This research applied muted group theory to investigate female and male athletes’ experiences with not reporting concussions sustained during athletic competition. Using snowball-sampling techniques, a total of 365 women and 247 men completed an online open-ended questionnaire about their reasons for not reporting a concussion. Results indicated that male athletes were more likely to continue to play through and not report a concussion than female athletes. Participants also indicated that they did not report concussions due to (a) perceived lack of resources, (b) perceived lack of severity, (c) conformance to sport cultural norms, which was comprised of two subthemes: adherence to the pain principle and team allegiance. The results suggest that efforts to address concussion management in sport need to focus on the communicative and structural elements that privilege hegemonic masculinity and playing through pain, as they contribute to muting athletes in advocating for their health.

In this report, we identify existing issues and challenges related to research on traumatic brain injury (TBI) in females and provide future directions for research. In 2017, the National Institutes of Health, in partnership with the Center for Neuroscience and Regenerative Medicine and the Defense and Veterans Brain Injury Center, hosted a workshop that focused on the unique challenges facing researchers, clinicians, patients, and other stakeholders regarding TBI in women. The goal of this “Understanding TBI in Women” workshop was to bring together researchers and clinicians to identify knowledge gaps, best practices, and target populations in research on females and/or sex differences within the field of TBI. The workshop, and the current literature, clearly highlighted that females have been underrepresented in TBI studies and clinical trials and have often been excluded (or ovariectomized) in preclinical studies. Such an absence in research on females has led to an incomplete, and perhaps inaccurate, understanding of TBI in females. The presentations and discussions centered on the existing knowledge regarding sex differences in TBI research and how these differences could be incorporated in preclinical and clinical efforts going forward. Now, a little over 2 years later, we summarize the issues and state of the science that emerged from the “Understanding TBI in Women” workshop while incorporating updates where they exist. Overall, despite some progress, there remains an abundance of research focused on males and relatively little explicitly on females.