Optimising gynaecological surgical care for elite female athletes: a narrative review

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Background: With the rapid growth of women's elite sport, there is an increasing need to optimise healthcare for female athletes. These athletes can present unique clinical challenges, including high physical demands, altered energy availability, increased rates of pelvic floor dysfunction, and sport-related psychological pressures. Gynaecological surgery may significantly disrupt training and competition schedules, impacting both short- and long-term performance. Objectives: This narrative review provides a practical, evidence-based framework to support clinicians in delivering tailored peri-operative care for female athletes undergoing gynaecological surgery. Key findings: Drawing from current literature and multidisciplinary expertise, the review outlines key considerations across the pre-, intra-, and post-operative phases. It emphasises the importance of pre-operative assessment of menstrual health, bone density, nutritional status, and psychological readiness, particularly in athletes at risk of Relative Energy Deficiency in Sport (RED-S). Intra-operatively, surgical techniques should account for anatomical variations in lean athletes, and measures should be taken to minimise complications such as neuropathy, wound breakdown and delayed recovery. Post-operative rehabilitation requires a coordinated, multidisciplinary approach integrating physiotherapy, nutrition, pain management, and psychological support to facilitate a safe and timely return to sport. Conclusions: This review highlights the need for athlete-specific surgical strategies that align with the physiological and performance demands of elite sport. Future studies are essential to inform sport-specific guidelines and optimise outcomes for this understudied population.

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