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Understandably many women are anxious about undressing for a Pelvic Health Physiotherapist, but I can assure you that we are here to make you feel as comfortable as possible.
Some of my patients explain that they have not seen many or any vulvae and although may have looked at their own, have little to compare with to know whats 'normal'. It can be helpful to take a look at your own vulva using a mirror so that you can be aware if something changes that may need attention from a doctor or physiotherapist. There is a great website for those interested - the great wall of vagina, a large-scale artist's installation of plaster moulds of hundreds of women's vulvae, which represents the huge variation of normal, http://www.greatwallofvagina.co.uk/home
What will happen in my appointment?
In your initial consultation we will spend time discussing why you have come for Physiotherapy, your symptoms and concerns and answer any questions you have.
The physical exam is an important part of the assessment, anyone is welcome to decline, maybe you don’t feel prepared, we won’t mind, it can be done at a later appointment.
The exam itself goes like this:
1. Undress your lower body, including your underwear, in privacy and lie on your back on the plinth covered with a towel or clinic tissue paper.
2. I will come back into the room. You will bend your knees up, feet flat on the plinth and we will part your knees and get you to relax your legs so that you are comfortable.
3. I will look at the general area of your labia, pubis, inner thighs and buttocks to see that the skin looks healthy.
4. I will feel your lower abdomen to check for any tenderness and your muscle tone.
5. Using a gloved hand, I will gently part the labia to take a close look at the skin of the opening to the vagina. At this point I will also ask you to cough and then try a pelvic floor contraction to see how all of the muscles functioning.
6. The internal exam involves using one gloved finger and some water-based lubricant, to insert just inside the opening of the vagina and feel the muscles of the pelvic floor.
Here I am looking for any areas of pain, tightness, scarring from previous child birth, lack of feeling. I will also ask you to try some pelvic floor contractions and feel for how the pelvic floor moves.
The whole process takes around 10 minutes and we can stop at any point if you want to.
7. I will finish by leaving you in privacy to get dressed again. Then we can talk through how everything felt to you, what I observed and what we need to do next to get your symptoms resolved.
***Common things some people experience during the exam that are no cause for serious concern.
Smell – there can be many reasons for an unpleasant odour. Recurrent urine leakage, bowel issues, vaginal or skin infections, hot weather. If there is any reason for concern I will sign-post you to a specialist nurse or your GP who can do further tests and solve the issue.
Leaking – you will be lying in a relaxed position and so leaking of urine or discharge can occur.
Pain – some women come to see a Physiotherapist because they experience pelvic or vaginal pain. It is important that we assess why and where this is coming from but we will be gentle and avoid aggravating the area.
Sounds - air can get trapped in the vagina, and gas is produced naturally in the bowel as part of digestion, these can escape from the body during an exam, but it is not something to be embarrassed about.
image credit: hello clue. www.helloclue.com/articles/cycle-a-z/vaginas-101
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