Pelvic organ prolapse (POP) in younger, pregnant and parous women is under-recognised, highlighting the importance of understanding women’s knowledge, attitudes and practices (KAPs) to inform care. This systematic review aimed to synthesise available evidence on prolapse-related KAPs in this population and examine how these are influenced by sociocultural and structural factors.

A systematic review and framework synthesis was conducted in accordance with PRISMA guidelines. Electronic databases (MEDLINE, CINAHL, Cochrane Library, PsycINFO) were searched in June 2024. Studies were screened independently by two reviewers; studies reporting prolapse-related KAPs in pregnant or parous women aged ≤50 years were included. Data were mapped onto the KAP framework. Qualitative and descriptive KAP data were coded and developed into themes. Quantitative KAP findings were categorised (poor, adequate/mixed, good) using predefined grading frameworks to enable comparison of studies. Study authors’ interpretations of sociocultural and structural influences on women’s KAPs were coded separately to generate contextual themes. Findings were synthesised by integrating quantitative and qualitative data within each KAP domain and interpreted in relation to the broader contextual themes. Methodological quality was assessed using the Mixed Methods Appraisal Tool.

Twenty-seven international studies (6,689 participants), comprising qualitative, cross-sectional, and interventional designs, were included. Studies assessed one or more KAP domains (knowledge n=25; attitudes n=16; practices n=15). Knowledge of POP was consistently low: in 11 of 15 quantitative studies, condition-specific knowledge was rated as poor (e.g. scores <50%). Many women had no prior awareness of prolapse and received little or no perinatal pelvic floor education. Knowledge was associated with sociodemographic factors, including educational attainment, occupation and ethnicity.
Attitudes were informed by the normalisation and stigmatisation of pelvic floor disorders. In one study, 44.7% of women considered pelvic floor dysfunction a natural consequence of childbirth. Embarrassment and shame influenced perception of symptoms and resulted in negative self-image. Interactions with healthcare professionals affected attitudes towards treatment, with many women feeling their concerns were dismissed. Although some women expressed positive attitudes towards pelvic floor muscle training (PFMT), this did not translate into behaviour: all studies assessing PFMT (n=7) reported poor baseline adherence.
Self-management and help-seeking behaviours were generally suboptimal. Two quantitative studies assessed help-seeking: in one, 70.8% of symptomatic women had never sought professional care, whilst in another, no participants had sought medical attention. Qualitative evidence described delayed help-seeking and reluctance to disclose symptoms. Barriers included competing caregiving demands, low confidence in treatment, unclear care pathways, and limited access to clinical guidance. Educational interventions significantly improved awareness, attitudes, and engagement; however, provision of information and support was inconsistent.

The findings suggest that poor prolapse-related KAPs in younger pregnant and parous women must be understood within broader structural and sociocultural contexts. Themes derived from study authors’ interpretations suggest that stigma surrounding pelvic floor disorders, alongside gendered caregiving expectations and wider inequalities that devalue and deprioritise women’s health needs, contribute to delayed help-seeking and reduced engagement with care. Gaps in healthcare professionals’ knowledge and training were identified as hindering diagnosis, further limiting access to care. Inadequate integration of pelvic floor education into perinatal care, alongside healthcare system barriers (e.g. waiting times, treatment costs), was also identified as restricting access. Sociodemographic factors amplify these issues, widening inequalities.

Despite the known benefits of pelvic floor education during maternity care, current provision remains inconsistent. The perinatal period represents an ideal opportunity for intervention. However, improving prolapse-related KAPs requires more than individual education. Addressing structural and socioeconomic determinants is essential to overcome barriers to care and improve the prevention, identification, and management of POP.