Co esponding au ho : Komal Hagawane
Copy igh © 2025 Au ho (s) e ain he copy igh o his a icle. This a icle is published unde he e ms o he C ea i e Commons A ibu ion License 4.0.
Komal Hagawane * Ishani Sinha and Zeeshan
Depa men o physio he apy, Mewa Uni e si y, Chi o ga h, Rajas han, India.
Wo ld Jou nal o Ad anced Resea ch and Re iews, 2025, 26(01), 3987-3995
Publica ion his o y: Recei ed on 18 Ma ch 2025; e ised on 23 Ap il 2025; accep ed on 26 Ap il 2025
A icle DOI: h ps://doi.o g/10.30574/wja .2025.26.1.1371
Abs ac
Backg ound: Pel ic loo dys unc ion (PFD) is a p e alen issue ha signi ican ly impac s women's heal h and o e all
quali y o li e, o en esul ing om ac o s such as childbi h, ana omical changes, and li es yle choices. Despi e i s
widesp ead occu ence, bo h awa eness and e ec i e ea men op ions emain insu icien .
Objec i e: This s udy aims o sys ema ically e iew exis ing li e a u e ega ding he p e alence, isk ac o s, ou comes,
and conse a i e ea men op ions o PFD in women.
Me hods: A o al o hi y-one pee - e iewed a icles published be ween 2007 and 2025 we e examined. The s udy
designs encompassed andomized con olled ials, coho s udies, c oss-sec ional s udies, and longi udinal s udies,
wi h pa icipan numbe s anging om 40 o 3,000.
Resul s: The indings indica ed ha aginal deli e y is consis en ly linked o a highe incidence o PFD compa ed o
cesa ean deli e y. The isk o de eloping PFD was ound o inc ease wi h pe ineal inju y, ele a ed body mass index
(BMI), ad ancing age, and imbalances in aginal mic o lo a. Weakness in pel ic loo muscles (PFM) was s ongly
associa ed wi h incon inence and dyspa eunia. Conse a i e ea men me hods, pa icula ly pel ic loo muscle
aining (PFMT), bio eedback, and he use o pessa ies, demons a ed e ec i eness in alle ia ing symp oms, al hough
cau ion was ad ised o ea ly implemen a ion. The psychological e ec s, including issues ela ed o body image and
diminished quali y o li e, we e signi ican ye o en o e looked. Awa eness o PFD was no ably low among a ious
popula ions, unde sco ing he necessi y o imp o ed educa ion and ea ly sc eening ini ia i es. Imaging and biome ic
assessmen ools we e ound o be e ec i e o clinical e alua ion. Addi ionally, cul u al and egional a ia ions
highligh ed he impo ance o pe sonalized ca e app oaches.
Conclusion: PFD is a complex condi ion wi h endu ing e ec s on women's heal h. Key con ibu ing ac o s include he
mode o deli e y, auma, and muscle unc ion. Indi idualized conse a i e managemen s a egies can enhance pa ien
ou comes. Inc eased awa eness, imely in e en ion, and cul u ally app op ia e ca e a e c ucial o add essing his
condi ion e ec i ely.
Keywo ds: Pel ic loo dys unc ion; Vaginal deli e y; Pel ic loo muscle aining; Risk ac o s; Women’s heal h
1.
