Pelvic Physical Therapy: The Reality Behind the Curtain

Written by Carrie Pagliano, PT, DPT, OCS, WCS 

There can be a sense of mystery behind pelvic physical therapy, not only from the point of view of the patient, but from professional colleagues in the medical community.  Perhaps this has to do with the fact that pelvic Physical Therapists (PT) are often tucked away in physical therapy clinics behind a closed door. But let’s be honest; most of the mystery comes down to the internal (vaginal or rectal) muscle examination as a potential component of examination and treatment. That said, simplifying pelvic physical therapy down to an internal assessment or a vagina therapist is akin to saying the late Stephen Hawkings studied donut holes.  There is so much more to pelvic PT and the conditions we treat.

The beauty of practicing in pelvic physical therapy lies in the culmination of so many areas of expertise.  It requires an integrative understanding of the human body, finding the right clinical hypothesis and treatment direction in an area of practice where research is still evolving.  Pelvic physical therapy has the unique privilege of being truly wholistic.  Our patients have issues ranging from pelvic organ prolapse, chronic pelvic pain, pain from oncologic or dermatologic issues, urinary and fecal incontinence, issues related to pregnancy or surgery, pain or difficulty with orgasm or intercourse, and the list goes on.  Our patients are female, male, intersex, and transgender.  Our patients are adults and children.  Our patients are referred to physical therapy from ObGyn, Urology, Colorectal, Neurology, Orthopaedics, Pediatrics, Psychology and Dermatology.  Our patient’s problems range from simple to complex.  Our examination includes the entire person, from a comprehensive subjective examination, where the patient can share their story, to a thorough objective assessment which includes the spine, pelvis, hips, etc.  The smallest part of the exam focuses on the internal assessment; either vaginal, rectal, both, or not at all.  For many patients, this portion of the examination is the first time which a medical provider identifies their pain or problem after seeking advice from multiple practitioners.  Pelvic PT’s are often the first provider who has listened to their story for more than a few moments and acknowledged that as a patient, they are not broken, and there is hope.

In the time of the Nassars of the world and #MeToo, clarification of what pelvic physical therapists do behind closed doors is more important now than ever.  When a person seeks treatment that involves the genital region, they deserve the same level of understanding and respect afforded to those receiving treatment to other part of the body.  Pelvic physical therapy and those who benefit from it should not be the fodder for tabloid tips on getting your best orgasm nor should it to be misconstrued as a sexual act.  Patients deserve evidence based expert care, appropriate support and resources to navigate their road to recovery.  Anything to the contrary is unacceptable.

Patients who seek treatment from pelvic Physical Therapists don’t see their issue as a joke.  Patients seeking pelvic physical therapy are patients after childbirth now dealing with changes in their bodies they did not anticipate, told to stop doing activities they enjoy.  These are patients unable to enjoy sexual activity due to pain, preventing normal intimacy or preventing opportunities to start a family.  These are patients struggling to combat the crippling pain of endometriosis.  These are patients who just completed cancer surgery, happy to be alive but wanting to live without the side effects of treatment including incontinence, pain and sexual dysfunction.  These are patients who are unable to comfortably sit for their commute after a fall on their tailbone.  These are children, fearful of social repercussions because they can’t control their urine or have nighttime bed-wetting.  These are patients looking for medical support after gender reassignment surgery.  Our patients deserve respect for their diagnoses, appropriate education and resources to make decisions regarding their care, and empathy for their medical journey.

Pelvic physical therapy is more than an internal muscle assessment or a gloved examination finger.  As pelvic physical therapists, we provide hope based upon legitimate physiological and medical examination findings.  Pelvic physical therapy treatment is fueled by evidence driven critical thinking and supported by a doctoral level professional education.  Pelvic physical therapy provides education and resources to our patients, so choices they make are influenced by evidence and not fear.  As pelvic physical therapists, we are honored and privileged to support the medical community, the patients we serve and those who will continue to benefit from our expertise in the future.