What to expect at your first Pelvic Health Assessment Appointment

What to expect at your first Pelvic Health Assessment Appointment

We are based at Tahi which is a beautiful, modern healing space that’s located on the first floor at 1 Devon Street East, New Plymouth. Our door is right next door to Swanndri located on the corner of Currie & Devon Street and there is parking on the street outside or nearby at Centre City (3 min walk away). There is a lift on the ground floor if you are not able to use the stairs and/or if you’re bringing your pram with you.

When you come upstairs into reception, you will be met by the lovely Kerry who is here to welcome you Monday-Thursday between 10 am and 2.30 pm. If your appointment is outside of these hours then we ask for you to just take a seat in reception, sit back, relax and enjoy a cup of tea. We will be with you shortly.

There is usually a consent form that we ask you to fill out which confirms your details and requires your signature. There are bathrooms located within reception and there is also a baby changing table in the Women’s Toilets. You are very welcome to bring your baby with you to your appointment and Kerry can often help out if you wish/ if she is available. Sometimes it is easier to leave them with a loved one if they can get a bit unsettled and this is the same for toddlers, who can get quite bored and feel confined within clinic rooms and are your responsibility whilst you are at your appointment.

Your initial appointment will last 75 minutes and the first half of the session is primarily us chatting. This gives us time to listen to your story, ask some questions, and find out what we can do to help.

The first thing we will talk to you about is your pelvic health history which might include: your periods and what they are like; any pelvic health issues pre-pregnancies; obstetric history and deliveries and whether you have had any surgeries or investigations and whom you have seen for these already.

Then we will go through a specific list of screening questions regarding bladder and bowel conditions. Quite interestingly a lot of people often say “Oh no it’s all fine”, but when we start going through some of the questions they say “Oh yes… sometimes that happens actually”. These questions stimulate your thinking and no one may have asked you these before but please know everything is held in absolute confidence and there is likely nothing you can tell us that we have not heard before!

We also ask a few questions around sexual health, history, and function. We understand how this can be acutely embarrassing, but the majority of women we ask these questions to are actually rather relieved to be able to talk freely surrounding these topics with no shame or embarrassment. There is no such thing as “too much information” for us and the more information you share with us really helps to direct our physical assessment and what we may need to look at.

By this time, we will already have a good idea of what may be going on and this will help us to know what to focus on during your physical examination. We will then ask if you need to use the bathroom and then have a look at you fully clothed in standing. If necessary we have shorts that you can wear or just wear loose comfortable clothing that will stretch. We will be looking at your positioning in standing and ask you to move so we can check your upper, mid, and lower back movements as well as your balance on one leg.

We will ask you then to lay on the bed and if you are happy we will place our hands on your trunk, ribs, abdomen, and pelvis and look at your rib angles, abdominal area, breathing patterns, and range of movement at your pelvis and hips. The reason behind this external checking is that pelvic floor muscles attach to pelvic bones and also integrate movement and function from the abdomen, ribs, diaphragm, lower back, and hips. We may spend some time here treating what we find or we may just collect information and move on to the next part. Pelvic Health Physiotherapy is treating outside of the pelvis more often than in and it is more than just Pelvic Floor Exercises.

Then, depending on the situation, we will check with the client if they are happy for us to perform an internal exam. This is completely within your control at your first appointment and we are not worried if this is something you are not comfortable with and would like to defer. It is YOUR appointment.

If the client is happy, we will then ask them to undress their lower half behind a screen and there will be a blue mat on the bed with a towel and also wipes if you wish to use them. You can place your garments and knickers wherever you like as we will not be looking at them! Once you are lying down, we will ask you to part your knees and feet and just take a look at your vulva and perineum area. This allows us to see from a tissue perspective, dermatologically if there’s any soreness or dryness, or scars, and then ask you to do a couple of actions such as bearing down, giving a small cough, and a pelvic floor squeeze.

At that point, if the client is happy too, we will insert one gloved finger at the vaginal entrance with lubricant and then feel superficially and then slightly more deeply around the clock. Starting at 6 o’clock, then to 9, 12, 3 and then 6 again. We may ask you if you can feel areas of the pelvic floor, if there is any soreness, if you can squeeze the muscles here, and also check where the cervix is placed. We may take some measurements at the same time.

As part of the pelvic floor exam, we may ask to check you in standing. This can be really helpful because the change of gravity can be quite different from an internal assessment. For example, often women may have been checked at the GP/Nurse clinic and not seen anything, however in standing it can be more noticeable and is more realistic to how they are the majority of the day. Then that is it. You are offered tissues and wipes and then asked to get dressed again and take a seat so we can put all the pieces of the puzzle together and formulate an action plan as to how to help you reach your goals.


FAQ’s

Here are some frequently asked questions:

  1. What do I do if I’m due on my period when I’ve booked a pelvic health appointment?

The answer is, you do you. What that means is that it doesn’t make a heap of difference to our assessment and in actual fact the internal check (always optional) is the shortest part of our appointment and sometimes isn’t even warranted at a first appointment. 

If you are on your period then you can:

a. Absolutely reschedule (soon as you know is best for us to fill the gap) 

b. You can come along and we can cover everything as normal and still assess your pelvic floor externally. 

c. You can come along and we can still do a full exam. Just wear a pad or cup/tampon that you can remove beforehand. Easy Peasy.

  1. What should I wear to the appointment?

Just wear loose, comfortable clothing that can stretch and be removed easily.

  1. What if I haven’t had a wax nor shaved my legs in weeks?

We. Do. Not. Care. Please, please do not worry about this. We have all been there! It is the last thing we will be looking at and we would hate for you to have another thing  on your ‘to-do’ list before you come to an appointment. Come as you are, as your beautiful self

  1. Do I have to have an internal examination on the first appointment and/or every subsequent appointment?

No. Your appointment is YOUR appointment. We often treat pelvic health conditions externally and often an internal assessment/treatment is based upon the individual presentation and comfort level. There are some clients that we have treated over Telehealth that resolved all their issues without even seeing them in person! So it is entirely possible to treat some pelvic health conditions without an internal exam.


We always strive to make our clients the most comfortable and so please just let us know what you would prefer. Know that it won’t embarrass us nor will you be describing something we haven’t seen or heard before. It’s a superpower of a pelvic health physio. So book it in and then if it crops up, we can sort it .