The aims of this study were: a) identify the approach of primary care physicians (PCP) in the presence of a woman with Pelvic Floor Dysfunctions (PFD) up to 1 year postpartum; b) understand if the identified strategies, in the opinion of the doctors, have a timely response.

Cross-sectional study through the application of an online questionnaire, to PCP doctors in an urban area. Data collection was carried out, in the period between 1 July 2023 and 31 August 2023. The questionnaire was composed of 20 questions: socio-demographic characterization, follow-up of pregnant and/or postpartum women; guidance of these women experiencing PFD and time to response following referral.
The study included specialists PCP or doctors doing an intership in PCP that work in healthcare center in an urban area.

50 doctors responded to the questionnaire, with 34 aged between 30-39 years. All professionals follow pregnant women and women postpartum. In the presence of a woman with postpartum urinary incontinence, 24 of the doctors refer to a gynecology hospital consultation and 21 request a Physical Medicine and Rehabilitation (PMR) consultation for physiotherapy clinic. Hospital referral for gynecology of women with prolapse (uterine/vesical/rectal) is made by 44 doctors, and by 38 in the case of women with sexual dysfunction, with 19 doctors from this latter group reevaluating in GFM consultation. In cases of women with hypotonia and/or decreased strength of the pelvic floor muscles, without other symptoms, the request for consultation for PMR clinic is made by 29 doctors, and 18 refer to PMR in the hospital. Most doctors (27) affirm that, on average, women referred to the hospital wait more than 6 months for the first consultation, with 49 considering this time “not” adequate. 29 of the GFM doctors said that the waiting time for consultation in PMR clinic is, on average, 1 to 3 months, "not" being considered adequate time by 26 doctors. 47 of the PCP doctors in this study also consider that pelvic floor physiotherapists should be part of primary health care.

This is the first study developed in this field in Portugal, as far as we know, and it prompts significant reflection on how to enhance the assessment of treatment for these women.
In this study, primary care physicians typically refer women with postpartum pelvic floor dysfunctions to other services in hospital. Unfortunately, the waiting time is too long, approximately 6 months. When referral is made to physiotherapy clinics, the waiting time can decrease by half.
The prevention and treatment of PFDs should involve a multidisciplinary team, with each professional practicing evidence-based care for the benefit of patients. 
This long waiting time for hospital consultation can lead to symptom exacerbation and subsequent impact on family and social life, with increased healthcare costs.
The prevalence of PFD in women is greater than 32%. Pregnancy and childbirth are acknowledged risk factors for PFD, particularly urinary incontinence, pelvic organ prolapse, and sexual dysfunction (1). Physiotherapy intervention is integrated into a multidisciplinary approach, with recent guidelines favoring conservative treatment as the first-line intervention, contributing to prevention, treatment, increased functionality, and quality of life. It becomes important, that physiotherapists take more concerted actions to raise awareness among physicians and the general population about the significance of physiotherapy in this condition.

Considering high presence of PFD in this population, as described in the literature, as well as the latest guidelines from the International Continence Society, which emphasize the importance of conservative approach, there is an urgent need to create referral pathways for the more effective and efficient management of these women.
This will result in improvements in health and quality of life.

Aoki Y, Brown HW, Brubaker L, Cornu JN, Daly JO, Cartwright R. Urinary incontinence in women. Nat Rev Dis Primers. 2017 Jul 6;3:17042. doi: 10.1038/nrdp.2017.42. Erratum in: Nat Rev Dis Primers. 2017 Nov 16;3:17097. PMID: 28681849; PMCID: PMC5878864