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Your First Visit With Your Pelvic Floor Physical Therapist



So you are a human with a pelvis, which means you would benefit from pelvic floor physical therapy.


Especially if you're a human with a birthing pelvis!


You can't help but feel a little nervous...what is this really all about?


Fear not! You are about to have a life-changing experience for the better!


But to help ease your mind about subjecting yourself to a field that readily endorses vaginal exams, let me give you a little background.


The first thing you should know is that we as 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 and experience in the field.


As a side note, I think this is one of the reasons we are so amazing at our craft. We see the body in a holistic way. We understand how all components of the body work together. We can see the whole picture.


For example, I treated a client with hip pain and stress incontinence that was being driven by stiffness and lack of motion from an old shoulder injury!


That's the kind of stuff we as pelvic floor PT's understand.


Here's how I navigate the first pelvic floor physical therapy session with my clients


On your first day of therapy, I ask will ask you about the history of your current issue. I'm interested to know about old aches and pains as well, because it's all relevant. Don't feel like you need to censor stuff and leave things out.


Tell your story.

I schedule an hour for all of my visits, including the first one, and it's not surprising to spend 30 minutes of the first visit just getting the story of a client.


Once you've told your story, I take some time to explain what the pelvic floor is, how it works, and how it likely relates to what you are experiencing. I use my pelvic floor model to demonstrate anatomy and help educate you on why performing internal exams is an essential part of the data gathering for healing.


At this point it's time to do an exam! Depending on why the client has come to me, I might start with an internal vaginal exam. Most pelvic floor PT's don't use a speculum or stirrups, and I am no exception.


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. The other day I was able to resolve hip pain in a client, that she had been experiencing for 4 years, in just one session. I released tight and tense pelvic floor muscles that I found when performing my exam, and voila! All better.


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! Because 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 get 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.


You can establish a trusting relationship with your pelvic floor PT before undergoing a vaginal exam if that is your preference. It's also possible to work with a pelvic floor PT without ever having a vaginal exam. I help clients all the time through telehealth. That said, there are some conditions that will really be improved best by having an internal exam.


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 reason 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 them around 12 weeks.


Conclusion


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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