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Traditional explanations of this \u201cobstetrical dilemma\u201d emphasize the role of bipedal locomotion in inhibiting the evolution of a wider, more spacious pelvis. Yet recent evidence suggests that additional selective pressures shaped human pelvic anatomy. The pelvic floor hypothesis proposes that expansion of the bony birth canal would compromise the pelvic floor's stability by increasing the distance over which it must span to support the lower abdominal organs. Here, we summarize comparative, clinical, and population\u2010based empirical evidence, as well as findings from biomechanical modeling studies, in order to evaluate the pelvic floor hypothesis. Across mammals, pelvic canal shape and size covary with posture and gravitational loading. In humans, wider and more mediolaterally expanded pelves are consistently associated with an increased risk of pelvic floor disorders, while biomechanical models show disproportionate increases in pelvic floor deformation and tissue stress with increasing canal width. Evidence that pelvic floor disorders can reduce biological fitness supports their evolutionary relevance. Together, these findings identify pelvic floor stability as an important and previously underappreciated factor constraining the evolution of the human pelvis.<\/jats:p>","DOI":"10.1002\/ar.70279","type":"journal-article","created":{"date-parts":[[2026,7,14]],"date-time":"2026-07-14T10:18:44Z","timestamp":1784024324000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Human evolution and the obstetrical dilemma: The pelvic floor hypothesis"],"prefix":"10.1002","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4492-8906","authenticated-orcid":false,"given":"Barbara","family":"Fischer","sequence":"first","affiliation":[{"name":"Konrad Lorenz Institute for Evolution and Cognition Research  Klosterneuburg Austria"},{"name":"Unit for Theoretical Biology, Department of Evolutionary Biology University of Vienna  Vienna Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8548-0995","authenticated-orcid":false,"given":"Ekaterina","family":"Stansfield","sequence":"additional","affiliation":[{"name":"Konrad Lorenz Institute for Evolution and Cognition Research  Klosterneuburg Austria"},{"name":"Unit for Theoretical Biology, Department of Evolutionary Biology University of Vienna  Vienna Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,7,14]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/0047-2484(87)90001-7"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1002\/ajpa.1330750107"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.eururo.2007.12.004"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1097\/00006254-199609000-00024"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.1196\/annals.1389.034"},{"key":"e_1_2_11_7_1","volume-title":"\u00dcber die Verh\u00e4ltnisse der W\u00e4rme\u00f6konomie der Thiere zu ihrer Gr\u00f6\u00dfe","author":"Bergmann C.","year":"1848"},{"issue":"7","key":"e_1_2_11_8_1","doi-asserted-by":"crossref","first-page":"451","DOI":"10.2165\/00007256-200434070-00004","article-title":"Urinary incontinence, pelvic floor dysfunction, exercise and sport","volume":"34","author":"B\u00f8 K.","year":"2004","journal-title":"Sports Medicine"},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00192-012-1876-y"},{"key":"e_1_2_11_10_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1464-410X.2011.10385.x"},{"key":"e_1_2_11_11_1","volume-title":"The female pelvis\u2014Anatomy, function and disorders","author":"Chen Y.","year":"2024"},{"key":"e_1_2_11_12_1","doi-asserted-by":"publisher","DOI":"10.1177\/000313480106700207"},{"issue":"3","key":"e_1_2_11_13_1","doi-asserted-by":"crossref","first-page":"175","DOI":"10.1515\/JPM.2000.025","article-title":"The effects of childbirth on the pelvic\u2010floor","volume":"28","author":"Dannecker C.","year":"2000","journal-title":"Journal of Perinatal Medicine"},{"key":"e_1_2_11_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2005.02.028"},{"key":"e_1_2_11_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.juro.2008.01.098"},{"key":"e_1_2_11_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bpobgyn.2005.08.009"},{"key":"e_1_2_11_17_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1464-410X.2005.05690.x"},{"key":"e_1_2_11_18_1","doi-asserted-by":"publisher","DOI":"10.1111\/jsm.12716"},{"key":"e_1_2_11_19_1","doi-asserted-by":"publisher","DOI":"10.1002\/aja.1000510203"},{"key":"e_1_2_11_20_1","doi-asserted-by":"publisher","DOI":"10.1006\/pmed.2000.0643"},{"key":"e_1_2_11_21_1","doi-asserted-by":"publisher","DOI":"10.1002\/ar.23549"},{"key":"e_1_2_11_22_1","volume-title":"Gorillas in the mist","author":"Fossey D.","year":"1984"},{"key":"e_1_2_11_23_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00404-016-4276-6"},{"key":"e_1_2_11_24_1","doi-asserted-by":"publisher","DOI":"10.1002\/ar.70173"},{"key":"e_1_2_11_25_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11934-022-01133-6"},{"key":"e_1_2_11_26_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjsem-2025-002564"},{"key":"e_1_2_11_27_1","doi-asserted-by":"publisher","DOI":"10.1002\/ajpa.24802"},{"key":"e_1_2_11_28_1","doi-asserted-by":"publisher","DOI":"10.1002\/ajhb.23227"},{"key":"e_1_2_11_29_1","doi-asserted-by":"publisher","DOI":"10.1002\/ar.23550"},{"key":"e_1_2_11_30_1","doi-asserted-by":"publisher","DOI":"10.1111\/brv.12744"},{"key":"e_1_2_11_31_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ogc.2015.10.008"},{"key":"e_1_2_11_32_1","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0b013e3182267f2f"},{"issue":"5","key":"e_1_2_11_33_1","doi-asserted-by":"crossref","first-page":"1045","DOI":"10.1097\/AOG.0b013e31816bbe85","article-title":"Female sexual function and pelvic floor disorders","volume":"111","author":"Handa V. 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