Hypothesis / aims of study
The specialty of pelvic health (PH) physiotherapy has been, and remains, predominantly female-led, rooted in its origins in obstetric and gynecologic care.[1] While the field has expanded to include male populations, the practice landscape remains gender-imbalanced. The perspectives of male clinicians navigating this female-dominated space remain largely unexplored. The primary aim was to describe the lived experiences and professional perspectives of cisgender male PH physiotherapists. Specifically, this research identified the facilitators and barriers, perceived benefits and risks, and the impact of gender on interpersonal dynamics with patients and colleagues. Given the exploratory, qualitative nature of this research, no formal hypotheses were established. This study is the first of its kind in the field of PH physiotherapy.
Study design, materials and methods
Through purposive snowball sampling, this study employed a qualitative approach to capture the nuanced narratives of 8 cisgender male PH physiotherapists trained in internal pelvic floor muscle examination and treatment. To ensure trustworthiness and rigor, the researchers utilized an iterative process of data collection and thematic analysis. Data was collected via one-time, semi-structured interviews conducted over Zoom. An interview guide was developed and piloted with two volunteer participants; pilot data were excluded from the final analysis. Several rigorous qualitative safeguards were used, including member checking, iterative coding, and researcher reflexivity.
Results
Analysis revealed two overarching categories of emergent themes: positive and negative influences. Motivations for becoming a PH physiotherapist, facilitators to developing into a PH physiotherapist, and benefits of being a PH physiotherapist shaped the positive influences category. A motivator among all participants was the opportunity to provide PH physiotherapy, particularly for male patients. The significant shortage of male PH physiotherapists was cited by most participants as a key facilitator. Some participants cited the benefit of differentiating themselves in the profession, which also makes them more marketable. Conversely, negative influences, shaped by the subcategories of barriers and risks, included stigma, the historical female predominance of the field, sex-based discrimination, and perceived risks of sexual misconduct allegations as a disproportionate professional challenge.
Interpretation of results
The current study’s findings suggest that increased barriers and risks exist for male PH physiotherapists; however, the positive influences fueled participants’ drive to treat this population. Male PH physiotherapists have unique challenges related to stigma, gender disparity, and professional maturity. They often operate under a cloud of suspicion, balancing their clinical expertise against prejudices that cast men as a potential threat. Following high-profile cases of medical misconduct, this stigma further complicates the integration of males into PH. While females dominate PH physiotherapy practice, the growing interest among males to work in this field is an important step in addressing gender disparity within the specialization and an important professional attempt towards corrective justice allyship from the historical trauma and the traditional paternalistic dominance exerted by men in healthcare. Participants' experiences highlight an evolution of professional maturity in PH, which requires a dual commitment: honoring the historical necessity of female-led safe spaces for populations vulnerable to sexual exploitation while simultaneously fostering an environment that evaluates all practitioners based on ethical standards rather than sex-based assumptions. This reconciliation may be achieved through universal trauma-informed safeguards and a focus on clinical integrity, ensuring patient safety remains the priority regardless of the provider’s sex.