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The Female Athlete

Written by Sue Fuller-Good (MSc Physio WITS) Physiotherapist with a special interest in the mind-body connection


Let’s talk about the female athlete?

This includes hot shot athletes and recreational athletes and everything in between. Females who exercise have very special needs and we need to recognize these special needs. As women who exercise, mothers of girls who exercise and daughters of Moms who exercise, we need to be exquisitely aware of the risks and problems these needs produce.

What are some of the risks female athletes face?

They are at high risk for suffering from stress related disorders like anxiety, obsessive compulsive disorder, disordered eating and body dysmorphia, among many others. Why? Because in many people’s minds women should be leaner than their bodies allow them to be. In many people’s thinking, females should be able to compete with males, even when they can’t. They should be able to compete at high levels all the time, despite the fact that they are cyclical beings with hormone fluctuations that affect performance and ability to train. This lack of acceptance of the true nature of females and especially those who exercise puts them at high risk for mental health challenges.

Many female athletes suffer from the female triad, which is a medical condition that involves three intertwined and interrelated conditions, all of which need to be recognized, diagnosed and treated as early as possible. These conditions include: menstrual disturbance, low energy availability and low bone mineral density. Any one or all three can be present, and should be seen within this triad and not as an isolated condition in a female athlete.

Diagnosis and early treatment of the triad, helps to avoid permanent damage to the fertility, bone architecture, psychological health and the neuro-endocrine system of a woman’s body. If athletes, families and friends aren’t aware of these conditions, these symptoms will be at risk of being ignored, leaving the triad undiagnosed. Not receiving the treatment required to restore their health and enable their sustainable performance and ongoing healthy participation in sports is calamitous for female athletes.

In addition to this ongoing excessive strain, both physically and mentally, may lead to faulty recruitment patterns of the core muscles. The pelvic floor muscle is particularly vulnerable to this and pelvic floor dysfunction is often the result. The prevalence of pelvic floor dysfunction among female athletes is extremely high and it may lead to many very disabling conditions, like: pain, ongoing sports injuries, incontinence, sexual dysfunction and sexual pain. The longer pelvic floor muscle dysfunction is left undiagnosed and untreated, the harder it is to rehabilitate this crucial muscle. Expertise is required to treat these female athletes. Lack of good treatment and intervention may lead to poor pelvic health and this may implicate performance and health adversely and add to stress and psychological challenges. It may lead to continence problems at a later time which could have been prevented and to future sexual dysfunction too.

Female athletes and exercisers are sometimes at risk of suffering from disordered eating, this may be the cause of low energy availability. Low energy availability may be the result of excessive training and not disordered eating, but relative energy insufficiency in sport (RED-S) causes a cascade of problems including pelvic floor dysfunction and hypothalamic dysmenorrhea (periods stop), osteoporosis (loss of bone density) (female triad) and many others.

Health care professionals who work with female athletes, coaches and family members need to be able to recognize energy deficiency and help to work to unravel it, through referral, education, awareness and providing empathetic support.

Knowledge is power, awareness is key, and this is a subject many people know very little about.

Knowing what you have just read can give you the insight you need so your female athlete self, friends and family members can all benefit.

If you are worried... seek help!

Let’s not leave anyone out there suffering without help.


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