I believe a big deterring factor from women seeking treatment from a pelvic floor physiotherapist is fear of the internal exam. Nobody enjoys going for regular Pap test and though it is a necessary piece to overall health it is my least favourite part of the physical.
Pelvic floor physiotherapy is different and when I explain the differences to my patients I hear things like “oh that sounds so much better”.
Below are some of the main differences between a Pap test and an internal exam by your pelvic floor physiotherapist
You will not have your feet in stirrups.
It is awkward lying on your back, legs up in stirrups with your bum at the edge of the table. Traditionally called lithotomy position, it has been used in the medical world since early times. There are obviously benefits to being in this position from the doctor or medical teams perspective (good visual and physical access) however I find it leaves a level of vulnerability.
During your pelvic floor physiotherapy exam, there are no stirrups, the exam can be completed on your back or on your side (in the position that you are most comfortable) and I will be next to you at the table so I can see your face, explain each step in the process and watch for any facial cues to let me know you are not comfortable.
Pelvic floor physiotherapists do not use speculums
The speculum is the plastic instrument (or if you remember the metal….) that is used to open the vagina to get a clear path to the cervix. Use of a speculum is never comfortable, however, they are a necessary part of the Pap test to allow a swab to taken without contamination from the vaginal wall.
During your physiotherapy exam this is not necessary (hooray!), as I want to be able to evaluate the walls of the vagina, the muscles and connective tissues what the tone feels like and the strength, endurance and symmetry of your contraction, the speculum would get in the way.
You will not be asked to wear an awkward paper gown
The paper gown never fits, and I always lose the plastic belt that is provided to tie it around. When I move it shifts, leaving me feeling exposed.
I provide my patients with a soft flannel sheet to cover the lower body, allowing you to stay covered, comfortable and warm.
You will not have to lie on table paper
The piece of paper designed to cover the exam table that is never wide enough. When I try to get up onto the table I shift it and it usually tears, leaving my bum directly on the vinyl tabletop (which is cold).
During your visit to my clinic, I cover the exam table with a fitted sheet (soft flannel) that is removed and washed after each patient.
You will remain in complete control
You always have the right to remove consent during any examination completed by your medical doctor or other health care professional. Many women will grin and bare the full Pap test, even if they are in pain or discomfort. Worse, some women will avoid them all together knowing the discomfort they feel.
At your pelvic floor physiotherapy exam, we will only complete what you are comfortable with on that day. This may mean only an external visual or it may be the full internal exam. I will talk to you during your visit to ensure you remain in complete control and feel comfortable for the duration of the visit.
Take home message
If you do need pelvic floor physiotherapy, know that it is not the same as a Pap test; don’t let fear, embarrassment or discomfort deter you from the treatment you require. If you have not had a recent Pap test, I encourage you to make an appointment with your doctor. It is a necessary part of your regular health checkup.