In oduc ion
Pel ic loo dys unc ion (PFD) encompasses a ange o clinical condi ions including u ina y incon inence, ecal
incon inence, pel ic o gan p olapse, and sexual dys unc ion. These diso de s esul om impai men o he pel ic loo
muscles, connec i e issues, and ne es, which play a c ucial ole in main aining con inence and suppo ing pel ic
Pel ic loo dys unc ion a e childbi h: A sys ema ic e iew o p e alence and
associa ed isk ac o s
Wo ld Jou nal o Ad anced Resea ch and Re iews, 2025, 26(01), 3987-3995
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o gans. Childbi h, pa icula ly aginal deli e y, is ecognized as a majo isk ac o o he de elopmen o PFD, due o
he mechanical and neu ological auma imposed on he pel ic loo s uc u es du ing labo and deli e y¹⁻². The
p ocess o childbi h leads o s e ching, ea ing, o a ulsion o pel ic loo muscles, especially he le a o ani muscle
complex, con ibu ing o bo h immedia e and long- e m pel ic loo diso de s³. Vaginal deli e ies, especially hose
in ol ing o ceps, p olonged second s ages o labo , and obs e ic anal sphinc e inju ies (OASIS), a e associa ed wi h a
highe isk o pe sis en dys unc ion compa ed o cesa ean deli e ies⁴⁻⁵. None heless, cesa ean deli e ies do no
p o ide comple e p o ec ion agains PFD, as hey may s ill esul in pel ic loo changes due o p egnancy- ela ed
ana omical s ess⁶⁻⁷.
P e alence e eals ha a signi ican p opo ion o pos pa um women expe ience one o mo e o ms o PFD. S udies
ha e shown ha u ina y incon inence a ec s app oxima ely 20–50% o women in he i s yea ollowing deli e y⁸,
wi h symp oms pe sis ing o mo e han a yea o wo in some cases⁹. Also, up o 30% o women epo symp oms o
pel ic o gan p olapse, and abou 40% expe ience sexual dys unc ion du ing he pos pa um pe iod¹⁰⁻¹². These
diso de s can ha e a p o ound impac on physical, men al and emo ional well-being, including body image dis u bances,
educed sexual sa is ac ion, and limi a ions in occupa ional and social unc ioning¹³⁻¹⁵.
The clinical p esen a ion and se e i y o PFD a e in luenced by se e al isk ac o s beyond deli e y mode, including
ma e nal age, body mass index (BMI), e al bi h weigh , pe ineal auma, and inadequa e pos pa um pel ic loo
ehabili a ion¹⁶⁻¹⁹. The se e i y o pe ineal ea s and associa ed pain can u he comp omise pel ic loo muscle
s eng h and delay eco e y²⁰⁻²¹.
Despi e he high p e alence o PFD, awa eness among pos pa um women emain low, wi h many no seeking imely
medical a en ion²². The s igma associa ed wi h u ina y and ecal incon inence, and he pe cep ion ha hese a e no mal
consequences o childbi h, con ibu e o unde epo ing and inadequa e managemen ²³. Mo eo e , heal hca e sys ems
o en lack s anda dized p o ocols o ou ine sc eening and in e en ion in he pos pa um pe iod²⁴.
Figu e 1 Ana omy o pel ic loo muscle32
This sys ema ic e iew aims o p oduce cu en e idence on he p e alence, isk ac o s, unc ional ou comes, and
ea men app oaches o PFD a e childbi h, u ilizing indings om ecen and comp ehensi e s udies. The goal is o
p o ide an e idence-based amewo k o guide clinical p ac ice, imp o e ma e nal ou comes, and in o m u u e
esea ch on p e en ion and ehabili a ion s a egies o pel ic loo diso de s.
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Figu e 2 (A) Good pel ic suppo wi h i m base, o gans in no mal posi ion. (B) Inadequa e suppo , pel ic o gans
descend32
1.1. Need o he S udy
Pel ic loo dys unc ion emains an unde diagnosed consequence o childbi h ha p o oundly a ec s women’s quali y
o li e. The majo i y o pos pa um women do no ecei e adequa e educa ion o sc eening ela ed o pel ic loo heal h.
The e is a clea need o collec e i ied e idence on isk ac o s, p e alence, and managemen s a egies in o de o
de elop s anda dized ca e guidelines. Add essing his knowledge gap will aid clinicians in ea ly iden i ica ion and
managemen o PFD, ul ima ely enhancing pos pa um eco e y and well-being.
1.2. Scope o he S udy
• This s udy e iews cu en li e a u e o e alua e he p e alence, isk ac o s, and impac o pel ic loo
dys unc ion ollowing childbi h.
