Pelvic Floor Disorders (PFDs) are common and negatively affect women's quality of life. Despite availability of treatments, women often do not seek medical care. Patient knowledge is a known barrier to accessing care. It has been shown that knowledge of PFDs is lower in Canadian immigrant communities. We hypothesized that educating Cultural Health Brokers (CHBs) on PFD will significantly increase the CHBs' knowledge and empower them to effectively communicate this knowledge to their communities, improving awareness and access to care among immigrant women. We developed a "train-the-trainer" model on PFD knowledge for CHBs. Two workshops were held for 36 CHBs. Written material was produced in ten languages. CHB perspectives on the training was assessed with the Kirkpatrick model and knowledge retention was assessed with Prolapse and Incontinence Knowledge Questionnaires (PIKQ) pre and post workshops and at 1-year follow-up. Participants found that workshop content, the facilitators' knowledge, and delivery were appropriate. Participating in the workshop increased knowledge in urinary incontinence PIKQ score (9.6 ± 1.9 vs. 11.2 ± 0.9; p = 0.0003); and prolapse (7.8 ± 2.4 vs. 9.8 ± 1.4; p < 0.0005). The 1-year follow-up survey revealed that over 80% of CHBs felt empowered to discuss PFD with clients, and 80% of CHBs believed that the training empowered clients to seek care. The "train-the-trainer" model was well received by our community partners and improved PFD knowledge in CHBs. We expect this will result in increased knowledge of PFDs among immigrant women and better access to care for this population.

Intimacy and Empowerment in Urogynecology: A Qualitative Exploration of Vibrator Use.

Introduction: Throughout life, the characteristics of a woman’s pelvic floor change due to physiological changes, including pregnancy, childbirth and menopause. These changes can predispose them to pelvic floor dysfunction. Objectives: To develop a linguistically and psychometrically adapted Portuguese (European) version of the Pelvic Floor Distress Inventory (PFDI-20) and Pelvic Floor Impact Questionnaire (PFIQ-7), for assessing symptoms and quality of life in women with pelvic floor dysfunction. Methods: This cross-cultural study used a translation method, followed by an assessment of the validity and reliability of the instruments. The Portuguese versions of the PFDI-20 and PFIQ-7 were completed by 287 women (33.47 ± 8.2 years). To assess reliability, internal consistency was evaluated using Cronbach’s alpha (CA). Descriptive statistical analysis was applied for sociodemographic and clinical characterization, as well as questionnaire scoring. Spearman’s correlation (r) and Student’s t-test were used to analyze criterion and construct validity. Results: The Portuguese versions of PFDI-20 and PFIQ-7 were effectively translated and adjusted, revealing excellent internal consistency, as reflected in Cronbach’s alpha values of 0.853 for PFDI-20 and 0.937 for PFIQ-7. No Ceiling Effect was observed, while a Floor Effect was identified in both Portuguese versions of the PFDI-20 (5.2%) and PFIQ-7 (41.5%). Significant correlations were established between the instruments and five questions. Conclusions: The Portuguese versions of the PFDI-20 and PFIQ-7 showed adequate psychometric characteristics and are valid for use in the Portuguese population.

The onset of symptoms associated with pelvic floor dysfunctions and injuries after pregnancy and childbirth has been well documented and studied. Avulsion of the levator ani muscle (LAM) is known to be a risk factor for these conditions. This study aimed to evaluate the prevalence of LAM avulsion in patients after their first vaginal delivery, associating this finding with factors related to pregnancy and birth. In a cross-sectional study, we evaluated 100 postpartum women after their first vaginal delivery to identify LAM avulsion using ultrasound imaging and to correlate the presence of this injury with pregnancy and birth-related factors. Of the 100 primiparous women evaluated, 46% had some degree of avulsion after delivery. Among these, 37% had complete and 63% had partial avulsion. Regarding laterality, 63% of the lesions were unilateral, affecting the muscle asymmetrically, and 37% were bilateral. The weight of the newborn was a significant factor and showed a statistically significant difference between the groups with and without avulsion. Another statistically significant difference observed between the groups was forceps delivery. The impact of pregnancy and childbirth factors on the pelvic floor muscles is not yet fully elucidated. Identifying these factors is crucial for developing multidisciplinary strategies to prevent such injuries during pregnancy and delivery, thereby reducing their consequences and impact on women's quality of life.

