Category: Gynecologic

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What Should I Expect at My First Pelvic Floor Physical Therapy Appointment?

If you’ve been diagnosed with pelvic floor dysfunction, you may be wondering what you can expect from your first pelvic floor physical therapy appointment. You may already know about physical therapy for other parts of the body, but pelvic floor physical therapy is different. You are entrusting us with a very private part of your body. It’s understandable, therefore, to feel confused and concerned. Knowing some of what to expect at your first pelvic floor physical therapy appointment, though, can go a long way toward easing your mind:

 

  • You will be there for a while. Pelvic floor physical therapy is not a quick visit, and that’s especially true for your first pelvic floor physical therapy appointment. How long can you expect your first pelvic floor physical therapy appointment to take? First sessions are typically an hour, and subsequent appointments are usually 45 to 60 minutes. 

 

  • Even though the session is long, you will have to change clothes fast! Physical therapy day is not the day to wear a complicated jumpsuit. Although your therapist should be patient while you change, you don’t want to spend too much time struggling with buttons or zippers. You need that time for your session. 

 

  • You will be expected to talk about your symptoms, medicines and medical history at your first pelvic floor therapy appointment. The night before, it’s a good idea to write down a summary of what brings you to pelvic floor physical therapy. Have you noticed urinary frequency? An increase of pain? Are you leaking? How long has this been going on? Don’t feel embarrassed. We need to know, just like any healthcare provider needs to know about your symptoms. Don’t be surprised if your pelvic floor physical therapist asks you about your sexual activity either! We’re not doing it to be nosy or judgmental. If your therapist is asking, she needs to know. It’s in order for them to understand your symptoms so that they can best help you. There is no wrong answer. Just answer truthfully. 

 

  • You will be asked for paperwork and IDs. This is why it’s a good idea to prepare the night before! You should have your driver’s license, health insurance card and a prescription from the doctor who is referring you to pelvic floor physical therapy (should that be required).

 

  • You may feel strange at first, and that’s ok. No matter how lovely your therapist is, having that part of your body explored by someone you don’t know could feel odd. Don’t be afraid to speak up in the session for anything you need that will make you feel more comfortable, whether that is an extra pillow or a fan. (We don’t want to treat your pelvic floor only to hurt your neck with improper support!) Over time, you may find you feel less strange during pelvic floor therapy appointments as they become more routine. 

 

  • There will be an external exam as well as an internal one. The external exam may involve your back and hips, among other areas. In addition to an internal vaginal exam, your physical therapist may ask to do a rectal exam. Remember, though, you always have the right to refuse any part of an exam, whether at a physical therapist’s office or anywhere else. This is as true for your first pelvic floor physical exam as it is for your 31st: Just because you approve an internal exam, for example, during the first appointment doesn’t mean you can’t refuse it later on. You are always in control, and you should always let your therapist know if you are in pain during a session!

 

  • You may have homework. You may need to do exercises and work with a dilator. Remember: You are a partner with your therapist in getting better – it’s not just him or her doing the work alone! Added bonus: patients who do their homework get better faster.    

 

  • You won’t be cured after the first session. You may have wanted this problem over with yesterday, but you must understand that physical therapy is a process. It’s not the same as taking a painkiller. That being said, the average time spent in physical therapy is 6 to 12 sessions. 

I hope this guide has helped. Going to your first pelvic floor physical therapy appointment is a brave, powerful step that can help put you on the path of a more comfortable life without drugs or surgery. You may question sometimes whether to keep going, especially during weeks when you have a setback, but know that it and you are always worth the effort. If you are in the New York area, feel free to contact me for a free phone consultation, so I can further encourage you about starting pelvic floor physical therapy.

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The Exam You Didn’t Know You Needed

News flash: There’s more to caring for your pelvic health than physical therapy. Whether or not you are sexually active, you should have had your first pelvic exam by age 21. If you haven’t because you think they’re scary or not needed, that’s understandable! No judgment here! There is a lot of mystery when it comes to pelvic exams, so let me help clarify so you can know what to expect. 

Who performs a pelvic exam?  

A pelvic exam is usually performed by a gynecologist, but your primary care doctor or a nurse practitioner are also qualified to perform it. 

What happens before and during a pelvic exam?

According to the Cleveland Clinic, you should be getting ready for your pelvic exam a full day before by not placing anything into your vagina, like tampons. This also includes abstaining from sex. Inserting something into your vagina prior may cause the pelvic exam to be less comfortable or interfere with the exam. 