• I aims o highligh gaps in clinical p ac ice and awa eness while explo ing e idence-based in e en ions such as
pel ic loo muscle aining.
• The indings a e in ended o guide heal hca e p o essionals in implemen ing e ec i e sc eening and ea men
s a egies and encou age u he esea ch in o holis ic pos pa um ca e.
2.
Me hodology
A comp ehensi e li e a u e sea ch was conduc ed using PubMed, Scopus, and Google Schola da abases o iden i y pee -
e iewed s udies ela ed o pel ic loo dys unc ion ollowing childbi h. The sea ch ocused on s udies published
be ween 2007 and 2025, wi h a pa icula emphasis on he pe iod om 2016 o 2024 o e lec he mos ecen e idence.
Inclusion c i e ia we e as ollows:
• S udies examining he p e alence, isk ac o s, and ypes o pel ic loo dys unc ion pos -childbi h
• Resea ch on ea men app oaches and quali y-o -li e ou comes ela ed o PFD
• A icles in ol ing human subjec s and published in English
• Obse a ional s udies, c osse-sec ional s udies, longi udinal coho s udies, and andomized con olled ials
A o al o 31 s udies we e selec ed based on hei me hodological quali y and ele ance o he esea ch objec i es. Key
a iables ex ac ed included s udy design, sample size, ype o deli e y, iden i ied isk ac o s, ea men in e en ions,
and epo ed ou comes.
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3.
Re iew o Li e a u e
Table 1 Tabula ed o ma o e iew o li e a u e
No.
Au ho (s)
Yea
Ti le
Me hodology
Sample
Size
Key Findings
Conclusion
1
Blomquis e
al.1
2020
Pel ic loo muscle
s eng h and
incidence o PFD
P ospec i e
coho
1,528
49% aginal
bi hs had PFD
s 11%
cesa ean
Vaginal
deli e y
inc eases long-
e m PFD isk
2
Bu kha e
al.2
2021
Occupa ional impac
and awa eness o
PFD
C oss-
sec ional
su ey
200
62% unawa e o
PFD; 35%
epo ed wo k
impac
Need o be e
PFD educa ion
and suppo
3
Hube e al.3
2021
PFD & pe ineal ea
se e i y
C oss-
sec ional
410
42% wi h
3 d/4 h-deg ee
ea s had PFD
Pe ineal inju y
is a isk ac o
4
Hagen e al.4
2020
OPAL RCT -
Bio eedback s
Basic PFMT
RCT
600
20%
imp o emen in
PFM wi h
bio eedback
Bio eedback-
PFMT mo e
e ec i e
5
Cheng e al.5
2022
Vaginal mic o lo a
and PFD
Obse a ional
150
35% wi h
imbalance
de eloped PFD
Vaginal heal h
p edic s PFD
6
Huse e al.6
2017
Vaginal s cesa ean
deli e y and PFD
Compa a i e
coho
450
60% aginal s
25% cesa ean
had symp oms
Cesa ean may
educe ea ly
PFD
7
Sia a ikas e
al.7
2022
Long- e m PFD
pos -deli e y
Longi udinal
300
34% had
pe sis en
symp oms a e
8 yea s
Long- e m
ollow-up
needed
8
Du ou e al.8
2018
Associa ion
be ween
lumbopel ic pain
and pel ic loo
dys unc ion in
women
C oss-
sec ional
150
40% wi h
lumbopel ic
pain had PFD
Lumbopel ic
pain co ela es
wi h PFD
9
Ca ani e al.9
2024
Body image & PFD
P ospec i e
coho
225
45% wi h poo
body image had
PFD
Psychological
heal h ma e s
10
Sigu da do i
e al.10
2011
PF muscle unc ion
p e/pos childbi h
Longi udinal
60
30% PF
s eng h
educ ion
pos pa um
Deli e y
weakens PFMs
