Why Shame Stops Women Getting Help and What Can Change That

In their lifetime, up to 50% of women will experience some form of pelvic health issue such as urinary incontinence, pelvic organ prolapse, pelvic pain, painful sex, and bowel symptoms. These issues can have a big impact on a woman’s physical, mental, and social wellbeing. Effective treatments exist – in particular, seeing a pelvic floor physiotherapist is often recommended as a first-line treatment for many of these conditions. Yet women consistently wait, sometimes years, before getting help. The reason is most often due to embarrassment, shame, and the stigma surrounding pelvic symptoms.

What the research says

A 2024 systematic review looked at the findings of 86 studies that represented over 20,000 women with pelvic health symptoms across 24 countries. This study found that across different pelvic symptoms and different countries, the barriers to women seeking help were essentially the same.

The three most significant barriers were:

1. Embarrassment and shame: Women described feeling embarrassed, ashamed, and reluctant to speak to anyone about their symptoms, sometimes for years. Many internalised negative beliefs about their own bodies, experienced reduced self-worth, and felt self-disgust or self-blame about symptoms that were outside their control.

2. Lack of knowledge: Many women did not know what their symptoms were, whether they were normal, or that effective treatment existed. Without this knowledge, they could not recognise that they warranted or deserved care. Many normalised their symptoms, particularly after childbirth or with ageing, and believed that leaking, prolapse, or pain were simply part of being a woman.

3. Fear of being trivialised by clinicians: Women described past experiences of having pelvic symptoms dismissed, minimised, or met with embarrassment by clinicians they approached for help. Some were told to simply "live with it” and others felt judged. The expectation that seeking help would result in being trivialised stopped many women from trying at all.

The cost of not reaching out

Women in the research described symptoms that became increasingly disruptive over time – affecting sleep, work, relationships, sexual health, and mental wellbeing. Many women became stuck in a cycle – shame prevented them from seeking help, symptoms continued or worsened, and the belief that nothing could be done deepened the shame further. For most women in the research, it was only when symptoms became severe enough that they finally sought care.

What supports women to seek help

The same study looked at what made a meaningful difference to women seeking help. The things that support women when shame is a barrier include:

• Education and awareness: Increasing knowledge about what pelvic symptoms are, whether they are normal, and that effective treatment exists supports women in identifying themselves as deserving of care. When women understand that their symptoms are common, explainable, and treatable, shame begins to lose its grip.

• Easy to understand information: The tone and framing of health information matters. Information that is warm, plain-language, and free of clinical jargon helps women feel that their experiences are valid and that care is available for people like them.

A supportive clinician: Women are significantly more likely to seek and continue with care when their clinician proactively raises pelvic symptoms, listens without judgement, and normalises the conversation. A pelvic floor physiotherapist who creates a safe, non-judgemental environment can reduce the anxiety and shame that may have prevented a woman from getting support sooner.

• Social support and shared experience: The research found that support from others, and knowing that other women share the same experience, encouraged women to reframe their symptoms as a medical issue rather than a personal failing. Open community conversation and reduced social stigma around pelvic health were also identified as meaningful contributors to help-seeking.

Where to from here

Shame is a well-documented response to a social environment that has historically treated women's pelvic health issues as taboo, and to healthcare experiences where symptoms have been dismissed or minimised. The research is clear that shame has a real cost, including delaying care, worsening symptoms, and affecting wellbeing in ways that are entirely preventable.

If you have been putting off getting help for pelvic symptoms because of embarrassment or uncertainty about whether your symptoms are serious enough, a pelvic floor physiotherapist can make that conversation easier than you might expect, help you understand your symptoms, and get you on track with the right treatment.

References

Jouanny C, Abhyankar P, Maxwell M. A mixed methods systematic literature review of barriers and facilitators to help-seeking among women with stigmatised pelvic health symptoms. BMC Women's Health. 2024;24:217. https://doi.org/10.1186/s12905-024-03063-6