Pelvic Health – What to expect

Good pelvic health is essential for your physical and mental wellbeing. At least 1 in 4 women have issues with their pelvic floor including leaking urine, pain, or a feeling of ‘heaviness’ or dragging. It is important to report any pelvic floor issues to someone who can help you get access to the assessment and support that you need. This could be your GP or if you have access to medical support such as a physiotherapist they could also help you to get the support you need. Early intervention with pelvic floor issues often means treatment is far more straightforward.

Why might I need to see a specialist?

Many women can improve their pelvic health by following some basic advice, but others may need to be seen by a specialist doctor (Gynaecologist), a women’s health physiotherapist or a women’s health nurse. When seeing a specialist for pelvic health, they may need to examine your pelvic floor. The specialist will always ask you for permission, and you have the right to say no or to think about it and come back at a later date. In some situations, this may mean they cannot diagnose and treat your problem to their best ability, and they will discuss that with you.

Who can offer to give me a pelvic health exam?

• Gynaecologists
• GP
• Women’s Health Nurse
• Women’s Health Physiotherapist – we advise that you use a physiotherapist who is a member of the Pelvic Obstetric and Gynaecological Physiotherapy group

Consent

Before any assessment or treatment, the health practitioner should gain informed consent. This means that they should:

• Fully explain what they are about to do and why
• Give you the opportunity to ask any questions
• Obtain your consent before proceeding

You can refuse any assessment or treatment that you are not comfortable with.

You can change your mind and withdraw your consent at any point during the assessment or treatment.

A female chaperone should be offered to you for any assessment or treatment, or an appointment rearranged for when a chaperone can be available, should you wish to have one. Girls under the age of 16 should always have a parent or guardian present for pelvic health assessments.

What is a pelvic exam and what to expect?

After obtaining your informed consent and the offer of a chaperone, your exam will happen in a private treatment area. You will be asked to remove your lower underwear and to lie on the examination bed on your back with your knees bent. You will be given a sheet to put over your lap.

A pelvic health specialist will look at the outer genital area for changes such as signs of infection, age-related changes and prolapse. You may be asked to try to squeeze your pelvic floor muscles, so they can see what happens from the outside in the vulva and your abdomen when you do this.

An internal vaginal examination may be performed. The specialist will explain the procedure and ask for your consent. If you agree, they will use one or two gloved fingers to feel the pelvic floor muscles internally. They can also check for prolapse and any internal tender or tight areas. They will ask you to contract and relax the muscles several times. This will usually be done lying down, but you may also be asked to check these muscles while you stand or sit.

If your main problem relates to bowel incontinence or a large tear resulting from childbirth, the specialist will ask to do a rectal examination.The specialist will explain the procedure and ask for your consent. If you agree, they will use one gloved finger to assess the pelvic floor muscles in the rectum. They will ask you to contract and relax the muscles several times.

Sometimes a specialist may check other things like your posture in standing and sitting, and the way you move. They may look at your pelvic floor muscles using ultrasound which uses a probe placed over your low abdomen, or over the outside of your perineum (between the vagina and anus) to check the pelvic floor muscles.

What happens if I don’t want to have a pelvic exam?

An internal exam provides your healthcare practitioner with more detailed information which they will use to provide you with treatment recommendations best suited to your needs however not everyone will be comfortable with being examined.
If you do not wish to have an exam, your healthcare provider will still be able to offer advice to help you improve your symptoms.