What Happens During a Pelvic Health Assessment?

And Do I Need an Internal Examination?

For many women, booking a pelvic health assessment can feel like a big step.

You might know you need support, but still feel nervous about what will happen during the appointment. You might be wondering whether you’ll need an internal examination, whether you’ll have to talk about things that feel embarrassing, or whether your symptoms are “bad enough” to ask for help.

First Things First – We'll Have a Conversation

The first thing I want you to know is this:

You will be listened to.

A huge part of my initial consultation is simply giving you the time and space to talk properly. Not rushed. Not dismissed. Not brushed over.

Many of the women who come to see me have spoken to someone about their symptoms before. They may have mentioned them to their GP, talked things through with a partner, confided in a close friend, or sought reassurance from family members.

And often those people have been wonderfully supportive.

In fact, many women tell me it was a friend, sister, partner or another mum who encouraged them to book an appointment in the first place. But even when we have supportive people around us, it can still be difficult to say exactly what we’re thinking.

Sometimes the thing that’s really worrying you feels too embarrassing to say out loud. Sometimes you’re worried you’ll sound vain if you’re concerned about how your vulva looks after childbirth. Sometimes you’re frightened of being judged if you’re struggling with intimacy, confidence or changes in your body.

Sometimes you’re carrying a sense that your body has somehow let you down, or that you’ve failed in some way, even though logically you know that isn’t true.

And sometimes you simply haven’t had the time or space to properly process everything that has happened.

So while many women have talked about their symptoms before, they often tell me this is the first time they’ve been able to say everything. The first time they’ve had an hour dedicated entirely to them. The first time they’ve been able to talk through not just the physical symptoms, but the worries, frustrations, fears and questions that have been sitting in the background for months, sometimes years.

That’s why tears are not uncommon in my consultation room.

Not because anything is wrong, but because finally having the space to talk about something you’ve been carrying on your own can be incredibly emotional. If tears come, that is completely okay.

My role is to listen, understand what you’re experiencing, and help you make sense of it all. You do not need to filter yourself, minimise your symptoms, or worry about saying the wrong thing.

Nothing is too embarrassing, too personal, or too small to discuss. You will not shock me.

Whatever you’re worried about, we can talk about it.

What Happens Next?

Something quite interesting often happens once a woman has had the chance to properly tell her story. The fear she arrived with begins to soften.

Not always completely, but often enough that I can see a physical change. Shoulders drop. The tension she has been carrying starts to ease. She breathes a little more deeply.

During that conversation, we often end up discussing what she has already been told.

Perhaps a GP has mentioned a prolapse. Maybe she has been told she has a weak pelvic floor. Perhaps she has read something online that has left her feeling worried or confused.

One of my jobs is to help make sense of all that information.

We talk about what these terms actually mean, what might be contributing to the symptoms, and importantly, what can be done about them. The reality is that pelvic health symptoms are rarely caused by one single thing.

Hormones may play a role.

Breathing patterns may play a role.

Stress may play a role.

Movement habits, previous births, surgery, exercise history, sleep, bowel habits and everyday life can all contribute.

As we begin to put the pieces together, I often see something shift. The guilt starts to lift.

The feeling that they have somehow failed, or that their body has let them down, starts to soften. Instead, they begin to understand that what they’re experiencing has reasons behind it. There is physiology involved. There are mechanics involved. There are often multiple factors interacting together.

And with understanding comes hope - sometimes even excitement - that getting back to what they love might actually be possible.

Looking at the Bigger Picture

Before we move on to any pelvic examination, I spend time looking at how your body functions as a whole.

After all, pelvic health doesn’t exist in isolation.

We’ll usually look at things such as:

• how you stand

• how you breathe

• how your rib cage and pelvis work together

• whether you’re able to relax as well as brace

• balance and single-leg control

• functional movements

• your abdominal wall

• C-section scars, where relevant

  
  

I do much of this in standing because that is where life happens.

Most people don’t experience their symptoms lying comfortably on a treatment bed. They experience them when they’re standing, walking, lifting children, exercising, shopping, working and getting through everyday life.

Looking at the body in these positions often gives us valuable information that helps explain what is happening.

Using Ultrasound to Take the Guesswork Out of Pelvic Floor Assessment

One of the things that makes my assessments a little different is the use of real-time ultrasound imaging.