Chatbots based on large language models have been rapidly incorporated into many aspects of medicine in a short time despite an incomplete understanding of their capabilities. This review focuses on ways these chatbots have been utilized in urogynecology. Publications regarding chatbots in urogynecology have centered on patient education, scientific literature review, clinical decision-making, documentation, and research. Several authors have evaluated the ability of chatbots to generate accurate and complete information about prolapse and urinary incontinence. While chatbots can generate accurate information about pelvic floor disorders most of the time, the studies we review indicate that incomplete, misleading, or incorrect information is generated up to 33% of the time. Newer chatbots that are trained for medical applications may help to limit some of these problems. Using chatbots to assist with scientific literature review and research is currently hampered by unpredictable 'hallucinations', where the chatbot may generate information or references that sound plausible but are factually incorrect. While chatbots are being rapidly integrated into many aspects of medicine, the research evaluating these tools in urogynecology is limited. Publicly available chatbots should only be used for patient education, clinical decision-making, and research with caution.

Assessing Postpartum Levator Ani Muscle Recovery: A Feasibility Study on Automated Texture Analysis in Transvaginal Ultrasound.

To err is human: lessons from prolapse studies to identify and strategies to reduce data errors.

Pelvic organ prolapse (POP) is a common pelvic floor disorder resulting from weakened supportive muscles and ligaments. Although the demand for surgeries involving surgical meshes is expected to increase, current options remain limited. In 2019, the Food and Drug Administration (FDA) banned polypropylene mesh for transvaginal anterior compartment prolapse due to safety concerns. This study aimed to develop and evaluate computational models of biodegradable implants made of polycaprolactone, designed to replicate the mechanical behavior of the uterosacral ligaments (USLs) and mitigate complications associated with traditional synthetic meshes. The goal was to assess whether such implants could effectively restore pelvic support under varying degrees of USLs damage. Sacrocolpopexy was simulated using two distinct implant geometries: three square and one sinusoidal configuration. These were integrated into a pelvic cavity computational model to evaluate performance during the Valsalva maneuver under conditions of 50% and 90% damage, as well as total rupture of the USLs. The model, established without implants, demonstrated that complete USL rupture led to an approximate 41% increase in vaginal displacement when contrasted with the healthy model. All implants demonstrated a beneficial effect, decreasing vaginal displacement. Some of these implants successfully reversed the damage-induced displacement, nearing the level of a healthy vaginal model. While further clinical and in vivo validation is essential, these findings illustrate a promising direction and contribute to the growing evidence supporting the potential of biodegradable meshes in POP surgery. However, current outcomes are derived from computational models and serve primarily as a biomechanical proof of concept.

Sexual performance is influenced by pelvic floor muscle (PFM) function. The hypothesis is that sexually active women with pelvic floor dysfunction (PFD) would have better PFM function compared with sexually inactive women. This study was aimed at comparing PFM function between sexually active and inactive women with PFD. This retrospective, cross-sectional study included women over 18 years of age diagnosed with PFD, divided into two groups based on sexual activity, as determined by a structured questionnaire. PFM function was assessed via bidigital palpation using the Power, Endurance, Repetitions, Fast contractions, and Every Contraction Timed scheme. Mann-Whitney, likelihood ratio tests, post hoc power and multivariate regression analyses were conducted, with a significance level of p < 0.05. A total of 229 charts were analyzed (117 sexually active, 112 sexually inactive women). Sexually active women demonstrated significantly better PFM function in terms of strength (p < 0.001), endurance (p < 0.001), and fast contractions (p < 0.001). Post hoc analysis revealed an overall study power of 0.93. Sexually active women had a fivefold greater chance of presenting better muscle function (OR 5.04; IC 95% 2.6-9.6, p < 0.001), longer endurance (+3.5; IC 95% 2.1-4.9; p<0.001) and a higher number of fast contractions (+1.2; IC 95% 0.56-1.84; p < 0.001). Increasing age reduces the PFM strength (p = 0.029), muscular endurance (p = 0.008), and fast contractions (p = 0.054). Menopause status reduces muscular endurance in 1.8 s (p = 0.005) and increase fast contractions in 0.8 (p = 0.021). Marital status and urinary incontinence were not associated with PFM function. Sexually active women with PFD exhibit superior pelvic floor muscle function compared with sexually inactive women.

