Diversity in Pelvic Floor Disorders Research: A Matter of Equity and Inclusion

U nderrepresentation of ethnic and racial minority groups has persisted in clinical trials across disciplines, including those related to pelvic floor disorders (PFDs). This matters because the overall prevalence of PFDs in the United States is similar among racial and ethnic groups. Several observational studies over the past 2 decades have reported disparities in treatment outcomes between White patients and other racial groups. In one analysis of the American College of Surgeons National Surgical Quality Improvement Program database spanning 10 years (2005–2015), non-White women received less prolapse surgery and women with Hispanic ethnicity were less likely to undergo an apical suspension for uterine prolapse. Analysis of this same database over a different period showed that non-Hispanic Asian and Black women were more likely to undergo an obliterative procedure compared with non-Hispanic White women. Other reports document the significantly greater risk of perioperative complications for non-Hispanic Black women compared with other races and ethnicities. It is important to understand disparities in outcomes across demographic groups to uncover potential etiologies. It could be argued that differences in treatment may be related to differences in symptoms or degree of bother related to certain PFDs; however, the methods by which these symptoms have been assessed in minority groups may be flawed because most validated PFD questionnaires were originally developed in a largely homogenous White population. In this editorial, we explore the problem of a lack of diversity in reported PFD research and provide possible solutions.