A controversy over gender discrimination in sumo tradition flared again this week when a referee urged two women to stay out of the ring as they tried to assist an official who was unconscious.

The sumo world has long maintained that the ring is a sacred place and that women cannot enter, in a tradition often criticized as discrimination.

Maizuru Mayor Ryozo Tatami, 66, was delivering a speech in the ring, in Maizuru, Kyoto Prefecture, on Wednesday when he collapsed due to a subarachnoid hemorrhage. He was later rushed to a hospital and underwent surgery. His condition is stable and not life-threatening, one of his secretaries told The Japan Times on Thursday morning.

The referee’s announcement, aired through loud speakers at the gymnasium, rekindled public criticism and prompted Japan Sumo Association Chairman Hakkaku to later issue a statement of apology.

“The referee was upset and made the announcement, but it was an inappropriate response because the situation could have been life-threatening,” Hakkaku said in the statement. “We extend a deep apology.”

He also said the association “deeply thanks the women for giving first-aid treatment.”

Video of the event was repeatedly aired on TV shows Thursday morning, showing several people rushing to help the mayor including at least two women.

Several commentators on different channels argued that the referee should not have urged the women to leave the ring. Numerous people also criticized the sumo tradition on social media outlets.

This is not the first time that the tradition banning women from entering the “sacred” area has been criticized as discrimination.

In 2000, then-Osaka Gov. Fusae Ota asked the sumo association to allow her to enter the ring so she could present the winner’s cup to the champion at a local tournament, but the association rejected the request.

Ota argued that the tradition should be changed if the sumo association wants to win more fans, including women.

Sumo is linked to Shinto ceremonies and matches are often considered offerings to gods. Critics say the rule banning women stems from traditional Shinto and Buddhist beliefs that women are “impure” because of menstrual blood.

The tradition drew public attention for the first time in 1978, when a 10-year-old girl advanced to the final round of a children’s sumo championship. But the association rejected her entry to the ring in the final round at the Kuramae Kokugikan, sumo’s former home arena in Taito Ward, Tokyo.

Mayumi Moriyama, then the head of the labor ministry’s bureau dealing with the welfare of children and women, lodged a protest alleging discrimination. In 1989, Moriyama became the first woman to become chief Cabinet secretary, and in 1990 she asked the association to allow her to enter a ring to present the prime minister’s trophy. The request was rejected.

Not all have criticized the tradition as discrimination. Makiko Uchidate, a writer and former member of the sumo association’s yokozuna council, argues that gender separation is a long-held custom and that the issue should be viewed separately from other gender discrimination.

“It goes without saying I’m against gender discrimination,” she wrote in a 2006 book, adding that if older cultural traditions are maintained, “it is only natural that they won’t fit today’s way of thinking and lifestyle.”

The men-only tradition is considered “a core part” of Japan’s national sport, and the sumo world itself should make any decisions on the matter, Uchidate wrote.