The female perineum plays a critical role in several physiological processes. During childbirth, this region undergoes significant stretching, resulting in perineal trauma in over 90% of vaginal deliveries. Despite advances in obstetric care, predicting and preventing such injuries remains challenging. Computational models offer a non-invasive approach to investigate female pelvic biomechanics. However, their reliability depends on a deeper understanding of perineal mechanics, an area that remains understudied. This study addresses this gap by characterizing the mechanical behavior of the human female perineal body. Perineal samples were obtained post-mortem from six women and subjected to stress-relaxation tests and ultimate tensile tests up to failure. A genetic algorithm and finite element simulations calibrated the material parameters of a visco-hyperelastic model to fit the experimental data. Stress-relaxation tests demonstrated a 40% stress reduction after 900 seconds, highlighting the tissue’s time-dependent behavior. The ultimate Cauchy stress was 224.70 ± 131.69 kPa at a stretch of 1.97. Histology revealed preferential fiber alignment with the direction of physiological stretching. Three ranges of material parameters were calibrated, enabling the data to be used in future computational simulations. The findings provide valuable insights into the mechanics of the female perineum, facilitating more accurate simulations. This study contributes to ongoing efforts to enhance the understanding, prevention, and management of pelvic floor dysfunctions. Graphic

This study translates and culturally adapts the German "Questionnaire for the Assessment of Pelvic Floor Disorders and Their Risk Factors during Pregnancy and Post Partum" into Spanish and evaluates its reliability, validity, and responsiveness in a Spanish population. Translation/re-translation and cultural adaptation were performed according to standardized guidelines for cross-cultural adaptation of self-report measures. A prospective study involving women in the early weeks of pregnancy was conducted for the validation process. Reliability was measured using Cronbach's alpha for internal consistency, and Cohen's kappa and intraclass correlation coefficient (ICC) for test-retest reproducibility. Construct validity was assessed by comparing median domain scores between women with and without bothersome symptoms using the Mann-Whitney U-test, and with a confirmatory factor analysis. Responsiveness was evaluated by comparing questionnaire responses from the first trimester, the third trimester, and 6 weeks postpartum using Wilcoxon signed-rank test, and effect sizes I and II. During the translation and cultural adaptation process, a minor modification was made to more accurately define postpartum pain. The validation involved 228 pregnant women, of whom 176 (77%) completed the questionnaire again 6 weeks after delivery. The questionnaire showed good internal consistency, with most Cronbach's alpha values exceeding 0.70. Test-retest reliability for each item ranged from moderate (0.59) to very good agreement (1.00) and the total score ICC was above 0.90, indicating excellent reliability. The questionnaire discriminated significantly between women with and without bothersome symptoms and demonstrated responsiveness during pregnancy and postpartum. The Spanish version of the questionnaire is a reliable, valid, and responsive instrument for assessing pelvic floor dysfunction during pregnancy and postpartum.

