Updated: May 16
Whether you are pregnant, postpartum, or just want to promote the best pelvic health possible, pelvic floor physical therapy is for you.
But many clients feel a little nervous or apprehensive about what pelvic floor PT entails.
I am here to put you at ease and prepare you for your first session with a pelvic floor PT. Although all physical therapists treat somewhat differently, I hope that by outlining my approach I will ready you for a visit with anyone.
The first thing you should know is that Pelvic Floor Physical Therapists are trained in all aspects of physical therapy. We are licensed PT's that have been through school and are proficient as general providers ready to work in any setting.
We go on from there to develop a specialized skillset in pelvic floor. This requires additional coursework, certifications, experience and training in the field.
This helps pelvic floor physical therapists uniquely view dysfunction holistically and as a whole-body approach.
Here's how I navigate the first pelvic floor physical therapy session with my clients
On your first day of therapy, we will start with your story. How long have you had what you are currently dealing with? What else is going on?
Tell your story.
We often spend the first 15 minutes of as session going through your story and your history. Pelvic floor conditions can begin early in life an be compounded overtime with life events.
Once you've told your story, we will discuss possible reasons why you are experiencing your symptoms. At this point I educate clients using models, analogies, and anatomy.
Then it's time to do an exam.
We typically start with a vaginal exam to assess the function, mobility, trigger points, and strength of the pelvic floor. Most pelvic floor PT's don't use a speculum or stirrups for for the exam.
A vaginal (or occasionally rectal) exam is important part of the visit for the therapist to gather information about how the pelvis is being affected by the pelvic muscles.
I use one finger to perform a vaginal exam, and I am looking for pain points in the pelvic floor, strength of the muscles, ability of the muscles to relax, skin integrity, signs of prolapse, position and irritability of the bowel/bladder/cervix.
Unfortunately you cannot get this data any other way.
From this exam, I can make an assessment of how much the pelvic floor is playing a role in a client's issue. I might also do some treatment for issues that I find.
From there, I can decide which additional areas, if any, I need to investigate further after the client gets dressed. I usually look at the outer hips, but occasionally I need to see spine and shoulder movements as well. At some point during the course of treatment, it's likely I've evaluated almost every part of the body! It's all connected and it all matters.
With the remaining time I will either provide hands-on treatments for the client or instruct in a home exercise program.
Follow up visits may or may not require additional internal work. It all depends on what structures are driving dysfunction.
And there you have it. That's how the first visit of pelvic floor physical therapy goes for my clients.
What if I really don't want a vaginal exam?
If you're feeling really hesitant to have a vaginal exam, don't worry, you can still come in for an evaluation of external structures. Seasoned pelvic floor PT's will have a good idea of what is going on in the pelvis from your story and exam of external structures, so it's likely we can still help.
What if I'm on my period?
If you are menstruating, it's really up to you whether your want to give consent for a vaginal exam or not. As pelvic floor PT's, menstruation does not present a barrier to performing exams and providing care. I tell my clients that if it really freaks them out then lets wait, because I would rather they feel as comfortable as possible.
Do I need to shave (down there) before I come in?
Nope! Just no. Shaving the pubic region is all about your comfort. We are looking primarily at the vulva, which doesn't even grow hair! Plus, we've seen it all and couldn't really care less.
How soon can I come in postpartum?
We typically do vaginal exams 6 weeks postpartum but we can help with shoulder pain, neck pain, low back pain, hip pain, core strengthening, and soooo many other things before the 6-week mark, so reach out before if you need it!
How soon can I come in when pregnant?
I usually start performing internal exams around 12 weeks, but if you are having issues earlier than that you are welcome to come in for an external assessment.
Pelvic floor physical therapy does usually include a vaginal exam, but we are also so much more than that. We see the body as a complete picture, while also attending to areas that are often left out by modern medicine.
If you are still hesitant to make an appointment after reading this, let me know what your concerns are in comments below,!
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