Pelvic Floor Physical Therapy: First Appointment

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Sometimes I pee a bit when I jump on a trampoline. Or laugh. Or cough. Or sneeze. Or… you get the idea. The one time I tried kegel weights, they did not want to come out. All the google searches in the world couldn’t find anything to do with “where to put kegel weights in vagina” or “kegel ball stuck behind pubic bone?”, so I figured it was time for some extra help. My partner, Simon, had told me about his physical therapist friend who specialized in pelvic floor health, so I set up an appointment. I was nervous and unsure at first, worrying about a stranger seeing my bits and potential awkwardness, but 1. A physical exam didn’t even happen in the first appointment, and 2. This person looks at vulvas and buttholes every day; mine will be no surprise. After convincing myself of this, I was actually kind of excited about this prospect. I couldn’t wait to learn more about my body.

The day of my appointment, I plopped down in the waiting room and was given some paperwork to fill out by a friendly receptionist. I filled out the usual name, date, address information, and signed my consent to a possible physical exam (which like I said, didn’t end up happening). Kate* came to meet me with a warm smile. After introductions and a handshake, I followed her into a little room down the hall. In it was a treatment table, two chairs, and a desk. I sat in one of the chairs and faced Kate, excited to begin. She did so by asking me lots of questions: when and how often I “leaked”, how often I urinated and defecated, if I was sexually active, if I experienced any pain during any of those activities, and if I ever peed during sex. I told her about my anxiety, my kegel weight attempts, and my issues using menstrual cups, to all of which she listened closely and scribbled down notes.

After this question and answer session, she pulled out a skeletal and muscular model of the pelvic region. She told me how the pelvic floor encompassed important organs such as the bladder, colon, uterus, and ovaries, then describing each individual component: all the bones, organs, and immediate and neighboring muscles. Kate made a point to say how they all worked together, and that anything wrong with the pelvic floor is usually caused by something else wrong with the body, whether that is a mental or muscular issue. For example, often people have a weak pelvic floor because to stand, they clench their buttcheeks together, forcing the pelvic muscles to do the core’s job and as a result, become too tight to function properly.

In my case, she thought my issues may stem from having constantly tensed muscles. My pelvic floor is like those bum-clenchers: too tight. She had told me about a study that examined where people hold tension when experiencing fear or stress, and the results showed the pelvic floor to be a main area. This could mean that my pee-leakage problems could stem from my long-term anxiety issues. She then explained what we could do to relax and strengthen my muscles. They usually wait to do a physical exam until after the patient has had their first gynecology appointment so they would be more relaxed. I haven’t been to the gyno yet but in the future I could definitely come back for a physical exam in order to get a more precise diagnosis and personalized therapy plan. Then, I could go over exercises to teach my muscles how to relax, learn pelvic floor massages (so curious about what this entails! Totally sounds like finger-fucking to me), and other methods of improving my condition.

Throughout the session, I asked Kate a lot of questions too. She sees both men and women of all ages for a variety of different reasons, from incontinence to pain to postpartum strengthening. Something she mentioned that stood out to me was that the condition of the pelvic floor is often psychosomatic. Psycho meaning pertaining to the brain and somatic meaning body. Sometimes women come in with tightened pelvic floors because of growing up in a sex-negative culture. Their mind is so tied to “NO SEX EVER” that their body  in turn refuses to function the way it should. I had told her I wanted to be a sex educator earlier, so at this point I turned to her and said “Okay, you fix the physical problem, I’ll try and work on the culture that surrounds it.”.

You’d feel no shame or nerves going to a doctor for a cold or a physical therapist for an injured ankle, so why should you feel embarrassed to see a specialist for help with your pelvic region? To quote Kate: “I see so many vulvas everyday that looking at a vagina is about as shocking as looking at a knee.” These therapists are not there to make you feel shame, but to help your individual body be the best it can be. My dad has bladder issues that are increasing as he ages, and I’m glad I’m starting out physical therapy now so I can fix and anticipate any of my own issues in the future. If you’re experiencing any sort of pelvic-floor troubles, whether they’re related to incontinence, pain, or trouble with kegels, I totally recommend going. If you have health insurance, it will most likely cover it, and if your physical therapist is anything like mine, they will be so kind, smart, and excited to share their knowledge with you. You’ll learn so much about your body and what you can do to help it be the best it can be.

*Name has been changed for privacy. Not that y’all would know who my vagina physical therapist is anyhow.

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