Demystifying the Internal Exam: Understanding Your Options in Pelvic Floor Therapy
Let’s talk about the internal exam. Many individuals considering pelvic floor therapy feel nervous about this. The first thing to know is that an internal examination is not necessary to provide relief from your symptoms. It is simply one of many assessment tools. At Restorative Foundations Pelvic Health & Wellness, client comfort and safety are our top priorities. That’s why we offer a variety of options to assess the pelvic floor, ensuring that each client’s preferences and comfort level are respected.
Pelvic Floor Exam Options
Feedback-Based Assessment
Non-Contact Visual Exam
External Assessment
Internal Exam
Feedback Based Assessment
For this assessment, clients remain fully dressed. The pelvic floor therapist provides verbal guidance through various movements, breathing techniques, and muscle engagement exercises. By assessing feedback related to sensations, movement, and breath control, the therapist gains insight into the function of the pelvic floor, core, and surrounding areas. This is an excellent option for clients who are not ready for hands-on work or undressing.
Non-Contact Visual Exam
This option involves no physical contact and focuses on external observation. Clients undress from the waist down before the exam begins. The therapist observes movement patterns, muscle activation, and posture without any touch. Once the exam is complete, the client dresses, and the session continues. This can be a great option for those comfortable with undressing but who prefer a no-contact approach.
External Assessment
This option includes hands-on assessment. The pelvic floor therapist uses a gloved finger to evaluate the external pelvic floor muscles, checking for muscle activity, tenderness, and mobility. Unlike an OB/GYN exam, this assessment does not involve stirrups or a speculum. Comfort is prioritized through positioning, personal preferences regarding lighting and location, and ensuring the client feels in control. The exam can be paused or stopped at any time upon request.
Internal Exam
This is the only option involving internal touch. A gloved, lubricated finger is used to assess the three layers of the pelvic floor internally. Before the exam, the therapist demonstrates the process using a pelvic model to enhance understanding and ensure informed consent. Similar to the external assessment, this is different from a gynecological exam—there are no stirrups or speculums, and the environment is designed to be comfortable and client-centered. Most importantly, clients can pause or stop the examination at any time.
The best option is the one that feels most comfortable for each client. Every assessment method provides valuable insight into pelvic floor function.
What Are We Assessing With an External Examination?
Movement Patterns
Posture & Alignment
Symmetry
Coordination
Tissue Appearance
What Are We Assessing With an Internal Examination?
An internal exam allows for a more detailed assessment of the three layers of the pelvic floor. Each layer consists of different muscle groups that work together to ensure optimal function.
Coordination - are muscles able to contract and relax smoothly?
Strength - do muscles have the power to function properly?
Muscle Tone - are muscles too tight, too relaxed?
Endurance - ability to hold a contraction or complete multiple repetitions
Pain - are there any areas that or tender or uncomfortable?
Symmetry - are all sides able to function effectively?
What we learn from any of these assessments helps tailor treatment, whether the focus is on strength, relaxation, coordination, or another area of need. An internal exam is never required to develop an effective plan of care.
Common Questions
Do I have to have an internal exam?
No. There are three other options: feedback-based assessment, non-contact visual exam, and external assessment. As discussed above, an internal exam is never required, and valuable insight can still be gained through other methods.
Do I have to undress?
No. You can remain fully dressed for the feedback-based assessment. For the external visual, external, and internal exams, you will need to undress from the waist down. However, you will remain covered with a sheet or draping for privacy. Once the assessment is complete, you will dress before continuing the session.
What if I’m on my period?
If you’re comfortable, you can still have an assessment during your period. In fact, this can be a beneficial time to evaluate pelvic inflammation, tension patterns, and cycle-related symptoms. If you prefer to skip internal work during your period, that’s perfectly fine as well.
Does it hurt?
Pelvic floor therapy aims to reduce or eliminate pain. Measures are taken to ensure your comfort during any exam. Your therapist will discuss preferred ways to communicate any discomfort, ensuring that the assessment can be modified, paused, or stopped at any time.
What if I change my mind?
You can change your mind about an assessment at any time without it affecting your care or relationship with your provider. Your comfort and safety are our top priorities.
Can I have an internal exam if I’m pregnant?
If you are pregnant and interested in an internal exam, we recommend obtaining a referral or script from your doctor to rule out contraindications. These may include first-trimester pregnancy, vasa previa, active infections, or other medical concerns.
Can I have an internal exam if I’m postpartum?
For postpartum clients, we typically wait until around six weeks postpartum, once clearance is given by a physician and tissues have had time to heal. However, pelvic floor therapy can still begin earlier, focusing on other aspects of recovery and adjusting to motherhood.
What if I have a history of trauma?
We use a trauma-informed approach with all clients, prioritizing a safe and comfortable experience. We encourage open discussions about concerns to ensure your needs are met and that you feel supported throughout the process.
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Pelvic floor therapy is a collaborative and individualized process, and choosing the right assessment method is a personal decision. No matter which approach you prefer, Restorative Foundations Pelvic Health & Wellness is here to support you every step of the way.
If you're interested in learning more about how we can help you reach your pelvic health goals, we invite you to book a free discovery call today.