My Pelvic Health Journey

I was first exposed to Pelvic Health Physical Therapy (PHPT) in 2020 when I worked as a technician at an outpatient clinic within my local health system. While in this role, I had the opportunity to work with several physical therapists who specialized in pelvic health. Unfortunately, all of the therapists who provided pelvic health services at this clinic only did so part-time. One of the therapists split her days between ours and another clinic and only worked 2 days a week at our clinic, another was a Doctor of Physical Therapy (DPT) program professor and worked per diem at our clinic, typically 1-2 days a month, whereas the other therapist worked full-time at our clinic but split her caseload between pelvic health and orthopedic conditions, so only treated about 30 percent of a pelvic health caseload. 

I spent a lot of time getting to know all of these practitioners and eventually became the primary person in charge of their schedules. This was when I realized how much of a need there was for PHPT. We were maintaining a 3- to 4-month-long waitlist with patients requiring PHPT for various dysfunctions, including urinary and fecal incontinence, prenatal and postpartum conditions, dyspareunia and other sexual dysfunctions, and more. When explaining our waitlist to patients over the phone, I often suggested they look into other local clinics offering PHPT to see if they could get an appointment sooner––the typical response I received was that every clinic they called also had a waitlist of about the same length.

Through this experience, my interest in pursuing the pelvic health speciality grew. It was evident that there was a need for pelvic health physical therapists that was not being filled, especially in my community. It was heartbreaking to know that patients with such socially debilitating and highly emotional conditions had to wait so long to be seen for an evaluation. I began my application process for physical therapy school that summer and from that point on, knew that I wanted to learn more about PHPT and hopefully pursue specialization in this area.

I began my DPT program at Drexel University in September 2021. It was during my second quarter that my anatomy professor first broached the topic of the pelvic floor. I was excited at the introduction but somewhat disappointed because we only briefly talked about a few of the muscles: levator ani, obturator internus and externus, etc., and did not go into much more depth regarding the pelvic floor anatomy. While our gross anatomy course was already so extensive in the amount of material that we were learning, it came as a shock that we did not allot a proportional amount of time to learning the pelvic floor. Fortunately, there were many more formal educational opportunities that arose during my time at Drexel to explore PHPT.

During the spring quarter of my second year, my Pathophysiology II professor introduced two guest lecturers with backgrounds in PHPT. The first held Women's Certified Specialist (WCS) and Certified Lymphedema Therapist (CLT) certifications and provided lectures on pelvic floor anatomy, common pelvic floor dysfunctions, and evaluation/assessment and treatment techniques. This was my first formal introduction into the ins and outs of PHPT and provided my class with a great foundation of knowledge. The second guest lecturer also held a CLT and specialized in pelvic health and oncologic physical therapy within an outpatient cancer center in Delaware. Her lectures really stuck out to me because I hadn't really considered the impact of cancer treatments on the pelvic floor or the lymphatic system and how all of these specialties are closely related. I connected with this guest lecturer through my professor and set up a shadowing opportunity to learn more and observe PHPT in action for the first time. While shadowing at the cancer center, I was able to observe sessions with patients experiencing concurrent cancer treatments or recovering from cancer treatments, post-mastectomy, post-lymphadenectomy, one with axillary web syndrome, and one patient requiring lymphatic drainage treatments and wound care. This experience was truly eye-opening and stuck with me because it introduced me to the vast opportunities and spaces that I can work in as a physical therapist, even within the speciality of PHPT.

I continued to embark on this journey of learning and experiencing the world of PHPT through my clinical education. I opted for my second of three clinical internships to be within a private outpatient pelvic health and orthopedic clinic in South Philadelphia. During this clinical rotation, my goal was to be a sponge and absorb as much information and as many skills as I could during my 11 weeks. From day one, I jumped right in to work with patients hands-on and gather feedback from my clinical instructor. I observed several initial evaluations and treatment sessions by my clinical instructor and her colleague prior to taking on any pelvic health patients of my own. However, once I felt comfortable performing the skills on my own, I became pretty independent from there. I was exposed to so many diverse pelvic health conditions, including some that challenged me much more than others. 

One of my most notable patients was a young woman who was experiencing dyspareunia and vaginal dryness post-breast cancer recovery. On day one, she was hardly able to tolerate a vaginal exam with just my index finger, but by week 3, she was tolerating dilator size 3 with little to no discomfort. This progress made such a huge difference for her confidence and hope, showing the powerful impacts that PHPT can have. Another patient who left a heartfelt impression on me was a soon-to-be mother who sought out physical therapy during pregnancy to train her pelvic floor with strengthening and relaxation techniques to prepare for the birth of her first child and address back pain during pregnancy. She was 35 weeks pregnant at the time my clinical rotation ended. Since then, she had her baby––a baby boy––and emailed photos of her, her husband, and their newborn son to the clinic, asking them to be forwarded along to me. In the email, she thanked me for my assistance in preparing her for that moment and noted that she did not have any perineal tearing! I was so touched that she shared that with me and I was so proud that her time spent in physical therapy contributed so bountifully to her and her family.

I am so grateful for the experiences I have had with PHPT up to this point and the lasting impressions they have had on me. With each experience, my love for this specialty grows more. Although my last clinical rotation strays away into the world of pediatrics, I do hope to continue my learning through the APTA Pelvic Health’s continuing education courses, moving onto the Level 2 Pelvic Pain and Bowel Dysfunction courses in the near future. As I emerge from physical therapy school this spring and begin my professional career, I desire to advocate for the pelvic health specialty to continue to grow this profession and educate the community of both medical professionals and patients on the benefits of PHPT and the value that pelvic health specialists have in treating these conditions.

Author: Teah Matthews, SPT

2023 CAPP Scholarship Recipient

Author Bio: Teah is a 3rd year physical therapy student at Drexel University in Philadelphia, Pennsylvania. In her free time, she loves cooking and baking, binge-watching a good TV show, traveling, and challenging herself with jigsaw puzzles.