Pelvic floor symptoms (PFS) are common, yet frequently underreported, and help-seeking behaviour varies considerably between individuals. Previous research has demonstrated associations between adverse childhood events (ACEs), depressive symptoms, and PFS (1,2). However, it remains unclear whether these psychosocial factors also influence help-seeking behaviour. We aimed to examine the associations of ACEs and depressive symptoms with help-seeking behaviour for PFS and to explore sex-specific patterns, accounting for symptom impact.

We conducted a cross-sectional analysis within a population-based cohort of community-dwelling men and women. PFS were assessed across five domains: lower urinary tract symptoms, bowel dysfunction, sexual dysfunction, pelvic pain, and pelvic organ prolapse, using validated questionnaires. 
Help-seeking behaviour was assessed per domain and defined as having sought professional care for at least one PFS (yes/no). Symptom impact was assessed across domains using a numeric rating scale (NRS, 0–10), reflecting the extent to which symptoms affected daily life.
ACEs were assessed using items from the NEMESIS questionnaire, covering emotional neglect, psychological, physical, and sexual abuse before the age of 16. A cumulative childhood trauma score (range 0–12) was subsequently derived. Depressive symptoms were assessed using the Patient Health Questionnaire (PHQ-9).
Logistic regression analyses were performed to examine the associations of ACEs and depressive symptoms with help-seeking behaviour. Analyses were stratified by sex. Model 1 included ACEs, depressive symptoms, and age. Model 2 additionally adjusted for symptom impact (NRS) to assess whether associations were independent of perceived symptom burden.

A total of 899 participants were included, of whom 66% reported help-seeking for at least one PFS.
In men, Model 1 showed no significant associations between ACEs or depressive symptoms and help-seeking behaviour, while age was positively associated. After adjustment for symptom impact (Model 2), higher ACE scores were associated with a lower likelihood of help-seeking (OR 0.87, 95% CI 0.76–0.99, p=0.046), whereas depressive symptoms remained non-significant. Symptom impact was strongly associated with help-seeking (OR 1.25, 95% CI 1.11–1.40, p<0.001).
In women, Model 1 showed that depressive symptoms (OR 1.10, 95% CI 1.05–1.15, p<0.001) and age were associated with increased help-seeking, while ACEs were not associated. After adjustment for symptom impact (Model 2), depressive symptoms remained significantly associated with help-seeking (OR 1.06, 95% CI 1.00–1.11, p=0.038), while ACEs remained non-significant. Symptom impact was strongly associated with help-seeking (OR 1.24, 95% CI 1.16–1.32, p<0.001).

Help-seeking behaviour for PFS is primarily driven by perceived symptom impact in both men and women. However, psychosocial determinants show clear sex-specific patterns. In men, higher ACE exposure was associated with reduced help-seeking after accounting for symptom burden, suggesting that early-life adversity may act as a barrier to care. In contrast, in women, depressive symptoms were independently associated with increased help-seeking, indicating that emotional distress may facilitate healthcare engagement.
These findings may reflect broader differences in psychosocial processing and health behaviour between men and women. Previous research has shown that men are less likely to disclose ACEs (3), and our findings are consistent with the notion that early-life adversity may also translate into reduced healthcare engagement. This may be related to factors such as stigma, avoidance, or reduced trust in healthcare systems.
Overall, these results highlight distinct psychosocial pathways underlying help-seeking behaviour and underscore the importance of considering both symptom burden and individual psychosocial context in clinical practice.

Help-seeking behaviour for PFS is largely driven by symptom burden, but psychosocial determinants differ by sex. ACEs may act as a barrier to care in men, while depressive symptoms appear to facilitate help-seeking in women. These findings underscore the need for sex-sensitive, trauma-informed strategies to improve access to care and patient engagement.

Mahjoob DM, Teunissen DAM, van Koeveringe GA, Leusink P, Blanker MH, Knol-de Vries GE. Depressive feelings as mediator in the relation between adverse childhood events and lower urinary tract symptoms in males and females. Neurourol Urodyn. 2024 Feb;43(2):479–85. doi:10.1002/nau.25368 PubMed PMID: 38108493.
Mahjoob DM, van Koeveringe GA, Vrijens DMJ, Blanker MH, Knol-de Vries GE. Depression as a mediator in the relationship between adverse childhood events, pelvic pain, and pelvic organ prolapse: A cross-sectional study using structural equation modeling. J Psychosom Res. 2025 Oct 1;197:112352. doi:10.1016/j.jpsychores.2025.112352
O’Leary PJ, Barber J. Gender differences in silencing following childhood sexual abuse. J Child Sex Abuse. 2008;17(2):133–43. doi:10.1080/10538710801916416 PubMed PMID: 19042242.