Prevalence of pelvic floor dysfunction in male athletes and its dose-dependency in high-intensity exercise: A scoping review

Background: This scoping review summarises literature on the prevalence and types of male pelvic floor dysfunction linked to increasing exercise intensity, with a secondary aim of exploring whether a dose-dependent relationship exists between the two. Methods: A comprehensive search of CINAHL, PEDro, PubMed, Scopus, and Web of Science databases was conducted up to January 2025 using MeSH terms and keywords relating to exercise and PFD. Results: The search yielded 6031 publications with 1199 duplicates removed prior to screening. After screening 4493 articles, 10 articles were eligible for inclusion. Substantial reporting differences of exercise-related variables were identified. Six studies reported prevalence rates of lower urinary tract symptoms (LUTS), including urinary incontinence, ranging from 3.8 % to 18.8 %. Only one study examined multiple pelvic floor issues, identifying anorectal incontinence in 61.8 % of participants. Studies investigating erectile dysfunction (ED) and chronic prostatitis/pelvic pain (CP/CPPS) reported hazard and odds ratios. When reporting as ratios for ED, CP/CPPS, studies identified that higher weekly MET-minutes of physical activity were slightly more protective than sedentary or lower physical activity levels. The cross-sectional studies reporting LUTS as a sample percentage identified a dose-dependent relationship between weekly MET-minutes and the prevalence of male LUTS, based on both minimum and maximum weighted averages (R = 0.86 vs. R = 0.87). Conclusions: Athletic males may experience higher rates of LUTS than the general population. A dose-dependent relationship between MET-minutes per week and male LUTS indicates that men who exercise intensely at higher volumes may be at greater risk of symptomology, whereas risk of ED and CP/CPPS may be reduced.