What can you expect from a pelvic floor examination?

A vaginal or pelvic floor examination can feel a bit intimidating so I wanted to fill you in with what to expect and give you some reassurance. As we know, there is still a lot of fear and shame from a young age about anything related to the vulva and vagina, and bladder and bowels. I think women worry about how their vulva looks, including their pubic hair and this can feel a barrier or feel embarrassing. Also I think as most women’s experiences of pelvic exams are either smear tests or during labour, they associate them a lot with discomfort or pain. However, having a pelvic floor check is so different.

So let’s get down to the nitty gritty and what is involved?

There are different types of pelvic examinations including vaginal examinations to check the pelvic floor and vaginal walls, these are different to smear tests.

A vaginal and pelvic floor examination with a physiotherapist will start with looking at the skin of the vulva, before doing an internal vaginal examination. Physiotherapists don’t usually use speculums, unless fitting a pessary. We will ask you to undress your lower half and lie on an examination couch covered with a paper towel. We will explain exactly what the assessment will involve and gain your consent before starting. The examination checks the pelvic floor muscles, how well you can contract and relax them, as well as checking the vaginal walls. It should not be painful, but can feel uncomfortable for some.

Smear tests are recommended to check for  human papillomavirus (HPV) to help reduce the risk of cervical cancer. This will involve a speculum that holds the vaginal walls apart so that they can access the cervix. The insertion of the speculum and when it is opened can feel uncomfortable and like pressure but it shouldn’t be painful.

For those of you that find pelvic exams uncomfortable / painful here is some advice on how to reduce the discomfort / tension, and help you to feel more confident.

Working on diaphragmatic breathing can be so helpful to facilitate relaxing the pelvic floor. Pain can be present for a few reasons, including increased tone in the pelvic floor.

Try the following:

• Take a deep breath into your lower ribs, allowing them to expand and the tummy to soften.
• As you breathe in visualise the vagina opening.
• Breathe out normally
• Practice and repeat this 5 times or during examinations

For a smear test you can always ask to help insert the speculum yourself or ask them to use a smaller size

Make sure you talk about any fears or anxiety you have to the medical professional and know that you are in charge and we can stop at any point!

Love, Clare x