Three female figures in underwear, with a target on each pelvic area that needs to be addressed in therapy.

Physical Therapy for Endo: The First Visit

So, you have made the decision to see a pelvic PT and now you are anxious, maybe a little scared, and maybe a little hopeful. In my many years of practice, there is one very common thing among many of my patients... the look of apprehension on their faces at their initial visit. Don’t worry, we know you are wondering what to expect, how invasive, and how painful will the exam be.

The vast majority of PTs who have chosen to work with women with pelvic pain have done so out of compassion and a real desire to help you get better. We choose to attend additional classes, read the latest research, join social media groups, engage in conversations with colleagues about vaginas, hormones, vulvas, etc. while our Ortho PT friends ask why oh why would we trade a knee for a pelvic floor? My point is that we care, and we want to help. That being said, just like any other health care provider, you may have to try a couple of PTs before you find one you click with or that can meet your needs.

What to expect

Your PT will talk to you before any exam happens. You will be given the opportunity to tell your story, express your concerns, and ask any questions.

Your PT will describe what will happen during any exam and why they are looking at the things they will be assessing. We will assess your belly, back and maybe hips, knees, and toes. We often will show you anatomy pictures so you can understand how all these things fit together.

We will ask you questions about things that may seem unrelated, like what you do for work, fun, and sport. We may ask in detail about your pooping patterns and what foods you like. We need to know who you are and what your life is like so we can help you live the fullest life you can and that you desire. If you are a triathlete, we may have a different program than our patient who is a Yogi.

The external exam

After all this, an external exam that may involve watching you move, checking your joints movements (range of motion), gently pushing on muscles and joints to see if you have pain or spasm, THEN we will ask if you feel comfortable with an internal exam. You will give verbal consent and, in some cases, will sign a written consent. There are patients who are eager and ready to know what we will find and some who choose to wait until another visit. Your comfort should always be the highest priority.

The internal exam

You are in a private room. The PT will offer a sheet or drape for you to cover up with. The PT steps out while you undress.

The PT returns and helps you to get comfortable. The PT uses gloves and some type of lubricant. They should ask if you have any skin sensitivities and offer other types of lube such as slippery stuff lube, olive, or coconut oil.

The PT will slowly perform the pelvic floor exam in a gentle way trying to avoid pain but also checking if your muscles are tender, so they will apply gentle pressure and ask for your feedback. You always have the right to stop the exam at any point, due to pain or any other reason.

We may ask you to try to tighten or relax your pelvic floor muscles voluntarily. Depending on how sore you are, we may offer a moist heat pack or cold pack to calm down the muscles after an exam. The PT steps out, lets you get dressed, and then comes in to discuss the findings and work with you on developing a treatment plan.

How long will the visit be?

If this seems like a lot, it is! Pelvic PTs will usually spend about 45 minutes to an hour with you on your initial exam. I hope this helps to calm the fear and anxiety that often accompanies the first visit!

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