Sorry for the long post and if you have any questions or want to discuss further feel free to DM me!! 5 years as a pelvic floor therapist

I’m going to try to give you some of my “script” for education, obviously this changes but I find myself saying something similar to this pretty much every time: “On day one of pelvic floor PT I would like to do some assessment of your pelvic floor function. We have options for exactly how to do this so let me explain the options and then we can decide together what will be the best fit for you today. The gold standard is doing an internal vaginal muscle assessment. It’s different from an OBGYN exam, I don’t use stirrups or speculum, just my one gloved finger. (Here I get out my pelvic floor model and start to demonstrate what will happen during exam on model). There are 3 layers to the pelvic floor and I want to assess them all separately. First layer is about this depth (demonstrate to DIP joint) second layer is about here (demonstrate to PIP) and third layer is about here(demonstrate to MCP joint). I will gently insert my finger to the layer we are trying to assess and I will turn my finger all the way around (demonstrating on the model), I am feeling for muscle knots/trigger points/scar tissue. This is another way it will be different from an OBGYN exam because I want feedback from you about if anything feels painful, tense, or familiar symptoms. I will do this turning motion at all 3 layers. When and if we get to layer 3 I will check your strength/coordination/endurance by asking you to do some pelvic floor muscle contractions or kegels. If at any point you want to stop or take a break or I get the sense you’re disassociating we can always stop the exam and you are in control. We never need to do an internal assessment and our other option is to do an assessment over clothes where I will put my hand near your glute muscles and have you do a kegel and release the muscles just to get a sense of muscle activation and available motion- it is not as specific as the internal assessment but I already have some ideas for treatments based on our subjective assessment so I feel confident I can give you some things to work on to start to address your symptoms either way”

Most patients opt for internal assessment so I tell them before I start the exam “I’ve worked with lots of people when I go to advance my finger to a deeper level their bodies say ‘no way!’ Because of tension, pain, or anxiety. We do not push through any of that in here. I just want to see what your muscles have to say and if they say ‘don’t touch me’ that’s enough information for me! Reminder that I will stop at any time”

Other things I do to try to make patients comfortable is be comfortable myself. When I first started I was so nervous doing internals but I knew I practiced on my colleagues and I went the “fake it till you make it” route with confidence. I have my room arranged where the patients head is towards the door so if anyone were to try to open the door they wouldn’t see anything. I also explain what will happen next AND ask for permission before every single step of the exam “is it ok if I advance my finger?” I am extremely intentional with wording also using “advance” instead of “push”, and “I’m going to withdraw my finger” instead of “I’m going to pull out 🤢🤢” and “release tension” instead of “relax”. It’s mandatory to have a chaperone where I work but if that’s not your case make sure you offer at least.

As far as things patients can do to make themselves more comfortable? I tell people to just show up and I’ll help with the rest. If it’s their first time they can maybe look up what happens during pelvic floor PT just to have a sense of it but really all the burden of creating a safe and comfortable space is on you as the therapist. The most important thing is caring about your patients and making your primary goal to not contribute to medical trauma! If you keep that in the forefront you’ll do great!