Worried about having an internal vaginal exam? I totally get it. Pelvic health physiotherapists learn to do vaginal examinations on each other so we understand just how daunting they can be! Knowing in advance what is involved in a internal exam will help you feel more prepared. The exam usually goes something like this…
First, we will always explain what is involved (similar to what I am doing now), the reason we are suggesting it, the benefits and any risks associated as well as the alternatives available so you can make an informed decision. Know that you don’t have to decide straight away. You can always think about it and decide at the next appointment.
You are welcome to bring someone along with you if this would make you feel more comfortable.
Set up
If you are happy to go ahead, we will give you the opportunity to use the bathroom. While you are there, we set up the treatment bed with a clean ‘bluey’ for you to lay on and a towel or drape to cover up. We then leave the room so you can undress in private.
Once we have washed our hands, we will knock on the door and make sure you are ready before coming in. We then set up any other equipment we may need. No speculums or stirrups, we promise!
External observation
First, we start with observation. We are looking at:
- where your perineum is sitting in relation to your sit bones to get an idea of your resting tone.
- the colour and quality of the vaginal tissues.
- any scars or adhesions.
- whether there is any visible prolapse at rest.
We may ask you to perform a:
- pelvic floor contraction and relaxation
- cough
- bear down. We may take some measurements externally while you do this. These are important measures as they give us an idea of your risk of prolapse and help to guide your return to exercise postpartum. In pregnancy, they can also indicate your risk of tearing during vaginal delivery.
Internal palpation
We then move on to palpation. First, we check for any sensitivity around the vaginal entrance. If there is no pain and you are happy to continue, we will move on to the internal part of the exam. This involves inserting one or two fingers into the vagina to palpate the pelvic floor muscles. We are checking for:
- muscle bulk
- muscle tone
- muscle strength – a lot of women struggle to contract their pelvic floor correctly on the first appointment. If you can get a correct pelvic floor contraction, we will usually grade the strength of the contraction.
- relaxation – are you able to fully relax your pelvic floor muscles? This is just as important as the contraction.
- endurance – how long can you hold your pelvic floor contraction for? How many times can you repeat this? This allows us to prescribe you an individualised pelvic floor muscle training program if needed.
- any tender points – if your primary symptom is pain, we want to know if palpating the pelvic floor muscles reproduces your pain.
If indicated, we will then assess for pelvic organ prolapse. This involves checking the position of your cervix as well as movement of the front and back walls of the vagina while you bear down.
Please note that this is a full internal vaginal examination. Depending on what your main concern is, not all components of the exam may be performed. We will talk you through exactly what we are doing the whole time and ask you to let us know if you experience any pain or discomfort. Know that you can stop the exam at any point.
frequently asked questions
Not all physios can perform internal exams, only those who have completed further postgraduate training in pelvic health physiotherapy. Even then, some physios have a special interest in women’s health but haven’t completed the training to perform internal exams.
Please don’t apologise for this, we honestly don’t take any notice!
This is a common question we get asked. You can still have an internal exam when you are on your period as long as you feel comfortable. When we learn to perform vaginal examinations, there are always physios on their period. It doesn’t bother us in the slightest.
We generally don’t do vaginal exams in the first trimester. There is no evidence that a vaginal exam will cause a miscarriage but we tend to err on the side of caution. The best time to do a vaginal exam in pregnancy is generally after your 20 week morphology exam. That way, we can make sure there are no contraindications like placenta previa or incompetent cervix.
We usually like to wait until you are 6 weeks postpartum before performing an internal examination.
We wait until you have been cleared by your surgeon to have a vaginal exam. This is usually around the same time they say it is ok for you to return to sex.
I hope this helps to reduce any fear around having an internal exam. They are considered the gold standard assessment as they provide the most information about your pelvic floor. However, there are other assessment options available such as real-time transabdominal or transperineal ultrasound. Speak to your pelvic health physio if you are not sure which one is right for you.
If you have any other questions about internal exams, please don’t hesitate to comment below or use the contact form.
Courtney x
