Pre-participation gynecological evaluation of female athletes: a new proposal

Abstract

Objective To propose the inclusion of a gynecological investigation during the evaluation of athletes before competitions, using a specific instrument called the Pre-participation Gynecological Examination (PPGE). Methods The study assessed 148 athletes, mean age of 15.4±2.0 years, who engaged in eight different sports modalities, and who responded to a questionnaire named Pre-Participation Gynecological Examination (PPGE), to the International Consultation on Incontinence Questionnaire - Short Form (for urinary loss), and to the Eating Attitudes Test (for eating disorders). Results Fifty percent of the participants reported irregular menstrual intervals, 23.0% did not know about sexually transmitted diseases, and 72.4% denied having, at least, an annual gynecological appointment. The study identified 18.2% who had urinary loss, and 15% presented with an increased risk of eating disorders. Moreover, 89.9% were not familiar with the occurrence of urinary incontinence in athletes and did not know that they were susceptible to the female athlete triad. A total of 87.1% of them stated that would not mention these issues to their coaches even if this would improve their health or performance. Conclusion The Pre-Participation Gynecological Examination can be considered an easy-to-apply instrument that allowed the diagnosis of alterations often underestimated by the athletes themselves. After its application, the alterations were identified, and determined the athletes’ referral to appropriate evaluation and treatment.

Objetivo Propor a inclusão da investigação ginecológica durante a avaliação pré-participação de mulheres praticantes de exercício físico, por meio de um instrumento específico, denominado Pre-Participation Gynecological Examination (PPGE). Métodos Foram avaliadas 148 atletas com média de idade de 15,4±2,0 anos, participantes de oito diferentes modalidades esportivas, que responderam ao Pre-Participation Gynecological Examination, ao International Consultation on Incontinence Questionnaire - Short Form (para avaliar perda urinária) e ao Eating Attitudes Test (para avaliar alterações alimentares). Resultados Cinquenta por cento das atletas referiram irregularidade menstrual, 23% desconheciam as doenças sexualmente transmissíveis e 72,4% negaram acompanhamento ginecológico, no mínimo, anual. Foram identificados 18,2% de mulheres com perda urinária e 15% de maior risco de alterações alimentares. Além disso, 89,9% desconheciam a existência de incontinência urinária em atletas ou o fato de estarem suscetíveis à tríade da mulher atleta. Entre elas, ainda, 87,1% afirmaram não se referirem a seus técnicos sobre as questões ginecológicas, mesmo que isso pudesse melhorar sua saúde e seu desempenho. Conclusão O questionário Pre-Participation Gynecological Examination mostrou-se um instrumento de fácil aplicabilidade e permitiu o diagnóstico de alterações por vezes não valorizadas pelas próprias atletas. Após a aplicação do questionário, as alterações puderam ser identificadas, determinando o encaminhamento das atletas para avaliação e tratamento adequados.