Document Type

Article

Publication Date

2026

DOI

10.1093/milmed/usaf431

Publication Title

Military Medicine

Volume

191

Issue

3-4

Pages

e672-e678

Abstract

Introduction

The health of the pelvic floor depends on the integrity of its muscles, connective tissue, ligaments, and their innervation. The female pelvic floor may be more vulnerable to repetitive heavy loads in a military environment than the male pelvic floor because of anatomical and physiological differences. The study aim was to identify and explore possible differences in the female pelvic floor conditions between active military and civilian women with similar demographics.To identify and explore possible differences in the conditions of the female pelvic floor between active military women and civilian women with similar demographics.

Materials and Methods

Military active and civilian women aged 18-39 years, with no history of pelvic floor surgery and not currently undergoing treatment for pelvic floor dysfunction, were invited to participate in the study under the appropriate regulatory approvals. The following data were acquired for enrolled subjects: age, weight, height, parity, and level of physical exercise. Additionally, urogynecological complaints (prolapse, incontinence, pelvic pain, vaginal tissue atrophy), the subjective questionnaire for the Pelvic Floor Distress Inventory-20, 52 biomechanical parameters with the Vaginal Tactile Imager (VTI), and the Biomechanical Integrity score (BI-score) with its five components were collected to objectively quantify tissue elasticity, pelvic support, and functions.

Results

Seventy-three women were enrolled in a civilian group and 100 in a military group. Both groups had similar demographic data. The physical load in the civilian group was significantly lower than in the military group, which included high-intensity training, boot camp, powerlifting, CrossFit, and others. At least one urogynecological disorder was found in 17.8% of the women in the civilian group and 42.0% of the women in the military group. Among them, pelvic organ prolapse was found in 4.1% versus 37.0%; incontinence in 13.7% versus 20.0%; and pelvic pain in 4.1% versus 5.0%. The average pelvic index was 24.7 in the civilian group and 50.0 in the military group (P = 9.3 × 10-⁵). Further, 23 of 52 biomechanical parameters demonstrated a statistically significant difference (P <  .05) between the groups. Among these 23 parameters, 10 VTI parameters showed negative changes for vaginal tissue elasticity, nine parameters showed negative changes in pelvic support strength, and four parameters showed positive changes in pelvic functions in the military versus civilian group (muscle contractive strength and mobility). In terms of the BI-score components (measured in units of standard deviation from normal conditions), the values were 0.28 and -0.42 for tissue elasticity (P = 1.1 × 10-⁶), 0.19 and -0.41 for pelvic support (P = 3.0 × 10-⁶), -0.20 and -0.21 for pelvic muscle contraction (P = .42), 0.05 and -0.15 for muscle relaxation (P = .25), and -0.19 and 0.14 for muscle mobility (P = .013). The BI-score was worse in the military group, with an average value of -0.38, compared to the civilian group, which had an average value of 0.03 (P = .015).

Conclusions

Collected data suggest a negative association between high-intensity physical training, common in the military, and urogynecological health, compared to that of the civilian cohort with the same demographic. Biomechanical markers have been identified that can objectively detect deterioration of the pelvic floor compared to normal conditions. Women's health in the military requires significant attention and advanced quantitative diagnostic techniques.

Rights

Copyright © 2026 The Society of Federal Health Professionals. This work is written by a US Government employees and is in the public domain in the US. Foreign copyright may apply.

Data Availability

Article states: "The data that support the findings of this study are available on request from the corresponding author. All data is freely accessible."

Original Publication Citation

Egorov, V., Takacs, P., Lucente, V., van Raalte, H., Greer, J. A., & Sarvazyan, N. (2026). Biomechanical integrity of the female pelvic floor: A comparison of military with civilian women. Military Medicine, 191(3-4), e672-e678. https://doi.org/10.1093/milmed/usaf431

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