I say “pelvic floor”, you say….therapy? It’s probably not your first thought, but you may be surprised to know that pelvic floor physical therapy is indeed a thing – and one well worth pursuing for most women!
As a young woman, I was well versed in the need for regular well-woman care with a midwife or OBGYN. I was familiar with the standard no-one-ever-likes-going-but-we-really-should visits involving paper table cloths, fluorescent lighting, and staring aimlessly at the ceiling waiting for “it” to be over. As a mother, I was also aware of the rueful comments and self depreciating jokes many of my mom friends told when it came to pelvic health. It seemed “normal” that once you were a mom, peeing when you sneezed (and sometimes in way more instances) just came with the territory. It wasn’t until I became a doula and childbirth educator that I learned pelvic floor physical therapy was even a thing. Once I found out it was, I was SHOCKED I had never heard of this before. You mean to tell me there’s actually things we can do to fix a variety of problems down there? SIGN ME UP! With all the myriad things that can happen after growing and/or pushing a HUMAN BEING out of your body (and if you’re like me, a huge one lol), why wouldn’t every mother go in for a tune up??
So what is a pelvic floor physical therapist, exactly? Let’s start with what they’re not. They are NOT a replacement for your regular well woman or maternity care provider. They do not perform pap smears or std testing and the like. They don’t deliver babies. They are strictly the experts on normal pelvic function and disorders that can benefit from non-pharmacological treatment. Like your standard physical therapist, they have received years of schooling and have an appropriate doctorate level expertise in their field. While it might be obvious that a standard physical therapist would show you stretches and exercises for your particular ailment, the ins and outs of pelvic PT are a bit more muddied for most new to the concept. What exactly does a pelvic PT do? How does one rehabilitate a vagina? I was on a quest to find out! Both for the health of my own hooha and, you know, for science.
I started this illustrious quest by seeking recommendations from peers. This was easier said than done because A: Who really goes on facebook and says “Hey guys! Anyone had any work done on their downstairs lately?” and B: Pelvic PTs are unfortunately in short supply. As an active member of the local birth community I did have somewhat of a leg up and a general idea of where to start. I came away with several local names, and chose one that was both close-ish to home and participated with my insurance provider (this itself was tricky. I for one was SHOCKED – not – to discover pelvic pt is often not covered under medical insurance in the USA). I called to make a new patient appointment and was more than a little discouraged to hear from the friendly gal on the phone that there was potentially a 3 month waiting period just to get an appointment. I gave my info for the wait list, and asked to be contacted if there were any cancellations.
Not 1 week later, I received a call that there had been a last minute cancellation, and could I come in the next day? Darn tootin i could! (Pelvic pun not intended). The next morning came and as I made my way to the office, I became more and more apprehensive. I mean, who really wants to go have a stranger go poking around their vagina? Kudos to you if that’s your cup of tea, but I’m slightly more vanilla in that respect and like to generally keep my bits and pieces under wraps. I pushed through, and walked inside. To my pleasant surprise, the office was beautiful. This particular office shared space with other holistic wellness providers so it had a more homey, spa-like atmosphere than your typical medical provider. Off to a good start! I sat in the waiting area on a cushy chair, listening to your typical token spa sounds of running water and smelling a faint aroma leftover from what I imagine was a hot stone massage or acupuncture session. I half expected my therapist to appear with a cold glass of cucumber water.
When Dr. J did appear, I was pleasantly surprised. She was warm and friendly, introducing herself with her first name only. With an easy demeanor and witty repartee I immediately liked her, even if she was sans pepino. This was very good, considering this person was likely going to have her hands in and around my poonany for the next hour. She had me at, “Hello, my calling is vaginas.” We are now BVFFs – best vajayjay friends forever.
The treatment room was small but cozy, with real linens on the exam table (more massage table looking actually, which was nicely disarming). We started off as you might expect, going over medical history and what had brought me in to the office. Pelvic pts treat a huge variety of ailments. Anything from urinary incontinence and bowel distress to pelvic prolapse, sexual discomfort, cancer of the pelvic floor, scar tissue, diastasis recti, and pain disorders like vulvodynia and interstitial cystitis. The list goes on and on – chances are if you’re having an issue in the general vicinity of your female anatomy and your GYN can’t treat it alone, a pelvic pt can help. I was happy to hear that the symptoms I had been concerned about after delivering my third child were both common and very treatable. Hooray!
We moved from the conversation part of the appointment, which felt more like chatting with a girlfriend than a medical provider, to the actual exam. I popped up on the table fully dressed and laid back. Dr. J started off checking out my abdominal muscles since I’d had several children, moved into examining my legs and pelvic area over my jeans to find muscle tension and areas of soreness, and finished after doing the same to my sacrum while I laid on my stomach. There were some gentle manipulations of my leg in different positions to find what hurt and what didn’t, but there was never a point I was uncomfortable enough to request her to stop. The entire time was latent with active consent, and her assuring me I could ask her to pause at any moment if I became uncomfortable or overwhelmed.
From this point we needed to move on to the internal examination. If you’d prefer NOT to read this part, I suggest scrolling to the next paragraph. However, I feel like keeping this stuff shrouded in secrecy is part of the reason so few women know it exists and so many are afraid to go when they do, so I’ll be blunt. For science. As much as this is something no one looks forward to, I felt comfortable and respected and was totally OK with proceeding. I used the ladies’ room quickly then shed clothes from the waist down, and hopped back on the table. There was a full sheet (no ridiculous paper gown) so despite my current state, I felt pretty covered. Dr. J explained everything that would happen each step of the way so there were no surprises. She used a hefty portion of water-based lubricant and started off pressing gently on various of my vulva to find out if there were any areas causing me pain. Next, she used one gloved finger inside my vagina to do the same. As odd as it sounds, it wasn’t difficult to maintain a conversation during this time and provide feedback on what she was doing. She was able to pinpoint several things that aligned with problems I had discussed with her and came up with a treatment plan. We spent the last half of the appointment doing some gentle internal stretching using her hand, and then some stretching of my inner thighs where I had a lot of tightness causing issues with my pelvis.
While the actual therapy was taking place, the chat was pleasant. I learned how when people in her modality go to school they learn these techniques by practicing on the other students in their class. Everything she does for patients she’s had done on herself. I found this remarkable! What an excellent way to practice medicine, and to learn empathy for what a patient may experience. I can’t think of a better way to learn how to be gentle and careful with such an intimate type of work.
Therapy finished, I got dressed and we chatted for a few more minutes about my treatment plan and how we would proceed going forward to accomplish my coochie christmas list. There will be some exercises and therapies I’ll do at home, and I’ll continue going back to see her in the office fairly frequently for a while.
Overall I can wholeheartedly say I was thrilled with the experience. Not so much because of what it entailed, obviously, but because there is actually hope! When current estimates tell us that 40-70% of women experience occasional urinary incontinence and up to 50% of women will experience some type of prolapse before they’re 44 I cannot proclaim loudly enough how essential this service is. I highly recommend seeking out a practitioner for yourself. Whether you’re pregnant, postpartum, or just uncomfortable there is NO reason to simply suffer in silence. Go find your own BVFF – and if you’re in Maryland, I am more than willing to share mine 😉