If you’ve spent time searching the web for information about recurrent vaginal infections or other gynecological health problems, you’ve probably encountered some content related to pelvic PT.

Perhaps you’ve been wondering if pelvic floor physical therapy can help you. Maybe you have no idea what pelvic PT is and you’re wondering why your vagina even needs a therapist. Regardless, you’re in the right place. Let’s discuss the basics of pelvic floor physical therapy and its role in your vaginal health.

What is pelvic floor therapy?

The phrase “physical therapy” is a protected term, which means only a licensed physical therapist with the appropriate education and credentials can provide physical therapy services. To practice physical therapy in the United States, aspiring physical therapists (PTs) must earn a clinical doctoral degree* (a Doctor of Physical Therapy, or DPT) from an accredited program and pass a national licensing exam.

As PTs enter clinical practice, many choose to specialize in one or two particular care areas and pursue advanced training in their chosen area. Pelvic health is one such specialty focus. 

Pelvic floor PTs specialize in the treatment of patients with a wide variety of pelvic conditions (more on that below). We can help people of all ages and genders, including cis, trans, and agender individuals.

As pelvic floor PTs, we strive to help our clients regain optimal function and participate fully in their lives. We design personalized care plans for each patient, which combine specific exercises, hands-on treatment, education, behavioral techniques, and more. 

While other professionals like chiropractors and massage therapists may also perform treatments similar to those we offer in physical therapy, they’re not providing pelvic physical therapy. It’s also important to note that not all physical therapists are pelvic health specialists.

*Note: US-based physical therapy educational programs transitioned to doctoral degrees during the 2000s and early 2010s. However, some older physical therapists practicing in the US still hold a master's degree in physical therapy: they have been “grandfathered in” by their many years of experience and continuing education.

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What pelvic conditions can pelvic PT help me address?

A good pelvic physical therapist can help with a myriad of different conditions, from pelvic floor dysfunction to painful sex and postpartum care.

Here are a few of the most common symptoms that pelvic floor physical therapy can help with: 

  • Loss of bowel and bladder control (urinary or fecal incontinence)
  • Sudden, intense needs to pee (urinary urgency)
  • Needing to pee quite often (urinary frequency)
  • Incomplete bladder emptying
  • Painful urination 
  • Sudden, intense needs to poop (fecal urgency)
  • Painful pooping
  • Certain types of chronic constipation
  • Certain symptoms of irritable bowel syndrome (IBS)
  • Painful intercourse (dyspareunia) 
  • Pain with anal sex
  • Vaginal muscle spasm (vaginismus)
  • Vulvar pain (vulvodynia)
  • Painful orgasms 
  • Endometriosis and adenomyosis
  • Uterine fibroids
  • UCPPS (aka interstitial cystitis or painful bladder syndrome) 
  • Painful periods (dysmenorrhea)
  • Pudendal neuralgia
  • Pain during gynecological exams 
  • Pain with the use of internal menstrual products 
  • Pregnancy and postpartum care
  • Vaginal dryness 
  • Muscle and joint pains
  • Muscle, joint, and nerve problems related to the pelvis
  • Transgender care during and after transition. 

And the list goes on! While this inventory isn’t exhaustive, suffice it to say that pelvic floor physical therapy can help you optimize your pelvic and vaginal health in multiple ways. 

How do I know if pelvic floor therapy is right for me? 

The best way to determine if pelvic floor physical therapy can help you is to consult with a pelvic floor physical therapist. Some providers offer brief, free consultations to help you determine if pelvic floor physical therapy is likely to improve your condition. 

During your initial evaluation, your pelvic PT will talk with you about your symptoms and goals, perform a thorough examination, and educate you about their impression and expectations for your recovery. Together, you’ll form a treatment plan to help you reach your goals.

How do I find a pelvic PT?

Finding a pelvic floor physical therapist can be challenging if you aren’t looking in the right places — remember, not every physical therapist is a pelvic specialist. Fortunately, there are a couple of websites that can make your search easier:

It’s important to note that PTs aren’t the only providers specializing in pelvic rehabilitation. Some providers from other healthcare backgrounds —  such as occupational therapy, nursing, and rehabilitation medicine — also train in pelvic health and care for people with pelvic conditions.

What should I expect in a first visit with a pelvic PT?

Patients often tell me they have been putting off pelvic PT because they were nervous about the first appointment, and they didn’t know what to expect. That’s perfectly normal. 

