Predictors of Perceived Sports Performance in Female Athletes: The Role of Pelvic Floor Dysfunction and Sleep Quality

This study aimed to examine the relationships between perceived sports performance (PSP) and pelvic floor dysfunction (PFD) and sleep quality, and to identify whether PFD and sleep quality serve as independent predictors of PSP.

A total of 95 female athletes from various competition levels (46.3% amateur, 46.3% professional, and 7.4% elite) (mean age 21.18 ± 4.51 years) were included in the study. Athletes' PSP, PFD, and sleep quality were assessed using the Perceived Performance in Sports Scale (PPSS), Pelvic Floor Distress Inventory-20 (PFDI-20) with its subscales [Pelvic Organ Prolapse Distress Inventory-6 (POPDI-6), Colorectal-Anal Distress Inventory-8 (CRADI-8), and Urinary Distress Inventory-6 (UDI-6)], and Single-Item Sleep Quality Scale (SISQS), respectively. Pearson correlation analysis was used to examine relationships between PPSS, PFDI-20, and SISQS, while multiple linear regression determined the predictive power of independent variables on PSP.

The PPSS total score correlated with PFDI-20 total (r = -0.239, p = 0.019) and POPDI-6 (r = -0.384, p < 0.001), while with SISQS scores (r = 0.212, p = 0.039). Psychological perception score correlated with POPDI-6 (r = -0.399, p < 0.001), PFDI-20 total (r = -0.353, p < 0.001), CRADI-8 (r = -0.205, p = 0.047), UDI-6 (r = -0.233, p = 0.023), and SISQS scores (r = 0.261, p = 0.011). Physical and tactical perception scores were linked to POPDI-6 score (r = -0.334, p = 0.001; r = -0.326, p = 0.001, respectively); tactical perception was also related to SISQS score (r = 0.242, p = 0.018). Environmental perception correlated with PFDI-20 total (r = -0.196, p = 0.046) and POPDI-6 scores (r = -0.299, p = 0.003). Significant regression models explained 7.3-17.5% of the variance, identifying POPDI-6 as the sole consistent independent predictor for overall PSP (β = -0.446, p = 0.003) and all subdimensions (p < 0.05), whereas SISQS did not emerge as a significant independent contributor in the regression models (p > 0.05).

Within the limits of the examined variables, pelvic organ prolapse symptoms emerged as a significant independent predictor for specific PSP domains, though the absolute explained variance remained modest (7.3-17.5%), while sleep quality was not a significant independent predictor. Rather than practice-ready guidelines, these cross-sectional findings suggest that future prospective and interventional research is warranted to explore whether integrating pelvic health screenings into training routines can meaningfully support athletes' PSP, while carefully considering that the feasibility, confidentiality, and healthcare support for such screenings may vary across different sport participation and competition levels.