11
Handa e al.11
2011
PFD 5–10 yea s
pos -deli e y
Longi udinal
1,011
37% aginal s
14% cesa ean
epo ed PFD
Deli e y
me hod a ec s
PFD
12
Aiyegbusi e
al.12
2023
P e alence o pel ic
loo dys unc ion
and associa ed isk
ac o s among
C oss-
sec ional
300
25% had PFD;
age and BMI
we e key isks
Younge age
and BMI linked
o PFD
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Nullig a ida college
s uden s
13
Neels e al.13
2017
PF exe cises & pain
Expe imen al
120
28%
expe ienced
pain wi h ea ly
PFMT
Tailo exe cises
pos -deli e y
14
Bay u e al.14
2007
Ana omical PF
changes
C oss-
sec ional
150
64% had
ana omical
al e a ion
pos pa um
Deli e y al e s
PF ana omy
15
Zizzi e al.15
2017
Incon inence and
PFM s eng h
C oss-
sec ional
150
52% wi h weak
PFM had
incon inence
S eng h ela es
o symp oms
16
Pe ei a e al.16
2018
Clinical & US
e alua ion o PFD
C oss-
sec ional
103
82% co ela ion
be ween US and
clinical e al.
Ul asound
use ul
17
Chan e al.17
2014
Biome y in
p imipa as
P ospec i e
120
40% had al e ed
PF pa ame e s
Biome ic ools
aluable
18
Oblasse e
al.18
2016
Vaginal balls pos -
childbi h
RCT
40
26%
imp o emen in
PF s eng h
Feasible
in e en ion
19
Simanauskai ė
e al.19
2024
PFM s eng hening
in OASIS
In e en ion
80
32% PFM
unc ion
imp o emen
Rehab a e
auma c ucial
20
Sigu da do i
e al.20
2021
Ea ly PFD
pos pa um
C oss-
sec ional
400
48% epo ed
ea ly symp oms
Ea ly sc eening
needed
21
De icioğlu e
al.21
2018
Adolescen
idiopa hic scoliosis
causes pel ic loo
dys unc ion
C oss-
sec ional
100
35% wi h
scoliosis had
PFD
Scoliosis
associa ed wi h
PFD
22
Dasikan e
al.22
2020
Risk ac o s o PFD
C oss-
sec ional
350
38% had PFD;
age and pa i y
we e key isks
Mul i ac o ial
isk
23
Tenn jo d e
al.23
2014
Dyspa eunia & PF
s eng h
Longi udinal
60
42% wi h weak
PFM had
dyspa eunia
Sexual unc ion
a ec ed
24
Ba bosa e
al.24
2013
PFD pos -cesa ean
C oss-
sec ional
116
32% had
incon inence
Cesa ean
doesn’
elimina e isk
25
Kie ne e al.25
2023
Pessa y pos pa um
P ospec i e
200
68% epo ed
symp om elie
Conse a i e
me hods
e ec i e
26
Abdool e al.26
2018
PF mo phology in
A ican women
Longi udinal
110
56% had
measu able
mo phological
changes
Cul u e-speci ic
da a needed
27
C is ó ão e
al.27
2025
PF s eng h and
incon inence
Coho
260
44% wi h low
s eng h had
bo he some
symp oms
S eng hening
imp o es QoL
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28
U banko a e
al.28
2019
Ana omy &
dys unc ion pos
aginal bi h
Obse a ional
130
57% ana omical
changes seen
P imipa i y is a
isk
29
Hagen e al.29
2024
PFD a e 20–26
yea s
Longi udinal
3,000
41% epo ed
PFD decades
la e
Long- e m ca e
needed
30
González-
Timoneda e
al.30
2025
QoL and PFD
C oss-
sec ional
470
61% had QoL
impai men
PFD a ec s li e
signi ican ly
31
Rao e al.31
2015
P e alence o pel ic
loo dys unc ion
among ma ied
women o
Ka na aka, India
C oss-
sec ional
250
21% had PFD;
u ina y
incon inence
was common
PFD p e alen
in u al India
4.
