What to Expect for your Pelvic Physical Therapy Appointment

When scheduling a pelvic health physical therapy appointment, there can be some questions on your end of how this appointment will actually go. We would love to lay that out for you! So upon attending your physical therapy pelvic health evaluation:

Short answer first: No stirrups and no speculums and absolutely no internal work if you aren’t interested

Long answer:

1. We start with getting to know each other. I want to hear your story: the good, the bad and the ugly. No matter how long it takes. This appointment is for YOU and no one else, even if you aren’t sure it’s relevant, I want to hear it.

2. We use a pelvic model to educate you about your pelvis. We’ll talk about how the model correlates to your body, what the functions of the muscles are, where the organs are, and what are common things to expect from this area of your body.

3. You’re going to move around, I’ll watch you perform random tasks so I can assess how your body is moving and how it reacts to the movements.

4. We will look further into the surrounding body parts of your pelvis (think hips, back, core) by testing movements and strength.

5. We complete an internal exam

   1. First we talk about what to expect using the pelvic model

   2. I will place a sheet on the mat with another sheet on top for you to cover with

   3. I’ll step out of the room so you can undress from the waist down and return when you are under the sheet

   4. The internal exam will consist of a single gloved and lubricated finger (I use “slippery stuff” lubrication, but have others if you prefer).

      1. We observe the tissues on the outside of your body (I have a handheld mirror for you to look with me and learn about your body!)

      2. Palpation of the external tissue of your vulva

      3. Separate labia majora and labia minora to observe your tissues. I will observe your tissues while I ask you to breathe, bear down, contract, and cough

      4. Insert a single finger to the vaginal opening while feeling the different layers of muscles (there are three different layers, we only go to the different layers as you approve)

      5. Learn how to relax your pelvic floor muscles and contract them

      6. Internal exam done!

   5. Come up with a plan to meet your goals

Do you need to do the internal exam? Absolutely not, that part is completely up to you. It does help us both learn more information about your body and tailor your treatment specifically for you, but is not crucial to help you meet your goals. We can skip the internal exam the first few appointments and revisit later.

Other things to consider:

• Your body changes at different times of the day. If you experience pelvic floor heaviness or pelvic organ prolapse, that can look and feel differently based on the time

• We can include a standing internal exam. This is a more functional position, we don’t usually lay on our backs all day

• Internal exams ARE safe throughout pregnancy

• Passing gas or queefing during internal exams is normal

• I have wet wipes and towels for you to use prior to and following internal exams

• Remember that this appointment is entirely for you, you are always in charge of what happens

This is of course a very complex topic and we want to make you as comfortable as possible as this is certainly a team effort! We want you to know though, that your best interests and goals are OUR priority. We look forward to being your teammate through that process. If you want to learn more, please find more information about what pelvic floor physical therapy can help with here. If you have further questions for us, schedule a free 15 minute discovery call or if you’re ready to get started, either of those appointments can be scheduled here !

Lexi Noel, Doctor of Physical Therapy

Loon State Physical Therapy