Learn How to Perform a Pelvic Floor Muscular Exam

 
 See how we're leveraging education to reach our goal of making pelvic floor muscular exams a standard procedure with every annual physical exam.

See how we're leveraging education to reach our goal of making pelvic floor muscular exams a standard procedure with every annual physical exam.

Pelvic Floor Exams Should Be Standard of Care

It is our goal here at Sarton PT that one day, a pelvic floor muscular exam will be standard of care and occur as a standard procedure with every annual physical exam.

We know we stand united with our many of our pelvic floor physical therapy colleagues out there, and we are confident that together we can make this happen—even if it is just 1 step at a time.

Last week, we took one more step in the right direction. Our team went onsite to a local OB-GYN office to teach 4 of their MDs how to incorporate assessment of the pelvic floor muscles into their pelvic exam.

We shared with them (and now are sharing with you!) this illustrative article that our own Dr. Julie Sarton, DPT, WCS authored on how to perform a comprehensive pelvic floor muscular exam.

 Figure 1  During the pelvic examination of women with sexual pain, the pelvic floor muscles (PFMs), one of the largest structures in the pelvis, should be palpated systematically. Using single-digit palpation, the clinician should assess for changes of the PFMs including hypertonicity, trigger point formation, and muscle shortening. Overall, the PFMs can be divided into 3 different layers. The superficial and intermediate muscles are depicted in step one. The superficial later consists of the bulbospongiosus, ischiocavernosus, and superficial transverse perineal muscles. The intermediate layer, also knows as the urogenital diaphragm muscles, consists of the deep transverse perineal, the sphincter urethra, and the compressor urethra muscles.

Figure 1

During the pelvic examination of women with sexual pain, the pelvic floor muscles (PFMs), one of the largest structures in the pelvis, should be palpated systematically. Using single-digit palpation, the clinician should assess for changes of the PFMs including hypertonicity, trigger point formation, and muscle shortening. Overall, the PFMs can be divided into 3 different layers. The superficial and intermediate muscles are depicted in step one. The superficial later consists of the bulbospongiosus, ischiocavernosus, and superficial transverse perineal muscles. The intermediate layer, also knows as the urogenital diaphragm muscles, consists of the deep transverse perineal, the sphincter urethra, and the compressor urethra muscles.

This is a great resource for physical therapists (PTs) and doctors of medicine (MDs) alike, as it outlines how to assess the superficial, intermediate, and deep pelvic floor musculature. It further highlights some of the most common sings and symptoms of muscular dysfunction that can exist at each layer. The full article with additional illustrations can be accessed via  J Sex Med 2010;7:3526-3529.

What Can Medical Professionals Do?

We want to encourage medical professionals out there to seek out pelvic floor education and training as an integral part of their practice. With many of our pelvic floor physical therapy patients waiting years, even decades, before they're referred to a pelvic floor physical therapist, it is more important than ever that the medical community is aligned. 

What Can Patients Do?

We also want to encourage patients to use their voices. We often get asked by patients how to even begin bringing up such a sensitive topic to their doctors. Be open, honest and direct about what you are experiencing. Ask for a pelvic muscular exam to confirm the diagnosis. If your OB-GYN doesn’t feel confident in performing this then ask for a referral to someone who does. You can print out one of our diagnosis pages and take it in with you to help educate your MD about the diagnosis and appropriate treatment. Most importantly, find a pelvic floor PT to help you! Hope and healing are possible!

It took me a few months for my doctor to finally believe me and perform an internal exam, where then she could finally literally see the pain I was experiencing. She immediately referred me to a pelvic floor physiotherapy and i have been understood & helped every since! Don’t keep waiting!!
— Anonymous patient