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Painful? Uncomfortable? Let’s find out the truth about your first pelvic exam!

As a pelvic floor specialist, I get my fair share of patients nervous about having a pelvic exam done, it’s their private area, they might not feel comfortable having someone looking at them in their most vulnerable position, and every time it happens I get the same questions: is it painful? Will it hurt? Why do I need it? 

Every time a patient voices those concerns I have to put myself in their position and make sure their questions are answered in the best way possible, but the truth is the answer is really no, it shouldn’t hurt unless something is wrong, and we need it to determine what exactly can be causing your pelvic pain, however, to ease their minds and yours, reader, I’ll explain in fuller detail exactly what can you expect from your first pelvic exam.

It isn’t like the pelvic exam you get on your gyno visit

What to expect on your first pelvic exam?

As physical therapists our focus is not necessarily on the same things a gynecologist would be interested in, therefore the pelvic exam you would get on your consult is different from the ones you get for your yearly checkup. Our evaluation is both external and internal, but let me explain why:

-We take a look at your body as a whole, and if a muscle is bothering you, your body will move and present differently trying to avoid the hurting, so this is basically the same thing that happens and the reason why we take a look at your vulva first. The exam is done in a completely sterile and private space, with a gloved hand, your pelvic floor specialist will take a closer look to see if there’s a sign of irritation, pain, or swelling. During this time, we’ll be asking some questions trying to understand more about your symptoms.

-When it is time for an internal exam, we want you to feel comfortable and in control of the situation, because the more relaxed you are the less uncomfortable the pelvic exam will be. As soon as you are ready, we apply some lube on the gloved fingers and proceed to do the internal exam. During this exam, we’ll evaluate the state of your internal pelvic muscles, see if they are reacting properly, where any tightness could be, and determine the root cause of the issue; we might also ask you to do a kegel to get a fuller read on how your muscles are moving and how much control you have over them.

The pelvic exam doesn’t have to be on your first appointment 

Because we want you to feel comfortable, we are more than open to push the first pelvic exam and work with what we have, we understand it can put you in a very vulnerable position, and that can be scary, however, I like to recommend this exam for a better understanding of what exactly is happening that can be causing you the pain, this way we can get started on a more informed course of action to make sure the pain you are experiencing is taken care of. 

Some patients prefer to wait a bit before they have their first pelvic exam, especially patients who are suffering from very painful experiences when it comes to contact with the vagina, such as individuals with vulvodynia or vaginismus, which are both incredibly painful illnesses affecting the muscles around that particular area, so as they pursue healing, that fear of the pain it could cause is still present there.

The pelvic exam shouldn’t really be painful, regardless of the condition you potentially have, the pelvic exam shouldn’t be painful, and if it’s anything more than uncomfortable, feel free to voice your concerns so your pelvic floor specialist can take a different approach while still getting the same results.

Findings and plan of action after the pelvic exam

What to expect on your first pelvic exam

Once the exam is done, the findings are discussed with the patient, explaining in detail what we found and how exactly it has been affecting them, during this process, we cross-examine what we were able to find with the symptoms you have been experiencing and we can establish a ground level in which to build up from, as we have a much clearer picture of what can be happening with your pelvic floor. Sometimes patients come in the appointment with their diagnosis and are just looking for a plan to make their pain manageable, but others we are the ones to make the suggestion of what can be happening.

When it comes to the treatment for pelvic pain, it’s pretty depending on what’s the root cause, for some Kegels might do the trick and solve the issue, others might need certain exercises to actually relax the pelvic floor. The many different conditions that can be causing your pelvic pain are what can determine your course of action.

Once I have a fuller understanding of my patient as a whole, I like to take a multifaceted approach to their journey, that’s why I have a selection of different specialists I can direct them to for maximum results, for example, if someone experiences pelvic pain thanks to a GI track issue, I can refer them to a specialist in the subject or a nutritionist, in company of my very own course of treatment to achieve the best results.

In conclusion…

The pelvic exam is a necessary part of some patient’s course of treatment, however, we as pelvic floor physical therapists are here to make sure this entire process is as easy going and relaxing as possible for our patients, we want them to feel empowered and in control of the situation. 

It shouldn’t be painful and it shouldn’t be without your permission, because while this will give us a better understanding of what could potentially be happening, it’s your body and absolutely your choice about when and how this process is happening.

If you have any questions regarding your first pelvic exam, please feel free to let me know as I would love to answer them. Also, I have some more content about the pelvic floor on my Instagram, feel free to follow me!