This is an area I have undertaken additional specialist training in because it allows us to gather information quickly, accurately, and in a way that many women find reassuring and empowering.

Traditionally, pelvic floor assessment relies heavily on how a woman describes her symptoms and how the muscles feel during examination. While those things remain important, ultrasound allows us to actually see what is happening.

Rather than guessing whether a pelvic floor contraction is effective, we can watch the movement in real time.

Rather than wondering whether the muscles are relaxing properly, we can observe them.

Rather than relying solely on verbal cues, we can use visual feedback to help you understand what your body is doing.

Many women describe this as a real lightbulb moment.

For the first time, they can actually see what is happening rather than trying to imagine it.

We can use ultrasound through the lower abdomen and, where appropriate, transperineally, with the probe placed externally alongside the vulva.

This can help us understand how the pelvic floor is moving, how it responds to breathing, and whether it is able to contract and relax effectively.

For women who prefer not to have an internal examination, ultrasound can provide a valuable alternative source of information and often helps guide treatment decisions.

It is one of the reasons I chose to train in and offer ultrasound within my pelvic health assessments. It can help us get clearer answers, more quickly, and gives you a better understanding of your own body.

Read more about ultrasound here.

Do I Need an Internal Examination?

For many women, this is the part of the appointment they have been thinking about most.

The answer is that an internal examination can provide very useful information, but it is not always essential at the first appointment.

In many cases, I can learn a huge amount from your history, symptom story, movement assessment and ultrasound assessment.

If you are feeling anxious about an internal examination, we can discuss the alternatives and decide what feels right for you.

There is never any pressure.

If we do decide that an internal examination would be helpful, I’ll explain exactly why I’m recommending it, what information it may provide and what will happen before we begin.

Nothing is rushed.

What Happens During an Internal Examination?

If we decide to proceed, I’ll leave the room while you undress from the waist down and cover yourself with a towel provided. Privacy and dignity are extremely important to me.

Before we begin, I’ll talk you through exactly what I’m assessing and why. I think it’s important that women understand there is a purpose behind every part of the examination.

It is not random.

Every observation helps build a clearer picture of what may be contributing to your symptoms.

One thing I often say is: “The talking takes longer than the doing.”

The examination itself is usually quite brief.

Throughout the assessment, I regularly check that you’re still comfortable and happy to continue. Consent is not something that is given once and forgotten about. You can change your mind at any point, and that is absolutely fine.

Sometimes we use a mirror during the assessment. Many women have never had the opportunity to properly look at their vulva with good lighting and someone available to explain normal anatomy.

If you would prefer, I can leave the room for this too and give you time to look on your own.

For some women, this can be surprisingly reassuring and empowering.

Assessing the pelvic floor in standing may also form part of the examination. Again, this is because symptoms usually occur when you’re upright and moving around, rather than when you’re lying down.

Many women tell me they appreciate this because they have previously been told everything looks normal when examined lying down, despite experiencing significant symptoms during everyday life.

Before You Leave

Once the assessment is complete, I’ll leave the room again so you can get dressed in privacy. We then sit down together and go through everything we’ve found.

Most importantly, we make a plan.

I try to keep those first steps manageable.

After an hour of talking, information, explanations and assessments, most women do not need a list of ten things to do.

They need clarity.

They need reassurance.

They need one or two practical things they can start working on straight away.

After all, most women are already juggling work, family, children and countless other responsibilities.

My aim is never to overwhelm you. My aim is for you to leave feeling informed, understood and back in control.

To understand what is happening in your body.

To know that there is a way forward.

And perhaps most importantly, to feel a little less fearful and a little more connected to your body than when you first walked through the door.

Ready to Book a Pelvic Health Assessment?

If you have been putting off booking because you’re worried about what might happen during the appointment, please know this:

You will be listened to.You will be supported. You will be in control throughout.

Whether you’re dealing with leaking, heaviness, prolapse symptoms, pelvic pain, scar discomfort, postnatal recovery, pain during intimacy, changes during perimenopause, or simply a feeling that something does not feel right, you do not have to work it out alone.

Book a pelvic health assessment and let’s start by talking it through properly, or red more about Pelvic Health Physiotherapy here.