what to expect during an internal exam with a women's health physical therapist

As a specialist in Women’s Health, I am competent in assessing the function of the pelvic floor both internally and externally.  At the time of initial consultation and after a thorough medical history and orthopedic assessment, it is determined if this type of evaluation is necessary to reach your treatment goals.  If so, and consent is given, an internal exam is done manually without the use of any instruments.   Since most of the women I treat are not familiar with this type of evaluation, I thought I would break down and simplify the steps that a Women’s Health physical therapist might go through with you.  

• First, the examination is explained verbally with visuals such as pictures and a pelvic floor model so you would know exactly what to expect. The therapist will talk you through the entire exam, allowing you to connect to your pelvic floor and work as a team throughout the process.

• Then in a lying down position, your external pelvic floor is assessed visually and tactilely. Looking for discoloration, movement during active contraction and relaxation, and bearing down of the pelvic floor.

• The external pelvic floor is then assessed for sensation and pain.

• The nervous system is then tested for normal reflexes with touch.

• Then using a water based lubricant, the internal examination begins. This is done with 1-2 fingers based on comfort.

• Tissue is assessed for elasticity, pain and trigger points.

• Strength is tested with the patient doing active pelvic floor contractions and relaxations.

• Prolapse is assessed.

• Depending upon findings and patient’s tolerance, treatment will also begin at that time. This could be education to correct a dysfunction, manual work such as applying pressure/scar tissue mobilizations to the painful or restricted areas of tension in the pelvic floor, and coordinating the pelvic floor work with breath and alignment.

• At the end of the assessment, a treatment plan is made with the patient for the goals moving forward.

Personally, I have never done internal work (pelvic exams)  in isolation from other treatment modalities, and believe most therapists are the same.  The internal work is just one component to the overall treatment plan.  I treat the patient as a whole and internal pelvic exam is only a part of that. 

“Our goal as a physical therapist is to get your body to work as optimally and efficiently as possible to prevent injury and for some people that might include assessing and treating the pelvic floor.”

Having the knowledge that this work exists can be so helpful in recovery of symptoms.  Some clients might need internal work weekly for a few weeks, others only once and some will even continue doing parts of it on their own at home.  It is completely individual, there is no one size fits all approach.

So if you are struggling with pain, incontinence, anorgasmia, recovery from labor or simply want to connect with your pelvic floor, this assessment could be for you. I look forward to connecting with you during a session.