Pelvic floor disorders are highly prevalent among reproductive-age women in sub-Saharan Africa and commonly lead to urinary incontinence, pelvic organ prolapse, bowel dysfunction, sexual problems, and reduced quality of life. Pelvic floor muscle exercise, defined as repeated contraction and relaxation of the pelvic floor muscles, is an effective preventive and non-surgical treatment of pelvic floor disorders. However, despite the high burden of pelvic floor disorders in Ethiopia, the significance and role of pelvic floor muscle exercise have not yet been studied in a study setting. This study aimed to assess the Pelvic Floor Muscle Exercise Practice and Its Determinants among Postpartum Women in Gurage Zone, Central Ethiopia. A community-based cross-sectional study was employed from May 12 to June 12, 2023. A 422 postpartum women were selected using a systematic random sampling technique. A pre-tested and structured questionnaire was used for data collection. Data were entered into Epidata 3.1 and exported into SPSS version 26 software for analysis. Both bivariable and multivariable binary logistic regressions were performed. Variables with a P-value < 0.05 at a 95% confidence interval were considered statistically significant. In this study,420 study participants were included with a response rate of 99.5%. The proportion of women practicing pelvic floor exercises was 12.14% (95% CI: 6.3, 18.7). Higher education (AOR = 1.40; 95% CI: 1.27, 4.31), ANC visits (AOR = 4.31;95%CI:1.36, 9.57), women with urinary incontinence (AOR = 6.47;95%CI:3.96, 11.54), and women's knowledge (AOR = 6.31;95%CI:3.59, 12.23) were determinants of pelvic floor muscle exercise practice. The present study showed that 87.86% of postpartum mothers lacked proper pelvic floor muscle exercise practices. Thus, encouraging women to attend ANC visits as recommended, providing awareness through health education, and offering counseling on pelvic floor muscle exercises can increase their practice and help reduce pelvic floor disorders.

Objective: To evaluate the frequency of Pelvic floor disorders (PFD) after vaginal deliveries and to compare their frequency in different forms of labor. Methodology: This cross-sectional study was conducted at the department of gynecology and obstetrics, Isra University Hospital, from January 2021 to July 2021, on 99 women aged 16 to 45 years who had given birth through vaginal delivery or assisted vaginal delivery (forceps or episiotomy) within the last six months, regardless of parity or booking status. A structured checklist or questionnaire, the Pelvic Floor Dysfunction Index-20 (PFDI-20), was used to assess symptoms experienced by the patients over the previous three months. Additionally, socio-demographic details, current and past obstetric history, and clinical characteristics were evaluated. The data was analyzed using SPSS version 21. Results: Overall mean age of women was 32.2 +6.03 years. Most common types of PFD were urinary incontinence (UI), and pelvic organ prolapse (POP) affecting 48.5% and 25.3% of the women respectively, followed mixed PFD (combination of symptoms) 7.1%, fecal incontinence FI 5.1%, and others were 14.1%. The mean PFDI-20 scores were significantly higher among women aged more than 30, parity above two, birth weight over 3.5 kg, prolonged or obstructed 2nd stage of labor, and assisted vaginal deliveries p=0.001. Conclusion: The urinary incontinence and POP were observed to be the most prevalent pelvic dysfunctions followed by fecal incontinence. Maternal age and new-born birth weight, parity, the second stage of labor, and mode of delivery were identified as factors for PFD. Keywords: Vaginal delivery, PFD, Urinary Incontinence, PO, Fecal Incontinence, Delayed 2nd stage labor.

This study aimed to evaluate the demographic, educational, and professional characteristics of Brazilian physicians and physiotherapists working with pelvic floor dysfunctions (PFDs), and to determine their association with difficulties in implementing evidence-based practice (EBP). This was an observational, cross-sectional study conducted online using a structured questionnaire distributed via Google Forms between August 2022 and January 2023. Participants included 139 professionals (63 physicians and 76 physiotherapists) with a mean age of 41.56 ± 10.41 years. Data on age, duration of professional practice, academic degree, workplace, and self-reported English proficiency were analyzed. Perceived difficulty in implementing EBP was assessed using the question: “Do I have difficulty implementing EBP in my clinical practice?” Associations were examined using Poisson and Binary Logistic Regression, analyzing the prevalence ratio of positive responses related to EBP implementation. Professionals with low English proficiency demonstrated a significantly lower prevalence of EBP implementation compared to those reporting “good” proficiency. Participants with good English proficiency were 5.26 times more likely to apply EBP. Additionally, those with postgraduate specialization were 5.26 times more likely, and those holding a master’s or doctoral/postdoctoral degree were 11.53 times more likely to implement EBP compared to professionals without postgraduate training. Age and clinical practice setting showed no significant association with EBP use. Limited English proficiency and lower levels of academic training were the main barriers to EBP implementation among professionals managing PFDs.

