Hypothesis / aims of study
Pelvic floor symptoms (PFS) are highly prevalent and can substantially impair quality of life. Despite the availability of effective treatments, many individuals do not seek professional help or delay consultation (1). Evidence remains fragmented across symptom domains, and a comprehensive synthesis of help-seeking patterns, including barriers and facilitators, is lacking. This study aimed to map the literature on help-seeking behavior for PFS in adults, including prevalence, barriers and facilitators, and sex-related differences.
Study design, materials and methods
A scoping review was conducted following Joanna Briggs Institute (2) methodology and reported according to PRISMA-ScR guidelines (3). Population: non-institutionalized adults (≥18 years) experiencing one or more PFS. Concept: help-seeking behavior, including healthcare and treatment-seeking, as well as reported barriers and facilitators. Context: community and primary care settings. A systematic search of PubMed (MEDLINE) was performed. Two reviewers independently screened studies and extracted data using a standardized charting form.
Results
A total of 204 studies were included, comprising 174 quantitative, 18 qualitative, and 12 mixed-methods studies conducted across diverse geographic regions (see Figure 1).
Help-seeking rates varied widely but were consistently suboptimal. For LUTS (n=123), consultation ranged from 4% to 76% (most commonly 20–50%). For sexual dysfunction (n=60), rates ranged from 1.8% to 76%, typically clustering between 15% and 40%, with higher informal than formal help-seeking. For bowel symptoms (n=28), help-seeking ranged from 5% to 50% for fecal incontinence. POP-related help-seeking (n=14) ranged from 16% to 46%, while evidence for pelvic pain (n=3) was limited.
Across domains, symptom severity and condition-specific quality-of-life impairment were the most consistent predictors of help-seeking. A dose–response relationship was observed, whereby increasing symptom frequency, duration, and perceived bother were associated with higher likelihood of consultation. In contrast, normalization of symptoms (e.g., attributing symptoms to ageing or childbirth), low perceived severity, and expectations of spontaneous resolution were consistently associated with non-consultation.
Psychosocial barriers, particularly shame and embarrassment, reduced help-seeking, whereas disclosure to others facilitated consultation. Healthcare-related factors also played a key role: awareness of PFS as treatable conditions, routine healthcare contact, and clinician-initiated inquiry promoted help-seeking, while structural barriers and negative healthcare experiences discouraged engagement.
Qualitative findings highlighted help-seeking as a dynamic, socially embedded process shaped by symptom appraisal, stigma, interpersonal influences, and healthcare interactions. Sex- related differences were observed, with men more likely to delay consultation and women, particularly postpartum, more likely to normalize symptoms.
Interpretation of results
These findings support a biopsychosocial model of help-seeking, in which care-seeking is not an automatic response to symptoms but the result of interacting biological, psychological, social, and healthcare system factors. While symptom severity acts as an important trigger, it does not consistently lead to healthcare utilization. Psychological processes, including symptom appraisal and beliefs about normality, and emotional responses such as shame, play a central role in shaping perceived need for care, while social influences further affect disclosure and decision-making.
Help-seeking is often delayed until symptoms exceed an individual threshold of tolerability, reflecting a reactive rather than preventive pattern. Healthcare system factors, including accessibility and clinician communication, further influence engagement. The commonly observed “they didn’t ask, I didn’t tell” dynamic highlights missed opportunities for earlier intervention. Sex- and gender-related differences underscore the influence of social norms on help-seeking trajectories.