Internal pelvic floor muscle examinations are the gold standard for understanding those pesky problems “down there.” Think about it: you wouldn’t go to a dermatologist and ask her to assess your skin through your clothes, and you wouldn’t get a cast put on without an X-ray to prove the bone is broken. Pelvic floor physical therapists have specific, high-level training to assess the muscles, nerves and connective tissues that make up the pelvic floor, and we do this by performing an internal exam of the vagina and/or the rectum, depending on what area we need to assess.
However, not everyone is comfortable with an internal exam, and your job is to let me know what those boundaries are so we can determine if it’s appropriate to proceed. Discomfort, pain, fear, or simply not wanting it are all 100% perfectly acceptable reasons. Just let me know! There are several conditions that can be treated successfully using external techniques if you don’t wish to have an internal exam.
Before we do any external or internal exam, I will show you on a model of the pelvis the muscles and structures I will be assessing. You will be asked to provide consent before any assessment or treatment, and most importantly, you can change your mind at any time. I will leave the room for you to undress from the waist down and lie on the treatment table, covering yourself with the sheet provided. There are no stirrups or speculum involved in pelvic floor physical therapy. I’ll use clean, non-latex gloves and first observe your pelvic floor muscles externally, assessing tissue quality and health, as well as muscle coordination. The internal exam involves inserting one or two gloved fingers into the vaginal canal, or one finger in the rectum, in order to access and assess the front and back portions of your pelvic floor muscles. I am examining the strength, endurance, muscle tone, coordination, connective tissue and tissue quality of these areas. While I talk you through the entire physical exam, you will provide me feedback about any areas of discomfort, altered sensation, or limited mobility. We can stop at any time, and may not even get to the internal exam on your first visit, depending on your comfort level or our time constraints.
NOTE: if you have never had a gynecological appointment (for women), you will be asked to get one before we do any internal work. Similarly, men who have never visited a urologist or proctologist may be asked to see one before we do any internal work. I ask this because it’s important to provide you with the best, most complete care possible and there may be necessary tests or treatment to be completed by an MD before a physical therapist provides treatment. Please ask for a referral to a medical doctor should you need one.