Q: What initially inspired your passion for advancing pelvic health education, particularly in bridging the knowledge gap for clinicians performing pelvic exams?
After my breast cancer treatment, I developed severe dyspareunia. Despite running a sexual and reproductive health program at a Federally Qualified Health Center (FQHC), I didn’t know how to help myself—and I quickly realized how little I had learned about the pelvic floor during my training.
I also recognized how privileged I was to access pelvic health care and wanted to make that care more accessible for my patients. Becoming a pelvic floor therapy patient myself opened my eyes to the fact that pelvic health is absolutely within the wheelhouse of any clinician performing pelvic exams.
This realization led me to secure a grant from the Massachusetts League of Community Health Centers to create a pelvic health clinic at my FQHC. The project, Bringing Awareness of the Pelvic Floor into Primary Care, highlighted the lack of training in pelvic floor assessment, even though 1 in 4 people with vaginas experience pelvic floor dysfunction.
There are fewer than 10,000 pelvic floor physical therapists in the U.S.—most are in urban areas, out of network, and English-speaking. My dream is that clinicians, including PCPs, internists, and OB/GYNs, assess pelvic floor muscle tone and motor control during the first visit to provide the right diagnosis and treatment plan in that very first office visit.
To address the broader knowledge gap, I co-founded the Institute for Pelvic Health with a pelvic floor physical therapist. Together, we’ve developed educational tools, including the evidence-based Beyond the Kegel™ course, a comprehensive Pelvic Health Resource Binder, and a Pelvic Health Clinician Certification to empower all clinicians who do pelvic exams.
What are the main challenges you’ve seen in raising awareness about pelvic floor physical therapy among both medical professionals and the general public?
One big challenge is the misconception that only specialists like pelvic floor physical therapists or urogynecologists can help. Long waitlists and access barriers leave patients, especially under-resourced ones, struggling. We need to empower clinicians to intervene during that first visit to prevent conditions from becoming chronic.
Another challenge? Many think pelvic health is just about kegels, but it’s so much more than that!
What are some practical ways clinicians can improve their skills in performing pelvic exams to better assess and manage pelvic floor dysfunction?
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Optimize breathing and biomechanics! It’s a quick, 3 step process that you can start using TODAY. Here’s how you do it:
- Lower the stool so you can put your feet flat on the floor
- Ask your patient to relax their fingers, toes and glutes
- Take 3 diaphragmatic breaths together
- Do you really need the footrests? Putting the patient’s feet on the table instead of in the footrest can make a big difference for the following two reasons:
- Your patient will be more comfortable during the exam
- It will make it easier for you to assess the pelvic floor
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Always use the smallest size speculum possible
- Our video about speculum size went viral on tiktok with over 1.4M views!
Our Institute for Pelvic Health has a clinician guide- “4 step guide to make your next pelvic exam easier”. You can download it here.
In your experience, how does vulvovaginal moisture assessment play a role in diagnosing and managing pelvic floor dysfunction?
When the vulvar vestibule or vagina is dry, it can lead to tightening and shortening of internal pelvic floor muscles. Dryness in these areas can also create microtears, further worsening dysfunction.
Can you explain the significance of lubricant osmolality in pelvic health and why it’s important to educate clinicians about lubricant choice?
Lubricant osmolality matters! High-osmolality lubricants (>1,200 mOsm/kg, as defined by the WHO) can dry out vulvovaginal tissues, slough off the epithelial layer, and cause microtears.
It’s crucial to educate clinicians—and patients—that the proper use of lubricant involves applying it inside the vagina and to anything being inserted. Osmolality should always be listed on the label, but unfortunately, many brands omit this information.
How do you address the stigma or discomfort patients may feel when seeking treatment for pelvic floor issues? How can patients advocate for themselves?
Education is key—for both providers and patients. When clinicians are uncomfortable, it makes it even harder for patients to talk about pelvic floor concerns.
I explain that the pelvic floor supports urinary, bowel, and sexual health. When it’s dysfunctional, it can create issues just like any other muscle in the body. By asking open-ended questions and normalizing these conversations, we create a safe space for patients to share.
For patients, I encourage them to advocate for themselves.
Try saying:
“I think this could be related to my pelvic floor. Can you check that for me?”
“Do you have a mirror so I can look while you do your external genitourinary exam?”
“I prefer not to use the footrests.”
“Can you use the smallest size speculum?
Small steps like this can lead to big changes in pelvic health care!
References
Kates, K. & Hines, M. (2023). High tone pelvic floor and bowel, urinary, and sexual health. Women's Healthcare, 11(5), 30-36
Meister MR, Shivakumar N, Sutcliffe S, et al. Physical examination techniques for the assessment of pelvic floor myofascial pain: a systematic review. Am J Obstet Gynecol. 2018;219(5):497.e1-497.e13
Potter N, Panay N. Vaginal lubricants and moisturizers: a review into use, efficacy, and safety. Climacteric. 2021;24(1):19-24
Ross V, Detterman C, Hallisey A. Myofascial pelvic pain: an overlooked and treatable cause of chronic pelvic pain. J Midwifery Womens Health. 2021;66(2):148-160