Imagine taking your car to the mechanic for a service, and the mechanic hands you the bill without looking under the bonnet. Quite odd, isn’t it?
Guess what—this goes the same if you’re consulting a physiotherapist for a pelvic floor-related concern. We might have to take a closer look—an internal pelvic floor exam.
Before considering the internal examination, your physiotherapist will familiarise themselves and thoroughly understand the reason for your visit, meaning assessing your goals and symptoms. They will review your medical history, inquire about any previous treatments you may have tried, and discuss your overall history to guide the assessment and treatment approach.
Moving beyond the pelvis, your physiotherapist will assess your breathing, posture, joint movements, muscle strength and the relationship of connective tissues to your pelvis—a holistic approach to understanding your condition.
While an internal pelvic exam is not obligatory, it is considered the gold standard for evaluating the function of pelvic floor muscles and connective tissues within the pelvis. Your physiotherapist will discuss and demonstrate the location of pelvic floor muscles using a model, explain the assessment process, and provide information about the pros and cons associated with an internal exam in relation to your specific goals.
WHAT HAPPENS IN AN INTERNAL EXAM?
The patient will disrobe from the waist down, including the removal of underwear, and lie on the plinth draped with a towel. Using lubricant, the therapist will gently part the labia to visually assess the vulva, perineum, and anus. In cases where pelvic pain management is sought, a Q-tip test may be performed at this stage to evaluate tissue sensitivity. For postnatal and prolapse-related concerns, a measurement known as GH + PB (Genital Hiatus + Perineal Body) is conducted to gauge pelvic floor support or tissue distensibility from the urethra to the anus. Measurements are taken both at rest and during strain, simulating a six-second attempt to blow up a balloon.
The exam also involves the insertion of one or two fingers into the vagina to individually assess:
- Position of pelvic organs
- Sources of pain or discomfort
- Integrity of pelvic connective tissue
- Muscle strength, endurance, coordination, and tone
This is the gold-standard examination and provides us with the most detailed information about your pelvic floor structures.
I AM NOT COMFORTABLE WITH AN INTERNAL VAGINAL EXAM, WHAT ARE MY OPTIONS?
Alternatives, such as real-time ultrasound (trans-abdominal or trans-perineal) and external palpation (with and without clothing), are available if you prefer not to undergo an internal pelvic exam. However, it’s important to note that these alternatives may not offer the same level of detail, regarding pain and muscle performance.
Before any assessment or treatment, your consent should and will be asked for. Do remember that you always have the right to withdraw your consent at any time.
If you wish to learn more about the pelvic floor exam or address your pelvic floor concerns, please call or WhatsApp us at 9780 7274, or get in touch by email at help@embracephysio.sg.
Feel free to look through our website, where you can learn about other women’s health conditions we treat. This is a safe space where we can discuss how we can help you with physiotherapy.
Note: While I am a physiotherapist, I am not your personal physiotherapist. The contents of this website are for informational purposes only and are not intended to serve as personal medical advice.
References:
- https://www.embracephysio.sg/what-is-the-pelvic-floor/
- https://pelvichealthsolutions.ca/knowledge-base/why-do-we-do-an-internal-exam
- https://www.mayoclinic.org/tests-procedures/pelvic-exam/about/pac-20385135
- https://inajog.com/index.php/journal/article/view/540/581
- https://www.wmhp.com.au/blog/transperineal-ultrasound-tpus-exciting-technology#:~:text=Transabdominal%20vs%20Transperineal%20Ultrasound&text=The%20transabdominal%20approach%20gives%20a,of%20pelvic%20floor%20muscle%20assessment.
