Imagine taking your car to the mechanic for a service and the mechanic asks you a few questions, takes a look at the car and passes you the bill without taking a look under the bonnet…
If you are seeing the Physiotherapist for a Pelvic Floor related concern, an internal Pelvic Floor exam may be recommended.
Before the internal examination is considered, your physiotherapist will determine why you have come for an assessment including your goals, and what your symptoms are. They will review your past medical history and ask about the treatments you may have already tried for your symptoms. Discussing your history will provide a good indication of what assessment and treatment techniques may be needed.
Next, your physiotherapist will take a look at your breathing, posture (not just your pelvis), check movements of your joints and assess muscle strength as well as how the connective tissues relate to your pelvis from the outside- a holistic approach.
An internal pelvic exam is not mandatory but is the gold standard to assess how your pelvic floor muscles and connective tissue within the pelvis are working. An internal exam may be highly recommended to further investigate the symptoms you are describing or to prevent conditions from occurring. However, your physiotherapist will first discuss and show you where your pelvic floor muscles are located on a model, how these muscles are assessed as well as inform you of any pros and cons associated with carrying out an internal exam in regards to your goals.
WHAT IS AN INTERNAL VAGINAL EXAM?
The patient will disrobe from the waist down- including removal of underwear and position herself on the plinth draped with a towel. Using lubricant, the therapist will proceed to part the labia to visualise the vulva, perineum and anus. At this point, if you are seeking management for pelvic pain, your Women’s Health Physiotherapist will perform a Q-tip test to assess for tissue sensitivity. For my post-natal mummies and mummies who present with pelvic organ prolapse concerns, a measurement called GH + PB (Genital Hiatus + Perineal Body) is performed to determine level of pelvic floor support or tissue distensibility from the urethra to anus. A measurement is taken at rest and on strain (think like trying to blow up a balloon for 6 seconds).
An internal vaginal exam involves the insertion of 1 or 2 fingers into the vagina to individually assess for
- position of pelvic organs
- sources of pain or discomfort
- integrity of pelvic ligaments
- muscle strength, endurance, co-ordination and tone
This is the gold-standard and gives us the most detailed information about your pelvic floor structures.
I AM NOT COMFORTABLE WITH AN INTERNAL VAGINAL EXAM, WHAT ARE MY OPTIONS?
Alternatives exist such as Real Time Ultrasound (trans-abdominal or trans-perineal) and external palpation (with and without clothing on), should you not wish to complete an internal pelvic exam. The difficulty with these alternatives is that they don’t give that level of detail (pain, muscle performance etc.).
You will always be asked to provide consent before any assessment or treatment is provided.
You are ALWAYS able to remove consent at any time.
If you wish to learn more about the pelvic floor exam or address your pelvic floor concerns, please do call/WhatsApp on 9780 7274 or get in touch over email.
You can also visit our website to learn about other women’s conditions we treat through physiotherapy and how we can help you.