Current guidelines mention the importance of initial management in pelvic floor dysfunction (PFD) and the limitations access to this treatment for patient making the right choices and guiding the patient is defined as the duty of health professionals (1). In this context, the awareness and knowledge levels of gynecologists should be increased in order to make the right decision in the treatment of patient and maximize health benefits. There are limited studies in the world to measure the awareness of gynecologists in this field (2, 3). We aimed to assess the attitude and practice patterns of gynecologists to patients with PFD.

This was an internet based cross-sectional survey via Google Forms. Gynecologists working in different cities of Turkey were invited via e-mail to participate in a 36-question regarding the level of attitude and practice in the evaluation of patients with PFD. Before this questionnaire was applied to the participants, 5 different experts with over 15 years of experience in the field of PFD were asked for suggestions and feedback on the survey questions, and the survey was structured and finalized in line with these results. Demographic information was collected. Statistical analyses were done.

A total of 306 e-mails were delivered, 100 responded (response rate 32.6%). Demografic datas were presented in Table 1. 82% of participants stated that they performed PFD evaluation during routine gynecological examination, 83% stated that they always performed speculum examination 34% Q-tip test, 78% cough test, 48% pelvic floor muscle strength measurement and 74% pelvic organ prolapse assessment in patients with PFD. They stated that they followed the guidelines in the evaluation of patients with PFD by 63% and in the treatment of patients with PFD by 49%. When the conservative methods frequently used in the treatment of patients with PFD were questioned, 72% of the participants stated that they preferred pelvic floor muscle training, 69% lifestyle modification, 64% bladder training, 14% biofeedback, 11% electrical stimulation, and 9% magnetic stimulation in the treatment of urinary incontinence (Table 2). When the attitude and practice in the management of patients with PFD were examined according to gender of gynecologists and where the residency training was completed, no statistically significant differences were found. There was also no significant difference between the duration of specialization and attitude and practice of gynecologists.

As a result, it can be said that gynecologists have the knowledge expressed in international guidelines in the evaluation and treatment of patients with PFD, which is frequently seen and creates a serious financial burden on the health system. However, according to the results of this study, it has been determined that the reflection of knowledge accumulation on attitude and practice is not at the same rate. Strategies to detect and improve this decline can play an important role in applying the right treatment and reducing the health burden.

More studies are needed to understand and eliminate the barriers to conservative treatment methods recommended in the guidelines.

Wein, A. (2009). Incontinence. Paris, France: Health Publication Ltd.
van Vuuren, A. J., Van Rensburg, J. A., Jacobs, L., & Hanekom, S. (2021). Exploring literature on knowledge, attitudes, beliefs and practices towards urinary incontinence management: a scoping review. International Urogynecology Journal, 32, 485-499.
Charette, M., Pacheco-Brousseau, L., Poitras, S., Ashton, R., & McLean, L. (2024). Management of urinary incontinence in females by primary care providers: a systematic review. BJU international, 133(5), 498-512.