Aim. To investigate pelvic and urodynamic disorders in women after spontaneous vaginal delivery complicated by perineal trauma. Materials and methods. The study included 200 women of reproductive age (18–35 years): the main group comprised 100 patients with perineal trauma (first- and second-degree tears, episiotomy), and the control group consisted of 100 patients after vaginal delivery without trauma. Six months postpartum, all participants underwent a comprehensive examination, including medical history collection, gynecological and physical examinations, perineometry, pelvic floor ultrasound, uroflowmetry, and questionnaires (International Conférence on Incontinence Questionnaire – Short Form, King’s Health Questionnaire). Pelvic floor muscle tone was assessed by palpation using the Oxford 5-point scale, while contractile strength was measured with perineometry (iEASE XFT-0010, China) using biofeedback (three 10-second trials). Pelvic ultrasound was performed on a Voluson E8 system with convex and transvaginal probes, both at rest and during the Valsalva maneuver, with evaluation of pelvic diaphragm morphometry, urethra, bladder, and α, β angles. Uroflowmetry was used to analyze urinary flow rate and voided volume. Results. The study groups were comparable in age, height, fetal head circumference, and labor duration ( p &gt;0.05). Neonatal weight was slightly higher in the main group (3479.3 ± 442.0 g vs . 3340.2 ± 381.4 g, p &gt;0.05). Birth trauma distribution included first-degree tears (36.9 %), second-degree tears (31.0 %), and mediolateral episiotomy (32.1 %). Lower urinary tract symptoms were more frequent in the main group: increased voiding frequency (71 % vs . 42 %), stress urinary incontinence (38 % vs . 21 % with exertion; 45 % vs . 32 % with cough / sneeze), and urgency (17 % vs . 12 %). King’s Health Questionnaire responses indicated more pronounced impact on quality of life (anxiety, self-esteem, daily activity, work performance). Perineometry demonstrated reduced pelvic floor muscle strength (all three measurements p &lt;0.05), with no significant difference in maximal contraction duration. Ultrasound revealed greater urethral length during Valsalva (31.71 ± 4.8 mm vs . 28.02 ± 2.5 mm, p &lt;0.05) and wider urethra at rest and during straining ( p &lt;0.05). Although mean α and β angles did not differ (p &gt;0.05), their displacement was significantly higher in the main group (α: 4.51 ± 2.5° vs . 2.49 ± 1.0°; β: 11.77 ± 7.0° vs . 6.94 ± 4.6°, p &lt;0.05), suggesting increased urethral mobility. Uroflowmetry showed reduced mean and peak flow rates (11.65 ± 3.7 and 20.57 ± 6.9 ml / s vs . 17.86 ± 2.0 and 25.18 ± 3.0 ml / s, p &lt;0.05) and a non-significant trend toward longer voiding time ( p &gt;0.05). Conclusion. The results of the study demonstrate that perineal birth trauma is a significant risk factor for the development of pelvic and urodynamic disorders in the early postpartum period. Women with perineal tears and episiotomy were found to have a statistically higher prevalence of urinary frequency, stress urinary incontinence, and urgency six months after delivery, accompanied by decreased pelvic floor muscle strength on perineometry and greater urethral hypermobility during functional tests. These changes were associated with a deterioration in quality-of-life indicators according to questionnaires, including increased anxiety, reduced self-esteem, and social maladaptation. Instrumental assessment (ultrasound and uroflowmetry) confirmed the presence of functional and morphometric changes, such as urethral elongation and widening, increased displacement of angles α and β, and reduced mean and peak urinary flow rates. The findings highlight the need for active screening and early correction of pelvic floor disorders in the postpartum period to prevent chronicity, reduce the risk of progression of urodynamic dysfunction, and improve patients’ quality of life.

