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Physical Therapy...For My Vagina?

Your introduction to the world of Women's Health Physical Therapy and what to expect on the first visit. (Twist ending: it's probably NOT Kegals!)



When it comes to my profession, I get a fair mix of folks who know exactly what I do, and those who have a vague clue. So, before we delve into the specialty of pelvic health, let's introduce the training and scope of a typical physical therapist:

PT's are neuromusculoskeletal rehabilitation experts who attend a rigorous graduate-level program of study in which they learn (literally) every nerve, muscle, bone, and ligament in the entire body (also the organs and physiology of each). They then apply that didactic knowledge in a series of intensive courses which prepare them to evaluate, assess, and prescribe a rehabilitation treatment plan of care which includes patient education, manual therapy, therapeutic exercise, and neuromuscular re-education skills. This is AFTER the candidate has successfully obtained at least a 4 year Bachelor's degree from an accredited university, completed all prerequisite course work required by most PT schools, earned hundreds of hours of observation experience in the rehab setting, taken and passed the Graduate Record Examinations (GRE) with satisfactory score, applied, interviewed, and been accepted into one of the accredited PT programs across the nation. Some even travel far from home for their education. I moved from Texas to Chicago for mine! Most programs in the US are now Doctorate-level and last on average 3 years, full-time. After hours upon hours of study and practice in the clinical setting, if grades are satisfactorily met and degree is awarded, the new graduate must then sit for a 3-hour long board exam and pass in order to put their skills to practice.

After THAT, therapists in my specialty must then return to the classroom for additional post-graduate training in order to learn and apply the skills necessary to treat pelvic floor dysfunction. After hundreds of hours of coursework, a minimum of 2000 hours in direct patient care, and submission of a peer-reviewed case study, the therapist may then sit for the board exam to award them the well-earned title as "specialist" in the area of pelvic health. Not to toot our own horns, but this is to say that you may rest assured that the person you are seeing is likely WELL trained and educated in their field. We are nerds to the core, and love what we do! For most of us the learning never ends, and we continue adding to the alphabet soup behind our names with numerous certifications and advanced skills that make us better practitioners and teachers. We want to teach YOU how to help and heal yourself.


Our specialty area may be the pelvis, but the body is all connected. Just because you come in for vaginal pain doesn't mean it's not somehow related to that broken ankle you had as a teenager. This means we need to be able to think way outside the box (or in this case, the pelvis), and put many clues together to treat an ever-dynamic and complicated system. So, while most people think of Kegals when they first learn about us, I can tell you that there is way more to it than that. Very generally, the vast majority of my patients come to see me for issues related to bowel and/or bladder (whether that be trouble keeping contents in or getting it out), and pain. Pain can be inside the vagina or rectum, the pubis, tailbone, groin, back, SI joint, abdomen, hips, knees, and so on. It can be muscle pain, nerve pain, pain with certain movements or functional tasks, intercourse, or joint pain in pregnancy. I also treat women with pelvic organ prolapse, endometriosis, PCOS, fibroids, and cancer. When I worked in pediatrics, most of the kiddos I treated had one big problem that caused a sequelae of other little problems: constipation. Can't poop, won't poop, poops all the time...we talked a lot about poop in our sessions, and I still do just as much with my adults. It's important.


Your initial evaluation with a Women's Health (AKA Pelvic Health or Pelvic Floor) Physical Therapist will likely be a great deal of education. Here's a generic outline of what you can expect on your first visit:

1. Subjective History: this is your opportunity to tell us ALL about it. Seriously, we want to know! The more information the better, and we will probably ask you questions about issues you didn't even know you had.

2. Exam: PT's are mechanical engineers of the body. We need to inspect the pertinent moving parts (which are all connected, remember?) to better determine where your symptoms are coming from. This could be anything from observation of posture, breathing, and walking, movement and range of motion, strength testing, and palpation (feeling) along the bones, muscle, and fascia (connective tissues).

3. Internal Pelvic Floor Exam: Guess what - the pelvis is comprised of bones and ligaments

that contain organs and nerves supported by muscles. Remember when I told you we are neuro-musculo-skeletal experts? Well, there you go. The best way for us to find out what's going on in there is, well, to go in! This means insertion of a single, gloved and lubricated finger through the vaginal or rectal opening, allowing us to palpate (feel) for muscle spasm, weakness, triggerpoints, and movement. We do not use speculums for this exam (you know, those duck-billed things from the OB-GYN office). Internal palpation gives us a ton of information, but I do wish to emphasize that this exam is always - and only - with your consent. You absolutely have the right to refuse an internal exam. Period. No reason necessary. Though, speaking of periods, I have had patients simply ask to wait until Aunt Flow leaves town; three's a crowd.

4. Home Exercise Program: Don't let the phrase fool you. "Exercise" does not always mean squats and Kegals in our world. Most of the time, the first thing I do with my patients is educate them about their own anatomy, and then teach them how to breathe. That's right. Air in-Air out. It's far more important than many people realize, and the groundwork for everything we do in the future.

5. Plan of Care: This is where we sit down and decide how often we would like to meet and for how long, taking into consideration any financial and scheduling barriers. On average, I see most of my women 1x/week for the first 4 weeks. Then, as improvements are made we are able to taper off to 1x every other week, once a month, maybe even just a 6 month follow up.


My private practice is a mobile clinic, meaning I travel to the women who need me. I currently serve the West Houston, Brenham, and Bryan/College Stations areas. But what do you do if you're reading this post from somewhere in Colorado? The great news is, our profession is booming. More and more therapists are jumping on the Women's Health wagon than ever before. It's a revolution of brilliant women who aren't afraid to use the word VAGINA! Sorry...I get over-passionate sometimes. But seriously, one of the best resources you didn't know you had could be the very women you're afraid to talk to about your issues: your own girl friends. I can absolutely guarantee, get 5 of you in a room, and at least 3 of you will share the same symptoms. Just ask! Maybe not everyone is quite as brash as I am, but I see nothing wrong with starting a conversation with, "Hey Susie, do you pee when you sneeze?" She might choke on her organic, local, cold brew, but that's probably only because she's thinking, "Holy crap, how does she know?!" Ask enough friends, and one of them will eventually tell you, "Yeah, I used to, but my PT helped me fix that. Are you having issues? Girl, you should totally go see (fill in the blank therapist)."

Your next best resource is literally in the palm of your hand. Now that you're well aware of the field and scope of Women's Health Physical Therapy, try scouring the internet. As I said, we have many names, so search for things like 'Pelvic Floor Physical Therapy' and 'Pelvic Health Physical Therapy'.

The American Physical Therapy Association and Herman and Wallace Pelvic Rehabilitation Institute have "Find a Practitioner" resources on their web pages which allow you to search for a PT by location. You might live right down the street from one and didn't even know! Here's the links to those pages:

So there you have it. The best piece of advice I can offer is to never assume your issues are unique or just "the way it is now that...". You had a baby, that doesn't mean leaking is normal. Sex has always been painful, that doesn't make it okay. You're over 65, had 5 kids, and now you have to push your organs back inside your vagina every time you poop. SAY something! Even if you don't always get a validating answer from the people you confide in, including other health professionals, don't take it on the chin and just accept that this is how your body has to be.

Keep asking, keep talking, and don't be afraid to call it what it is: VAGINA.

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