If the thought of any kind of pelvic exam makes you immediately clench your pelvic floor, you're not alone — more than 50% of people report having anxiety when it comes to pelvic floor physical therapy. We get why. It can be incredibly awkward to describe the consistency of your poop to a medical provider or talk about the pain you've been having with sex. And given how few doctors educate patients on the benefits of pelvic floor physical therapy, you may wonder if seeing a PT and getting a pelvic exam will actually help you.
We're here to pull back the curtain on the pelvic floor muscle exam and reassure you that 1. it's far more comfortable than you might imagine, and 2. it's 100% worth doing. The info below — which includes genuine feedback we've gotten from our patients — will help answer your questions and alleviate your concerns, so that you can get the medical care you need to feel better.
"Why should I get a pelvic muscle exam?"
If you aren’t familiar with your pelvic floor, this multilayered and multi-talented group of muscles sits deep in the bottom of your pelvis. Running from your pubic bone to your tailbone and wrapping around the urethral, vaginal, and anal openings, your pelvic floor muscles provide support to and facilitate the functions of all the pelvic organs.
When these muscles are not working the way they should (aka pelvic floor dysfunction), you may experience symptoms such as:
- Leakage (stool or urine)
- Urinary retention
- Difficulties having a bowel movement (constipation, straining to empty)
- Pain with vaginal penetration (gyn exams, tampon insertion, sex) or sexual dysfunction
- Pelvic heaviness/feeling of your organs falling out (aka pelvic organ prolapse)
- Low back or pelvic pain
- Urinary urgency or frequency
If you have symptoms of pelvic floor muscle dysfunction, getting a pelvic muscle exam can be one of the most important steps you can take. The exam will provide your physical therapist with critical information about the source of your symptoms. As your PT examines your muscles, they'll determine if they are tight, weak, under-active, and/or uncoordinated. Once they understand what's going on with your pelvic floor, they can provide you with an evidence-based and effective treatment plan.
"What can I expect during a pelvic muscle exam?"
The first thing we want you to know about the pelvic floor muscle exam performed by physical therapists is that it's nothing like your annual GYN visit. Although gynecologic exams are a vital part of women's health care, for those who have pelvic muscle dysfunction, they can be uncomfortable or even painful. If you've had this negative experience in the past, it's important to acknowledge how that might justifiably fuel your fears. Rest assured that while both exams are largely completed through the vagina, that's where the similarities stop — so you can strike stirrups and speculums from your list of worries.
First, your physical therapist will start with a thorough explanation of what you can expect — no element of the exam will be a surprise — and you should feel fully informed before you consent. You'll then be comfortably positioned on the exam table with pillows supporting your legs and hips in a position that allows the PT to examine your pelvic floor muscles. Part of the goal of ditching the stirrups is to improve your comfort and minimize the feeling of being open and exposed. You’ll also have several pillows to support your head, so you're not left staring at the ceiling.
Disposable sheets are used to maximize your privacy, and are often only lifted when visually examining your vulvar tissues for areas of scarring or irritation. Your PT may also assess your perineal body (the tissue between the vaginal and anal openings) to get a general sense of the movement and activity of your muscles. This is an important step in helping them gauge your level of sensitivity and minimize discomfort during your exam.
When examining the pelvic floor muscles, either through the vaginal or rectal walls, your physical therapist will insert only one finger, pushing through the walls to feel your muscles. This significantly minimizes any pain you may experience and allows the PT to feel the specific qualities of your muscles, including your muscle strength and coordination. By directly feeling your muscles, your PT can determine if you have trigger points, overactivity, or if there is under-activity that is causing your symptoms.
It's common to come away from a pelvic muscle exam feeling heard and hopeful. A few things we often hear after the exam is over:
"That was nothing like my GYN exam."
"That wasn't anywhere near as bad as I anticipated."
"No one else has been able to reproduce my pain."
"That was fascinating!"
There are many different methods that pelvic physical therapists can use to assess your pelvic floor muscles, but due to where they're located deep in the pelvis, they're best examined through the vagina or rectum. If that’s not what’s best for you, or if you are being seen virtually, the good news is there are a variety of other ways to examine the pelvic floor muscles.
"What if I'm not comfortable with an internal pelvic muscle exam?"
If an internal exam isn't appropriate or comfortable for you, your pelvic floor PT can get a general sense of your muscle function by palpating (aka manually examining) the muscles externally. They can also use surface electromyography (sEMG), which is a form of biofeedback that uses sensors (applied externally around your external anal sphincter) to assess certain properties of your muscles.
When appropriate, a specially trained PT can even teach you how to assess your own pelvic floor muscles, which we often do for virtual patients at Origin. A pelvic floor self-assessment isn't as detailed or comprehensive as an exam performed by a PT, but it can still provide you and your PT with a wealth of information about your pelvic floor muscles, and surface some amazing, first-hand insight into your pelvic health.
When you opt for a self-assessment at Origin, your PT will provide you with an overview of the process using a 3D model of a pelvis. After your visit, you'll be given detailed instructions on your Origin Dashboard so that you can complete the internal muscle assessment on your own, before your next visit. The instructions will help clue you in on what to look and feel for. We encourage you to take your time, explore, and make detailed notes of what you find.
Curious to learn more about your pelvic floor? You don't have to see a pelvic floor PT to get started. This pelvic self-check is something you can do at home, anytime.
If you're experiencing any kind of pelvic issue, we hope the info above has made the idea of getting a pelvic floor muscle exam much less intimidating. An estimated 32% of women in the U.S. have at least one pelvic floor disorder and no one should "just deal" with uncomfortable or painful symptoms. The sooner you see a pelvic physical therapist, the sooner you can get back to feeling your best.