The Internal Pelvic Floor Muscle Exam
Your questions about the internal exam answered and understanding your rights as the patient.
What is an internal pelvic floor muscle exam?
For our female readers, an internal pelvic floor muscle (PFM) exam is not like a pelvic exam you have had with your gynecologist where they check the health of the pelvic organs. For our male readers, an internal PFM exam is not like a prostate exam. An internal PFM exam is how a pelvic floor physical therapist evaluates and assesses the health of the pelvic floor muscles.
The pelvic floor muscles are located inside the pelvis underneath the skin and external genitalia. These are muscles that we cannot see outside of our body. These muscles do not create any large movements in or around the pelvis (although they do flex the tailbone under us). This means that we cannot evaluate these muscles by observing how the body moves.
In order to properly evaluate the pelvic floor muscles, we must perform a digital, internal exam. Depending on your anatomy and symptoms, this exam may be performed through the vaginal opening or anal opening. The physical therapist takes one gloved finger, applies lubricant, and presses on different points of the pelvic floor muscles to assess their tone, strength, endurance, and control. In total, the exam takes about 10-15 minutes.
Do I have to have an internal PFM exam?
The short answer is yes. To fully understand how your pelvic floor muscles contribute to your symptoms, your physical therapist must perform an internal PFM exam. There are a few exceptions to this but in most cases it is necessary.
There are a few things I urge you to keep in mind when it comes to an internal exam:
- Consent is absolutely required prior to performing the exam. Your physical therapist should not perform a PFM exam without your written and verbal consent.
- You have the right to stop the exam at any point. If you are uncomfortable, voice this to your therapist and stop the exam immediately. Your physical therapist should also be checking in to confirm your comfort level.
- While the exam may cause discomfort if you have pre-existing pelvic pain, it should not be intolerable. I coach patients that their pain should never go higher than 6 out of 10 (on a zero to 10 pain scale) during the internal PFM exam.
While an internal exam is never desirable, it is often necessary to see the full picture and understand your pelvic symptoms. Discuss any concerns you have with your physical therapist prior to starting the exam.