFM exercise, showing a reduction in pad weight gain after the intervention in the experimental groups only. PFMT with and without biofeedback randomised among soldiers demonstrated a reduction in the frequency of urine leakage episodes in both groups, while supervised and unsupervised PFMT randomised among athletes from different sports showed pad weight gain reduction in the supervised group only. Seven single‐arm studies suggested that PFMT alone or combined with other modalities may reduce UI severity in active women based on questionnaires, bladder diaries, and self‐reported symptoms. A single‐arm and a crossover study found pessary use beneficial in reducing urine leakage based on questionnaires and pad weight gain, respectively. When comparing pessary, tampon, and no intervention, two repeated‐measures studies found tampons may reduce leakage more than pessaries in CrossFit exercisers and women performing aerobic exercises. A vaginal sponge also reduced pad weight gain during aerobic exercises. Other modalities (i.e., an intraurethral device, photobiomodulation, and combined therapies) were investigated using case series or single case studies. While all interventions showed some evidence of effectiveness, the results must be interpreted with caution due to methodological limitations and high risk of bias. In particular, despite a high reliance on pad tests as a primary outcome, we identified inconsistencies in how pad tests were administered and interpreted. Conclusion: Only the effectiveness of PFMT to reduce urine leakage during exercise has been evaluated through RCTs, with some evidence of effectiveness. We identified a clear need for higher quality studies, with better reporting on the interventions, and more judicious use and interpretation of outcome measures. [ABSTRACT FROM AUTHOR]

Objective: To investigate pelvic floor dysfunction (PFD; urinary incontinence (UI), faecal incontinence (FI) and prolapse) ≥20 years after childbirth and their association with delivery mode history and demographic characteristics. Design: Cohort study with long‐term follow‐up. Setting: Maternity units in Aberdeen and Birmingham (UK) and Dunedin (NZ). Population: Women giving birth in 1993/1994. Methods: Postal questionnaires at 20 (New Zealand) or 26 (United Kingdom) years after index birth (n = 6195). Regression analyses investigated associations between risk factors and UI, FI and prolapse symptoms. Main Outcome Measures: Prevalence of self‐reported UI, FI, 'something coming down' from or in the vagina (SCD), and the Pelvic Organ Prolapse‐Symptom Score, and relationships with delivery method. Results: Thirty‐seven per cent (n = 2270) responded at 20/26 years, of whom 61% reported UI (59% of whom reported more severe UI), 22% FI and 17% prolapse symptoms. Having only caesarean section (CS) was associated with a significantly lower risk of UI (OR 0.63, 95% CI 0.46–0.85), FI (OR 0.63, 95% CI 0.42–0.96) and SCD (OR 0.44, 95% CI 0.27–0.74) compared to only spontaneous vaginal deliveries (SVDs). Having any forceps delivery was associated with reporting FI compared to only SVDs (OR 1.29, 95% CI 1.00–1.66), but there was no association for UI (OR 0.95, 95% CI 0.76–1.19) or SCD (OR 1.05, 95% CI 0.80–1.38). Higher current BMI was associated with all PFD outcomes. Conclusions: Prevalence of PFD continues to increase up to 26 years following index birth, and differences were observed according to delivery mode history. Exclusive CS was associated with less risk of UI, FI and any prolapse symptoms. [ABSTRACT FROM AUTHOR]

Introduction: Erection dysfunction (ED) is an important health problem that affects millions of men throughout the world. Biofeedback (BF) pelvic floor training is reeducation therapy to teach patients with erectile dysfunction how to strengthen their PFMs which play a role in erection through the enhancement of blood flow to the penis. Aim of the Work: The aim of this study was to assess improvement of BF pelvic floor training in the management of patients with erectile dysfunction (ED). Material & Methods: Thirty men presenting with ED were evaluated with Erectile function domain of International Index of Erectile Function (IIEF), Erectile Dysfunction-Effect on Quality of Life (ED-EQoL) and Maximum squeezing pressure of pelvic floor muscles (PFMS) according to manometric BF before and after receiving BF pelvic floor training. Results: The patients who received BF showed significant subjective improvement in their Erectile functions according to (IIEF)and (ED-EQoL) questionnaires and significant objective improvement in the form of mean of maximum squeezing pressure of PFM susing BF (McNemar test, McN = 0.031, p = 0.001*). Conclusion: Biofeedback pelvic floor training is highly effective easily applicable tool of management in the patients with ED with good outcomes on patient's complaints and quality of life through their effect on improving strength of their PFMs. [ABSTRACT FROM AUTHOR]

Research on justifications has shown their significance in advice-giving, decision-making and children disputes. However, the majority of studies gloss over practical functions of justifications in patient-physician interactions as they are often expected and pursued by patients and in turn, are adopted by physicians to support their stance and authority. This study, through conversation analysis (CA), aims to explore a) what are pragmatic functions of justifications in patient-physician interaction? b) how and when do physicians unfold their justifications for treatment recommendations? c) how do physicians deal with different responses based on their epistemic and deontic domains?. A total of 32 video-recordings between postpartum women and physicians are collected and studied. Four pragmatic functions of justifications drawn upon by physicians are explored: justifications as face-saving, reassurance, risk discussion and clarification-seeking. Despite physicians' attempts to justify their positions as less challenged by patients, this is not the entire picture as they demonstrate their desire to resolve patients' concerns and coordinate their viewpoints to achieve the best practice that facilitates patients' well-being. [ABSTRACT FROM AUTHOR]