BackgroundThe central and peripheral effects of pelvic floor muscle training (PFMT) combined with functional magnetic stimulation (FMS) on postpartum pelvic floor dysfunction (PFD) remain unknown. This study aimed to compare the efficacy of PFMT + FMS versus PFMT + sham FMS on postpartum PFD and to explore the underlying central nervous mechanisms.MethodsSixty women with postpartum PFD were randomly assigned to receive 8 weeks of PFMT + FMS or PFMT + sham FMS. Women in both groups were assessed using pelvic floor surface electromyography, transperineal four-dimensional ultrasound, and functional near-infrared spectroscopy at baseline and after 8 weeks of treatment. The primary outcome was to compare the improvements in muscle strength between the two groups. T-tests and Pearson correlation analyses were employed for statistical analysis.ResultsAfter 8 weeks, compared with the sham stimulation group, the active stimulation group exhibited greater improvements in anterior (p = 0.048) and posterior (p = 0.047) resting muscle tone, fast-twitch [mean difference = 7.52 μV (95% CI, 4.36 to 10.68)] and slow-twitch muscle strength [8.56 μV (4.77 to 12.34)], and slow-twitch muscle endurance [7.13 μV (3.51 to 10.76)] (p < 0.001), with more pronounced improvements across all ultrasound metrics. Concurrently, oxyhemoglobin concentrations in sensorimotor cortex (SMC), supplementary motor area, and premotor cortex (PMC) were elevated in the active stimulation group during Kegel exercises. Functional connectivity increased between the ipsilateral PMC and SMC and between the bilateral SMC, with a rising trend in brain network connectivity efficiency [0.0639 (0.0136 to 0.1142), p = 0.015]. These reflected enhanced recruitment of the central nervous system and more efficient coordination of motor control strategies. Moreover, correlation analysis revealed a positive correlation between improvements in pelvic floor muscle function and changes in brain network efficiency.ConclusionCompared to PFMT alone, combined treatment demonstrates superior efficacy in improving pelvic floor muscle function and anatomical structure in women with postpartum PFD, centrally characterized by increased motor cortex activation and brain network connectivity efficiency.Trial RegistrationChinese Clinical Trial Registry, ChiCTR2400084678. Registered 22 May 2024, https://www.chictr.org.cn/.

Pubovisceral muscle (PVM) avulsion affects over a third of women post-vaginal childbirth and is a significant risk factor for pelvic floor dysfunction (PFD). Prior studies show that even a 5mm posterior-inferior shift of the perineal body (PB) enlarges the genital hiatus, contributing to prolapse. Building on this, we investigated the relationship between PVM avulsion andPB movement, correlated prolapse metrics, and sacrum/coccygeal movement with the injury. Moreover, we used statistical shape modeling (SSM) to see shape variation among different groups. A total of 112 MR defecography scans were included from a mixed sample of clinical defecography's. This includes 68 radiologic cystocele patients, 20 patients who were obstruction defecation patients, and 20 nulliparous patients, taken from previous studies Routzong et al. (Ann Biomed Eng 51(7):1461-70); Martin et al. (Int Urogynecol J 36:1607-1615); Routzong et al. (Comput Methods Biomech Biomed Eng 24(2):122-30). These scans were analyzed using axial T2 images to assess PVM avulsion. Patients were categorized into four groups: asymptomatic-nulliparous, non-avulsed, partial avulsed, and avulsed. The asymptomatic group was excluded from statistical analysis because of differences in demographic variables. Measurements were performed on mid-sagittal slices using HOROS at rest and evacuation. SSM was then used to assess shape variation of the pelvic floor. Among 89 parous patients, 25 had avulsion, 18 partial avulsions, and 46 were non-avulsed. The avulsed group was significantly older (p = 0.001), with more pregnancies (p = 0.049) and deliveries (p = 0.021). At rest, they showed increased pubic symphysis-to-PB distance (p < 0.001), and greater bladder descent during evacuation (p = 0.003). Vaginal apex was well-supported in the non-avulsed group at rest (p < 0.001), while sacrococcygeal angle (p = 0.031) significantly increased in avulsed patients. SSM identified shape variation with the avulsed group having the greatest descent of the pelvic floor musculature, perineal body shift, and overall increased levator bowl area. In a cohort of women undergoing pelvic MR defecography, we observed PVM avulsion is associated with inferior PB shift, increased bladder descent, and shape changes to the sacrum/coccyx, underscoring its impact on level III support. Despite limitations from the retrospective design and patient selection, these findings offer valuable insight into the anatomical consequences of avulsion during rest and defecation.

