Pelvic Health Physical Therapy – More Than Just Kegels!
It is oh so common to hear that people are hesitant to go to pelvic health physical therapy. Here are some frequent concerns: “It seems like it would be awkward.” “Is it going to hurt like it does at the gynecologist’s office?” “I already know how to do kegels. What else is there?” And finally, “I am not about to go talk to a therapist about sex toys!”
Wow, so many myths to bust in just one paragraph! I figured it would be a good thing to write out what women should actually expect from going to see a pelvic health physical therapist. You may be surprised.
“It seems like it would be awkward.”
Pelvic health is a very private matter. Often women worry that they may feel uncomfortable or embarrassed about working with a therapist. But it should never feel awkward or intimidating. When you enter the office, you will likely fill out paperwork, like you would at a doctor’s or dentist’s office. The paperwork will ask you about what problem brings you in for therapy, your relevant medical history, and medications. It may also include questions about your pelvic health, like your bowel and bladder habits, if you have ever been pregnant, any pain you are having, and often some screening questions about sexual history. These questions are all important to help the therapist know more about your pelvic health and to create some goals that are relevant to you. But rest assured, you should have ample opportunity to discuss with the therapist in more detail.
It is important for you to be as honest as possible, so that the PT can make sure she is treating you appropriately for your needs. If there are any questions that you feel uncomfortable answering, simply tell the PT that you would rather not answer. This is MUCH better than being deceptive or telling half-truths.
Next, you would have a physical examination. Some pelvic health PTs do only external pelvic work, meaning that they never actually do an internal pelvic exam. Many do external and internal exams, in order to get a more full picture of what is going on with your health. If you are uncomfortable with an internal exam, speak up. A PT should respect this and come up with alternative assessment or treatment strategies. It is also okay to opt out of a pelvic exam the first one or two appointments and then change your mind later as you get more comfortable with the PT.
“Is it going to hurt like it does at the gynecologist’s office?”
Some women do experience pain with pelvic exams that their doctor’s perform. (To clarify, a medical pelvic exam should not hurt! So if you are having pain, that may be a sign that you do need some help from a PT). A pelvic health exam with a PT should not be like this. With a doctor, they are often trying to assess internal visceral structures like your cervix. At physical therapy, this is not the goal. We never use speculums, a device that helps a doctor visualize the cervix but often aggravates a women’s pelvic pain symptoms. At PT, you will always have the option to stop a pelvic exam if it begins to be uncomfortable. Often times, women are coming in to be treated for pelvic pain! So why would we want to make it worse?
“I already know how to do kegels. What else is there?”
While kegels can be helpful for some women who have weakness in their pelvic floor muscles, there is so much more to therapy than just that. After a thorough examination and discussion with you about what your goals are for therapy, a PT will have a lot of different options of how to help you. This significantly depends on your condition and current function. For some women, therapy is focused on strengthening the pelvic floor (see more about incontinence here). This can help with incontinence, pelvic organ prolapse, and with sexual function.
Other times, women have too much tone, or resting “tension” in their pelvic floor muscles, and may benefit from learning how to turn these muscles off more often. Biofeedback is one way a therapist may help you learn how to turn your pelvic floor muscles off or on. Another common reason to go to PT is for pelvic pain, like vaginismus, vulvodynia, or pelvic girdle pain. Your PT may do massage, relaxation techniques, and stretching with you. With most of these conditions, she should also be helping you with posture and with your breathing (your breathing has a lot of surprising connections to your pelvic health!).
“I am not about to talk to a therapist about sex toys!”
While sexual function is one reason women may seek out help, it is certainly not the only goal of therapy. Some specialized pelvic equipment can be used to assist your recovery, like dilators or pelvic weights. While they may look like sex toys sometimes, your experience at pelvic health PT should always remain professional and should never make you feel uncomfortable or threatened sexually.
Pelvic health PTs understand that some women would prefer a light-hearted, humorous environment, so that they feel more comfortable. After all, talking about bowel movements, peeing, and sex can sometimes be funny! But others want a more serious and medical culture. Your PT should follow your cues on this in what would make you feel the most welcome and at ease. Always remember that you are in control of your body at therapy and can always speak up if you are feeling uncomfortable or nervous.