When attending a pelvic health physiotherapy appointment it is very common that your physiotherapist will discuss the concept of an internal vaginal exam with you. As the pelvic floor is on the inside of the body (sitting at the base of the pelvis), the best way to assess the muscle is to palpate or feel the muscle internally via the vagina.
Every assessment begins by gaining informed consent and making sure you are comfortable to proceed with the assessment. If so, we will begin by assessing the entrance to the vagina to look for things like scarring, discolouration, the position of your muscles and any muscle overactivity. We will then ask you to contract and relax your pelvic floor muscles, cough and bear down or push down like doing a poo. When completing these actions we are looking at how your muscles move and how they respond to pressure e.g. how much do your muscle move when you cough or push down?
If you are happy to continue, we will proceed with the internal part of the assessment. It is important to note that lots of information can be gained just by observing what is going on from the outside, so if you are not comfortable to proceed that is okay!
During the internal component the physiotherapist will use gloves and lubrication for comfort and safety. You will be lying on your back with your knees bent and a towel over your hips. We do not use a speculum. One finger will be inserted into the vagina and you will be asked again to squeeze and relax your muscles, cough and push down. Depending on your symptoms and comfort, we may insert two fingers to further test your muscles and assess for prolapse.
The assessment is now complete!
Please remember that pelvic floor assessments should not be painful. If you are experiencing pain, tell you physiotherapist and remember an assessment can be stopped at any point in time.