In recent years, the convergence of aesthetic medicine and urogynecology has reshaped the dialogue on women’s health. Procedures once confined to reconstructive domains—repairing pelvic floor disorders, perineal trauma, or postpartum laxity—now coexist with aesthetic motivations emphasizing appearance and self-confidence. This editorial reflects on how female genital cosmetic surgery (FGCS) and female genital aesthetic surgery (FGAS) overlap yet differ ethically, functionally, and philosophically.Defining FGCS and FGASAccording to the American College of Obstetricians and Gynecologists (ACOG) and the Royal College of Obstetricians and Gynaecologists (RCOG), FGCS comprises elective surgical procedures that modify the appearance of genitalia without clear medical indication. These interventions originate in the cosmetic surgery paradigm, focusing on visual symmetry and patient satisfaction. In contrast, FGAS has evolved within gynecology and minimally invasive aesthetic medicine, aiming not only at external appearance but also at comfort, tissue quality, and functional harmony. The distinction matters: while FGCS is largely appearance-driven, FGAS aspires toward holistic well-being and sexual confidence. Recognizing these nuances helps physicians maintain ethical boundaries and ensure that patient motivation is grounded in informed understanding rather than social pressure.

Introduction:Diastasis recti abdominis (DRA) is a frequent postpartum condition characterized by separation of the rectus abdominis muscles along the linea alba. Although often considered benign, it may contribute to trunk instability, low back pain, pelvic floor dysfunction, and body image concerns. Increasing evidence recognizes DRA as both a functional and psychosocial component of postpartum recovery. Methods:This narrative review summarizes latest studies, including randomized trials, observational cohorts, systematic reviews, and expert consensus statements. The analysis focuses on pathophysiology, diagnosis, conservative rehabilitation, pelvic floor integration, and minimally invasive surgery. Results:Evidence supports early, guided exercise programs emphasizing transversus abdominis activation, hypopressive breathing, and pelvic floor co-contraction as effective in reducing inter-rectus distance (IRD) and improving functional stability. Adjunctive modalities such as neuromuscular electrical stimulation, manual therapy, and Kinesio taping may enhance recovery and psychological well-being. For persistent or severe DRA (&gt;3–5 cm) or DRA with midline hernia, minimally invasive repairs such as MIRRAD and retromuscular or endoscopic sublay approaches offer high patient satisfaction, rapid recovery, and low complication rates. Recent classification systems and national consensus statements have improved diagnostic clarity and treatment planning. Conclusions:DRA management requires a multidisciplinary, individualized approach. Early screening, evidence-based physiotherapy, and integration of pelvic floor and psychological support are essential to optimize recovery. Future work should prioritize standardized diagnostic methods, long-term functional outcomes, and the creation of international rehabilitation guidelines.

Pelvic floor disorders (PFDs) affect women's quality of life through physical, psychological, and social domains. The Pelvic Floor Distress Inventory-20 (PFDI-20) and the Pelvic Floor Impact Questionnaire-7 (PFIQ-7) are validated tools for assessing symptom severity and quality of life impact. The current study aim to investigate the reliability and validity of the Hungarian versions of these questionnaires in women with PFD symptoms. This validation study was carried out at the University of Debrecen among women with clinically confirmed pelvic floor disorders. The PFDI-20 and PFIQ-7 questionnaires were translated into Hungarian using independent native English speaker in the back- translation process. Psychometric testing included internal consistency (Cronbach's alpha), test-retest reliability (ICC), and construct validity using the SF-36 Health Survey. The tools were valid and reliable for assessing pelvic floor symptoms and their impact on the quality of life in Hungarian women. One hundred fifty patients completed the Hungarian PFDI-20, PFIQ-7, and SF-36 questionnaires for psychometric evaluation. Both Hungarian versions showed excellent internal consistency (PFDI-20 α = 0.885; PFIQ-7 α = 0.939) and strong test-retest reliability (PFDI-20 ICC = 0.903; PFIQ-7 ICC = 0.933). The Hungarian versions of the PFDI-20 and PFIQ-7 questionnaires demonstrated excellent reliability, validity, and cultural relevance for assessing symptom severity and quality of life in women with pelvic floor disorders. Strong internal consistency, high test-retest reliability, and significant correlations with the SF-36 support their psychometric soundness. These tools are suitable for both clinical and research applications in Hungarian-speaking populations.