Perspective on Women’s Health PT Services in Japan by Obstetrician and Gynecologist, Dr. Yumie Ikeda

Yumie Ikeda is an obstetrician and gynecologist who specializes in women’s health. She sees many patients in her line of work who have health problems associated with menstruation and menopause, many of which also have chronic pelvic pain. Dr. Ikeda was invited to participate in the  Section on Women’s Health continuing education courses that were hosted in Tokyo, Japan in May 2017. Below is Dr. Ikeda’s account on her course experience from the eyes of an OBGYN practitioner and her perspective on the status of women’s health physical therapy services in Japan.

Section on Women’s Health-American Physical Therapy Association (SOWH) is a professional association of over 3,000 physical therapists treating patients with pelvic and abdominal health issues worldwide. Members provide the latest evidence-based physical therapy services to everyone from childbearing women to peri-menopausal mothers, young athletes to men with incontinence or other pelvic health complications. In addition to top-quality continuing education, certification, and Clinical Practice Guidelines, the Section provides the Journal on Women’s Health Physical Therapy, PT Locator directory, lab training in pelvic and abdominal health physical therapy, career resources, and networking.

SoWH has hosted the Pelvic Health Physical Therapy Level 1 course and the Fundamental Topics of Pregnancy & Postpartum Physical Therapy in Tokyo, Japan, which were attended by 40 Japanese physical therapists.

Key Takeaways from the SoWH Courses in Japan

The first Section on Women’s Health course in Japan in 2017 was my first time meeting dedicated Japanese physical therapists who are interested in Women’s Health. I met many patients cared by physical therapists when I visited the women’s health department at the Mayo Clinic in 2012, and I felt sorry that Japanese patients could not get physical therapy services. The contents of the SoWH course I have attended was so interesting and useful – however also meeting the physical therapists at the course made it even a more memorable experience for me. This experience was encouraging for me, I met so many Japanese physical therapists that want to help patients despite the barriers to practice women’s health physical therapy in Japan.

When taking the courses, I was very interested in chronic pelvic pain because I have a lot of patients that experience it. After attending the course, I was able to apply new skills immediately – I made a diagnosis of myofascial pelvic pain based on the intra-vaginal examination techniques I’ve learned at the course.

The most impressive part was seeing the course participants experience their first ever intra-vaginal examination. I went through the gynecology residency in Japan, I remember I had to do my first pelvic examination on a real patient before I had enough confidence in my skills. Still now, we (even OBGYN doctors) have only books and plastic models to learn how to conduct a pelvic exam.

I envy the physical therapists at these courses that had the opportunity to practice pelvic exams before seeing real patients. It inspired me to brush up on my pelvic exam teaching approach at a Japan gynecology residency.

Current Status of Women’s Health Physical Therapy in Japan

Women’s health physical therapy should be based on the continuous care for all stages of life. I have to say Japan has not successfully imported the concept of reproductive health and rights. Japan has a really nice health care system and insurance system and we do not have much of a gender gap in terms of accessibility. However, our national insurance covers disease-care, not prevention, which is one of the reasons why women’s health and reproductive health physical therapy is still an unfamiliar concept in Japan.

Currently, physical therapists in Japan can only work with patients after patients obtain a prescription from their medical doctors. Physical therapists in Japan can not work independently in the Japanese healthcare system.

Future of Women’s Health Physical Therapy in Japan

The medical team approach is now very common in community hospitals in Japan, so it will be easy to start perinatal physical therapy if the compensation issues get addressed. I think that it will take time for physical therapists to include intra-vaginal examinations in their diagnosis and healthcare practices. The Japanese OB society is uncomfortable about non-OBGYN medical practitioners conducting pelvic examinations, as even very few primary care doctors and ER doctors conduct pelvic exams. I think that OB doctors will enjoy working with physical therapists one day once the connection between the two fields is educationally established and taught to both professionals.

It will be important for physical therapists to establish a good connection with the society of OB doctors in Japan. This relationship will help spread awareness about women’s health physical therapy and evidence-based physical therapy research in the medical field so that women’s health physical therapy is a welcomed concept and becomes part of healthcare services offered in the nation.

Japan has a rapid aging population due to the birthrate decline. How to maintain the health of the aging population is one of the most important issues Japan is facing at this time. Japan needs to offer more physical therapy services for its growing aging population and needs to begin offering women’s health physical therapy services for its perinatal women.