Resul s and discussion
1.3. P e alence and Risk Fac o s
A majo i y o s udies, including hose conduc ed by Blomquis e al., Handa e al., and Sia a ikas e al., ha e demons a ed
a signi ican ly highe p e alence o pel ic loo diso de s (PFD) among women who unde wen aginal deli e ies in
compa ison o hose who had cesa ean sec ions. The epo ed p e alence o PFD anges om 21% (Rao e al.) o 60%
(Huse e al.). Mo eo e , ac o s such as age, body mass index (BMI), and pa i y ha e been ecognized as impo an
con ibu o s o his condi ion (Aiyegbusi e al., Dasikan e al.). Addi ionally, he incidence o hi d- and ou h-deg ee
pe ineal ea s has been shown o conside ably inc ease he isk o de eloping PFD (Hube e al.).
1.4. Pel ic Floo Muscle Func ion
Reduced pel ic loo muscle (PFM) s eng h has been linked o u ina y incon inence, pel ic o gan p olapse, and
dyspa eunia, as no ed by Zizzi e al. and Tenn jo d e al. Resea ch employing biome ic assessmen s and ul asound
imaging, conduc ed by Pe ei a e al. and Chan e al., has alida ed he p esence o ana omical and unc ional impai men s
in women ollowing childbi h. Sigu da do i e al. (2011, 2021) epo ed ha muscle s eng h could dec ease by as
much as 30% a e deli e y, wi h nea ly hal o he pa icipan s expe iencing his educ ion se e al mon hs pos pa um.
1.5. In e en ions and Managemen
Mul iple s udies ha e assessed conse a i e ea men al e na i es. Hagen e al. (2020) ound ha bio eedback-assis ed
pel ic loo muscle aining (PFMT) esul ed in mo e signi ican unc ional enhancemen s compa ed o s anda d PFMT.
Kie ne e al. epo ed ha 68% o pos pa um women expe ienced symp om elie when using a pessa y. Howe e ,
Neels e al. wa ned ha 28% o women el discom o when ini ia ing PFMT oo ea ly, indica ing he necessi y o
pe sonalized iming in ea men . Addi ionally, Simanauskai ė e al. no ed ha ocused ehabili a ion o obs e ic anal
sphinc e inju y (OASIS) cases led o a 32% imp o emen in muscle unc ion.
1.6. Psychological and Social Impac
PFD has been linked o dec eased sa is ac ion wi h body image (Ca ani e al.), diminished sexual unc ion, and
di icul ies in he wo kplace (Bu kha e al.). Acco ding o González-Timoneda e al., 61% o women expe iencing his
condi ion epo ed a no able decline in hei quali y o li e. Addi ionally, Bu kha e al. no ed ha 62% o he
pa icipan s we e no awa e o PFD, and mo e han one- hi d belie ed i impac ed hei job pe o mance.
1.7. Diagnos ic Tools and Epidemiological T ends:
Pe ei a e al. iden i ied an 82% co ela ion be ween clinical assessmen s and ul asound esul s, he eby endo sing he
la e as a aluable diagnos ic ool. Region-speci ic esea ch conduc ed by Abdool e al. and Rao e al. highligh ed he
in luence o cul u al di e ences on p e alence and symp oma ology. Fo example, Rao e al. epo ed a 21% p e alence
o u ina y incon inence among women in u al India, iden i ying i as he mos common symp om.
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5.
