Current Periodic Health Evaluation for athletes exclude pelvic floor health: Are we neglecting an essential domain?

In recent years, the Sport and Exercise Medicine community has in- creasingly recognised the importance of pelvic floor (PF) health, driven by initiatives from global sport organisations such as FIFA, World Athlet- ics, England and World Rugby1–4 and supported by a growing body of scientific literature.32 The rising focus on PF health is also highlighted in the recent International Olympic Committee (IOC) consensus state- ment, which recommends comprehensive methods for the epidemio- logical monitoring of injuries and illnesses in sport, explicitly including a dedicated domain for female athletes.5 Within this framework, pelvic floor dysfunction (PFD) is recognised as a clinically relevant health problem, encompassing a range of condi- tions such as urinary and anal incontinence, pelvic pain, overactive blad- der symptoms, and pelvic organ prolapse.6 The pathophysiology is complex and multifactorial, with symptoms typically attributed to a combination of predisposing, inciting, and intervening factors, rather than a single cause.7,8 In this context, sport participation may act as a significant intervening factor that places unique demands on PF struc- tures, potentially increasing susceptibility to PFD symptoms.3 However, despite this emerging awareness, PF health remains largely overlooked and underestimated in standard practice.9,10 The present viewpoint calls for the integration of PF health into routine Peri- odic Health Evaluation (PHE) for all athletes. The inclusion of PF health is essential not only for the early identification and management of symptoms but also for advancing broader surveillance systems, as high- lighted by previous authors.11 These systems could collect informative epidemiological data, providing a more accurate understanding of the true prevalence and impact of PFD in athletic populations. The resulting insights could guide future research to assess the long-term benefits of systematic screening. By incorporating PF health into PHE, the sport medicine community could move beyond addressing individual health issues to tackling systemic knowledge gaps, ensuring the biopsychoso- cial approach.