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Do you feel apprehensive about having a pelvic floor exam?

Or maybe you have no clue what to expect. You are not alone!! This post will tell you exactly what to expect in a pelvic floor exam. Don’t miss the FAQ at the bottom!

What to expect in your first/second visits for pelvic floor exam:

First visit:

As in every exam, we will talk extensively about your personal history, what you are dealing with and your individual goals.

Then we will go through a full-body movement screen. The whole body is connected and I would do you a disservice not to look at you as a whole moving human!

Once I have watched how you move as a whole, I will assess more closely certain muscles, joints etc for range of motion, tightness, strength and pain points. Part of this closer look includes external assessment of the pelvis, including the hips, inner thigh muscles, and some pelvic floor muscles that I can feel from the outside. All of this is while you are fully clothed, and I stay in close communication with you throughout to assess your comfort level.

Sometimes first visit, sometimes second visit:

Depending on what we find, and only with your full comfort and confidence, we may find it necessary to move to closer observation of pelvic floor movement and structures, which is done with your bottom half unclothed with some touch from the PT on the external structures of the vulva and perineum. From there, with your consent, we will perform an internal exam in which the therapist will insert one finger into the vagina to assess tightness, strength, endurance of the internal pelvic musculature.

Pelvic Floor Exam FAQ:

Why would I need an internal pelvic exam?

Certain important muscles and structures of the pelvis cannot be seen or assessed from the outside. Therefore, while we can see a lot and treat a lot from the outside, sometimes things are missed that could help someone heal or decrease the problem they are coming to Physical Therapy for. This does not mean I do an internal exam on everyone, sometimes there is no need. I also usually do not perform the internal exam on the first visit. There is plenty other work to get done and this way you have time to ask questions and we can figure out together if you need/want the internal exam and what benefits there might be from having one.

Does it hurt?

Short answer, sometimes! Oftentimes, we have tight/overactive muscles, sometimes we are guarded depending on comfort level. Your therapist should be able to tell quickly and adjust pressure so you are more comfortable. The great news is, if you are tight/overactive/guarded, internal techniques are great treatments and they will be done on the spot, with your consent, and to your level of comfort. I will ALWAYS keep checking in with you to make sure you are comfortable and tolerating the treatment well!

So, I have to be naked?

If you and your therapist decide an internal pelvic exam is indicated, you will need to be undressed from the waist down. Your therapist should give you a sheet or some type of drape so you feel more comfortable and less exposed. Again, I will continue to check with you regarding your comfort level with each step- pulling up the drape, touching your skin and external structures, and ultimately inserting my finger for the internal exam.

What if I change my mind?

The nature of the internal exam can be triggering and might bring up feelings of discomfort or unexpected emotions. Your comfort is my highest priority! For these reasons, we therapists say “consent is ongoing.” If at any point in the exam, for any reason at all, you want to stop, we are done! No hesitation, no questions asked!

Is it like a gynecologist exam?

In short, no. Pelvic PT’s do not use a speculum (the tool that holds your vagina open). We also spend at least 60 mins with you, so the majority of your appointment is doing other things besides the internal exam including talking about your goals and what to expect. Most importantly, you can choose to stop at any time and we can still get a ton of information and be able to start you on a treatment plan with that info!