Discussion
This e iew highligh s he in ica e and mul i ace ed na u e o pel ic loo dys unc ion (PFD) in women. The e is
consis en e idence indica ing ha aginal childbi h is he p ima y ac o con ibu ing o his condi ion, wi h
mechanical inju ies, pe ineal ea s, and age- ela ed issue degene a ion u he inc easing he isk. The pe sis ence o
PFD symp oms o yea s ollowing deli e y (Hagen e al. 2024; Sia a ikas e al.) indica es a necessi y o con inuous
moni o ing ha ex ends beyond he immedia e pos pa um phase. Pel ic loo muscle s eng h has been iden i ied as a
c ucial ac o in luencing he se e i y o symp oms, wi h weakened muscles closely associa ed wi h u ina y and sexual
dys unc ion. Ad ances in echnology, such as ul asound and biome ic e alua ions, imp o e clinical accu acy and
acili a e non-in asi e moni o ing, ye hese ools a e s ill no widely adop ed in s anda d ca e p ac ices. Al hough
conse a i e ea men s like pel ic loo muscle aining (PFMT) and he use o pessa ies ha e demons a ed signi ican
e ec i eness and sa e y, he indings also emphasize he need o pe sonalized ea men s a egies. While ea ly
in e en ion may be bene icial o some, i can be uncom o able o discou aging o o he s (Neels e al.), highligh ing
he necessi y o pa ien -cen e ed ca e app oaches.
The psychosocial aspec s o PFD—such as dissa is ac ion wi h body image, wo k- ela ed limi a ions, and diminished
quali y o li e—a e signi ican bu o en o e looked in a o o physical symp oms. Despi e he high p e alence o PFD,
gene al awa eness emains low ac oss a ious demog aphics, including young nullig a ida women (Aiyegbusi e al.)
and indi iduals in u al a eas (Rao e al.). These insigh s collec i ely indica e ha while he physical aspec s o PFD a e
becoming be e unde s ood, a comp ehensi e app oach o managing his condi ion—one ha inco po a es social,
psychological, and cul u al ac o s—needs o be p io i ized in bo h esea ch and clinical se ings.
6.
Conclusion
Pel ic loo dys unc ion (PFD) is a common ye o en o e looked condi ion ha has las ing e ec s on women's heal h
and o e all well-being. Key ac o s con ibu ing o PFD include aginal deli e y, pe ineal inju y, age, numbe o
childbi hs, and diminished pel ic muscle s eng h. While conse a i e ea men s, especially pel ic loo muscle
aining (PFMT) and he use o pessa ies, ha e p o en e ec i e, hey mus be ailo ed o he indi idual, pa icula ly
du ing he pos pa um phase. The psychological e ec s and implica ions o quali y o li e a e signi ican bu a e no
adequa ely add essed in cu en heal hca e p ac ices. The e is an u gen need o ea ly de ec ion, heigh ened awa eness
among bo h he public and heal hca e p o essionals, and comp ehensi e ca e s a egies ha ake in o accoun physical,
emo ional, and sociocul u al dimensions. Inno a ions in diagnos ics and cul u ally sensi i e in e en ions will be
essen ial o imp o ing he managemen and p e en ion o pel ic loo dys unc ion on a global scale.
Fu u e s udies should ocus on he ollowing objec i es:
• Es ablish s anda dized p o ocols o pos pa um sc eening o acili a e he ea ly de ec ion o pel ic loo
dys unc ion (PFD).
• In es iga e he long- e m e ec s o new in e en ions, including pessa ies, aginal ib a o y de ices, and
digi al bio eedback ools.
• Examine he in luence o p ena al educa ion and an ena al pel ic loo aining on he p e en ion o
pos pa um dys unc ion.
• Implemen longi udinal esea ch o e alua e how sociocul u al belie s and heal h li e acy a ec indi iduals'
willingness o seek ea men .
• Ad oca e o he in eg a ion o pel ic loo assessmen s and ca e as a undamen al componen o pos na al
heal hca e se ices wi hin all ie s o heal hca e sys ems.
Compliance wi h e hical s anda ds
Acknowledgmen s
We hank he au ho s o he included s udies and pee e iewe s o hei aluable con ibu ions. Also acknowledging
he co-au ho s o hei in aluable suppo .
Disclosu e o con lic o in e es
No con lic s o in e es o be disclosed.
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