Internal Exams 

Why Do Them?

The pelvic floor muscles are located inside the pelvis. PF physiotherapists are certified to perform internal pelvic exams because the pelvic floor muscles cannot be fully assessed externally. It is important for the therapist to be able to feel the tone, length, and strength of the muscles in order to make an accurate diagnosis and provide the patient with an individualized treatment plan.

What Does an Internal Exam Involve?

An internal exam involves the therapist inserting 1-2 gloved fingers into the vagina and/or 1 gloved finger into the rectum. A rectal exam is not always performed, but can provide very helpful information when symptoms include pain in the sacroiliac joints, sciatic and pudendal nerves, and tailbone (coccyx), or in cases of bowel incontinence.

Internal exams assess the following:

·      Pelvic organ prolapse (position of the organs in the pelvis)

·      Ability of the muscles and tissues within the pelvis to stretch

·      Tone of the pelvic floor muscles

·      Ability of the pelvic floor muscles to relax and contract (strength, endurance)

·      Ability to coordinate pelvic floor muscles with the rest of the core muscles

·      Areas of pain or tenderness in the pelvis

·      Pelvic reflexes

·      Position and appropriate movement of the tailbone

Internal exams are different than those performed by your doctor. Speculums are NOT used, because physiotherapists are less concerned about seeing inside the pelvis than feeling and testing how the tissues function.  

Is an Internal Exam Required?

Nothing is ever mandatory. Internal exams are only performed with informed patient consent.

It is important to know that a full and complete assessment of the pelvic floor cannot be performed without an internal exam, so without one some important information may be missed. However, the patient’s comfort is always top priority, and there are less direct ways of assessing the pelvis if an internal exam is not possible. Keep in mind that progress can still be made without an internal exam.

A history of trauma, including sexual trauma, can sometimes impact a person’s comfort level with internal exams. It is helpful to disclose this information to the therapist if possible.

Internal exams are not performed on younger patients who are not sexually active.

All patients are able to withdraw consent at any time, even if they have previously agreed to an internal exam.  

Informed Consent for Internal Exams/Treatment

This is the informed consent form all pelvic health patients will be provided with. They may choose to consent or not consent to an internal exam.

Pelvic Health Physiotherapists are certified to perform internal exams involving the vagina and/or rectum. The examination is performed by observing, palpating and/or inserting a gloved finger into the perineal region including the vagina and/or rectum. This evaluation will assess skin condition, reflexes, muscle tone, length, strength, endurance, scar mobility and/or function of the pelvic floor region.

Internal exams are not mandatory, but they allow the therapist to assess important tissues and muscles that cannot be assessed externally. I understand that I will discuss this exam with my therapist and have the opportunity to ask any questions I have prior to the exam being performed.

I understand that I may have a person of my choice accompany me during the evaluation, and that the exam will occur in a clean, private & secure area.

I understand that I will be required to disrobe from the waist down for the exam and that appropriate draping and coverings will be provided.

I will communicate relevant medical history information to the therapist including, but not limited to, medication use, IUDs (or other implants), pre-existing urogenital infection or known sexually communicable diseases, or change in pregnancy status.

Treatment may include, but is not limited to the following: observation, palpation, stretching and strengthening exercises, soft tissue and/or joint mobilization, mindfulness-based exercise, pain/bladder/bowel diaries, bladder/bowel habit retraining, educational instruction, use of vaginal weights, and vaginal or rectal sensors for electrical stimulation

Potential benefits:

• The therapist will gain a better understanding of my symptoms and physical function

• As a result, the treatment plan will be more individualized to my current needs

• Decreased pain and discomfort

• Improvement in and/or resolution of pelvic dysfunction/symptoms

• Improved body awareness, strength, flexibility and endurance

Potential risks of an internal exam:

• Pain/discomfort (during or after the assessment)

• Light spotting/bleeding (during or after the assessment)

• Anxiety/emotional response

• Skin reaction/irritation (from gloves and/or lubricant)

• Vago-vagal response (nausea or lightheadedness)

These effects are rare and usually temporary. If they do not subside in 1-3 days, I agree to contact my physiotherapist.