What happens during pelvic floor physiotherapy?

My wife had a pelvic floor physiotherapy appointment with a male physiotherapy last week. She asked me not to come with her to the appointment. After her appointment she didn't tell me the details of the exam, she just said everything went well and I have follow up appointment in 4 weeks. I'm curious what happened there, I know usually PT physiotherapist do internal examination. Should I be jealous? How did he do the internal examination?

Pelvic health physiotherapy is a specialist service that can help you to manage and improve pelvic health problems such as bladder and bowel incontinence (leaking wee, wind or poo), prolapse (heaviness dragging or bulge in your vagina) and pelvic pain. Specialist pelvic health physiotherapists can help you to understand your problem and offer advice and treatment tailored to you.

A first pelvic floor physiotherapy appointment usually lasts 45 to 60 minutes and involves a private discussion about your symptoms, an educational overview, and a physical assessment.

The Initial Discussion

• Medical history: Your therapist asks about your general health, past surgeries, and pregnancies.
• Symptoms: They ask detailed questions about your bladder, bowel, and sexual health, or any pelvic pain.
• Goals: You discuss what you want to achieve from therapy.

Education and Planning

• Anatomy review: The therapist uses models or charts to explain how your pelvic floor muscles work.
• Consent: They explain every step of the physical check before it starts. You can say no to any part of the exam.

The Physical Assessment

• External check: The therapist may look at your posture, breathing, and lower back movement.
• Internal check: With your permission, they often do a gentle internal exam using a gloved finger to test muscle strength, tension, and tone.

If you choose to have a pelvic floor examination, you will be asked to remove your underwear and lower clothing and lie on an examination couch. You will be given a paper sheet so you can cover yourself. Your physiotherapist will give you privacy to get ready, either by standing behind a curtain or leaving the room.

Once you are ready your physiotherapist can start the examination. A pelvic floor examination includes:

• Looking at your genitals (vulva, perineum and anus/bum). Your physiotherapist can assess whether your skin is healthy, look for scar tissue and look for signs of prolapse.
• Feeling inside your vagina using a gloved finger, and asking you to cough, push down, squeeze and relax your muscles. This helps your physiotherapist to assess how well you can squeeze and relax your pelvic floor muscles. They can also assess for prolapse.
• Asking you what you feel as they gently touch outside and inside your vagina.
• Feeling inside your anus using a gloved finger and asking you to squeeze their finger. This will only be offered to you if you are finding it hard to control your bowel such as leaking poo or wind or having a sudden urge to poo. This helps your physiotherapist to assess how strong the muscles around your anus are.

After your pelvic floor examination, your physiotherapist will explain what they felt, and you can ask any questions you may have.

What does physiotherapy treatment involve

Depending on your pelvic health problem, your treatment may include a combination of:

• Pelvic floor exercises: Together you and your physiotherapist may decide how many, how long and how often you should do your pelvic floor exercises, depending on your needs
• Exercise advice depending on your needs
• Breathing techniques and relaxation strategies
• Manual therapy: Your physiotherapist may use their hands to move your body and joints
• Specialist advice to help manage and treat your pelvic health problems

Your physiotherapist will discuss with you whether you can continue treatment on your own, or whether you would benefit from further appointments with them.

Taking an active role in your treatment can help you achieve the best possible outcomes for your pelvic health.

If you can elaborate on what the therapy appointment was for, for instance urinary incontinence, post childbirth issues, sexual problems, etc I can probably give you a good idea of what took place. It is going to be quite different depending on the reason for the visit.

@Sarahgyn Recently my wife had a little bit of pain during intercourse. The pain was the reason she booked pelvic floor physio appointment.

If you can elaborate on what the therapy appointment was for, for instance urinary incontinence, post childbirth issues, sexual problems, etc I can probably give you a good idea of what took place. It is going to be quite different depending on the reason for the visit.

I'm currently going to pelvic physio for pain and a tight pelvic floor (I'm trans masculine but haven't had surgery yet, so vagina etc).

Most of the first appointment was talking. What my history with the pain was, what had I tried myself, what did I want to achieve.

I was told to use the toilet then she scanned my bladder, just to check that it was emptying fully (it was). She did a quick abdominal exam, pressing quite deeply on places, and found some pain.

Then she asked if I was still happy for me to examine my genitals. I said I was and she went back to the other side of the curtain to prepare and give me privacy to undress. I removed my shorts and underwear.

When she came back she had me put my feet together and separate my knees, then positioned a bright light to have a look. She asked if she could "separate the tissue" and then said I'd feel a couple of fingers on me while she checked my vaginal entrance, but nothing internal yet. She commented on my atrophy (I'd already explained I'm being treated for it) then I felt her push quite firmly into me at a few spots around my entrances. After that she had me contract the muscles which she watched and felt.

The next part was the hardest for me. She asked permission to put the tip of her finger into my vagina. She spent a couple of minutes asking me to comment on how it felt when she moved itna few millimeters at a time. That was the only pain, but she stopped where it hurt and didn't expect me to push through it.

Once her finger was fully in it didn't hurt. She asked me to contract the muscles again, then to relax them. They took about 30 seconds to let go. She then put the ultrasound probe on my abdomen to show me this.

And that was it. From me undressing to her pulling her finger out was probably about five minutes. I'm sure timings will vary a lot, but there was much less hands on stuff than I'd expected for the assessment.