While each pelvic PT will practice somewhat differently, there are many commonalities we all tend to share. Here are a few things to expect on your first visit:

Plenty of talking

Your pelvic PT will spend the first portion of the visit getting to know you: they’ll ask you about the symptoms and concerns that brought you to PT, the goals you’d like to achieve, and the basics of your daily life. 

A comprehensive exam

Your pelvic health can be affected by body parts, from your hips to your jaw, so a comprehensive physical exam is a key component of the diagnostic process. 

Your physical therapist may ask you to perform movements like bending, squatting, and walking so they can see how your body parts move together. Additionally, this exam often includes a detailed assessment of the body regions closest to your pelvis, like your abdomen and lower back.

Pelvic floor assessment

For many people with pelvic health conditions, direct examination of the pelvic floor tissues can be extremely valuable. Your pelvic PT may ask to examine the skin of your vulva, checking for signs of skin irritation or sensation changes. 

With your permission, they may also perform an internal examination, using one or two fingers to gently press on the pelvic muscles inside the vagina. This allows them to identify areas of tension or tenderness that they can treat. They may also ask you to perform various movements with your pelvic floor muscles to measure their strength, endurance, and coordination.

However, an internal examination isn’t always necessary or appropriate during your first visit (or ever). Your pelvic PT will explain each proposed element of your examination to ensure that you’re comfortable and consenting throughout the process.

Education and explanation

Expect to learn a lot during your first pelvic PT visit and beyond: there’s so much to know about your pelvic health, but your PT will gradually explain the basics in terms you can understand. They will teach you techniques, pelvic floor exercises, and other strategies you can perform at home to manage your symptoms. Together, you’ll build a plan to address your concerns and move you toward recovery.

Can Evvy help me understand if I will benefit from PT?

In my own practice, I often find that people who experience frequent vaginal infections also live with one or more of the conditions from the list above.

The research supports this observation: for example, chronic pelvic pain is frequently present in people who experience recurrent infections. 

Together, Evvy and pelvic rehab can help you tackle several concerns simultaneously. Your Evvy test results will help you better understand your vaginal microbiome and how best to promote its health. This includes identifying that your vaginal microbiome is in a protected state, which may indicate you have something more structural going on, which a Pelvic Floor Therapist can help with. 

And, if you’re eligible for Evvy Clinical Care, you’ll have access to research-backed medications and supplements that will help you address imbalances in your vaginal microbiome.

A multidisciplinary approach to care will help you find solutions to optimize your vaginal and pelvic health. Evvy is here to support you, every step of the way!

FAQ

What do they do during pelvic floor therapy?

Pelvic floor therapy for women involves a combination of exercises, techniques, and lifestyle adjustments to strengthen and relax the pelvic floor muscles. During therapy, a trained professional may use biofeedback, manual therapy, and guided exercises to help you improve muscle coordination and control. You'll also learn how to correctly do Kegel exercises, work on improving your posture, and practice relaxation techniques to reduce tension. The therapy also includes education on managing symptoms such as pelvic pain, incontinence, or prolapse, and suggestions for making specific changes to your daily habits to support your pelvic health. The program is personalized to your needs and goals, ensuring a thorough approach to enhancing pelvic floor function and overall quality of life.

How do you know if your pelvic floor is weak?

If you're experiencing leaks when you cough, sneeze, exercise, feel a sudden urgency to use the restroom, or have trouble fully emptying your bladder, it might be a sign of a weak pelvic floor. You might also notice a bulging sensation in your vagina or have difficulties with bowel movements. If you're also dealing with sexual discomfort during intercourse, it could be related to pelvic floor weakness. It's a good idea to reach out to a healthcare provider or pelvic floor specialist for support and guidance if you recognize any of these symptoms.

Is pelvic floor therapy painful?

Pelvic floor therapy is usually not painful, although it may cause some discomfort, especially if you have tight pelvic floor muscles or pelvic pain. The therapy is meant to be gentle and is usually customized to your comfort level. Therapists use methods like manual therapy, biofeedback, and guided exercises to improve muscle function, and their goal is to make the experience as comfortable as possible. It's important to communicate openly with your therapist; if any part of the therapy is painful, it's essential to let them know so they can adjust the treatment. Ultimately, the aim is to reduce pain and enhance pelvic health over time.

Originally published on Aug 14, 2023
Last updated on Jul 23, 2024