Before a pelvic exam starts, you may be asked for a urine sample, so drink up before just in case, and don’t empty your bladder before you leave the house! 

If you are menstruating let your doctor know so he or she can make the proper arrangements for the exam room, such as placing a disposable chuck on the table. No need to feel embarrassed though! Chances are, you are probably not the first patient your gynecologist has seen who is having her period, and, if she’s a woman, she has likely been there herself and gets it. 

When the appointment starts, your doctor will talk to you about past and/or current health issues and will then leave the room to provide you with privacy while changing into a gown for the examination.

During a pelvic exam, which should take all of 10 minutes, a gynecologist checks the health of your female anatomy, like the vulva, cervix and uterus. 

Your gynecologist will push on your lower stomach to examine the organs.

They may have you maneuver your hips to the table’s edge. You will place your feet in stirrups. 

The insertion of the speculum can be a particularly intimidating part of the pelvic exam, but remember—even if it is uncomfortable, you should never be in pain! A speculum will be inserted so the gynecologist can see your vagina and cervix. If the regular sized speculum feels too intense, don’t be shy—please ask that they use a junior sized speculum instead. 

You will typically get a Pap test, also known as a smear, which involves taking cells from your cervix, and it should feel like just a minor pinch. (A bit of trivia: The test was named after the Greek doctor Georgios Papanicolaou who developed it in 1941, allowing women to get treatment much earlier and survive.) Vaginal fluid may also be collected. The bimanual exam involves the doctor feeling your vagina from the inside and outside simultaneously. That’s to check for any important changes in your organs. You may also need a rectal exam, which involves the insertion of your doctor’s finger. This can be done as part of the doctor’s routine, if you present with particular symptoms, or if the doctor believes it will help him make a potential diagnosis. You might have a breast exam, and an HPV test. You may even get your heart and lungs checked. 

What happens after the pelvic exam? 

The doctor may speak to you and you can learn about how and when to access test results. 

What is the doctor looking for during a pelvic exam? Why is it so important that I go to my pelvic exam?

One of the things your doctor is testing for is cancer. If you’re a young person, you may think that’s not a concern, but cancer can strike anyone. 

A Pap test is a way to detect cervical cancer or suspicious cells that may lead to it. HPV is the most common STI and can lead to cervical cancer. When cervical cancer is found early, the survival rate is as high as 91%, but once it spreads, it is much more difficult to treat. 

One thing a digital rectal exam can detect is rectal tumors. As with cervical cancer, the survival rate is good in the early stages, but not as the disease progresses, so early diagnosis is essential.

Your gynecologist is also checking for ovarian cancer. If you are of Ashkenzazi Jewish descent, you have a 1 in 40 chance of having a BRCA gene mutation, which increases your chance of a number of cancers, including ovarian. However, ovarian cancer has a 94% survival rate when diagnosed early.

You may be tested for STIs like chlamydia or gonorrhea. Typically, a chlamydia or gonorrhea test is done via either a urine sample or swab sample in a procedure called a nucleic acid amplification test (NAAT). 

A pelvic exam is also a reliable test for pelvic floor dysfunction! If even the junior sized speculum hurts or if the internal digital examination is very painful, that may be your body’s way of telling you that it’s time to schedule an appointment with your local pelvic floor physical therapist. In fact, one of the screening questions that we pelvic floor PTs ask is “Do you have a history of pain during gynecological exams?”

How can I make my pelvic exam more comfortable?

There are steps you can take to make your pelvic exam more comfortable. Communicating with your provider and deep breathing is suggested. As I mentioned, you can request the speculum be a pediatric one and that it be warmed and lubricated. You can also employ one of my favorite techniques, diaphragmatic breathing, to help relax your pelvic floor muscles during the examination. 

You may want to ask friends and family for their gynecologist recommendations to find the best match. 

If you have sexual trauma, it’s very important to communicate that to your gynecologist. He or she can slow down the examination to ensure maximal comfort and can stop if you need to. This article provides excellent ways to start that conversation.

I hope I’ve made you feel more comfortable about pelvic exams. Also, don’t be afraid to involve your physical therapist as well! We can be great resources for names of trusted gynecologists, or to discuss the details of the process with you to help you prepare mentally. We’re also happy to be in contact with your gynecologist, if you need us to talk with them about your pelvic floor dysfunction. But I bet after your first pelvic exam, you’ll probably realize there wasn’t much to be afraid of after all! And you’ll have that amazing, priceless peace of mind that comes with knowing your pelvic health is being prioritized just as it should be.