What to expect at women’s physio

Recently I was talking to other ladies with broken vaginas and I was surprised to learn how many were deeply disturbed by their women’s physiotherapist appointments. And then I was like: well hold up Miriam, the only reason you we’re surprised is because you had friends who’d gone before and prepared you for the experience.

Other ladies might not be so lucky. Other women (or enbies, or trans men; all vagina owners are welcome here) might be the first person they know to prolapse, or might not be comfortable asking their mates, “so how’s your vag?”

So here it is. Let’s talk about what goes down at the women’s physio. What you can expect, what you should be concerned about, etc. This might get graphic; if you know me in real life or don’t have a vagina, share my link with your vagina-owning friends and call it good. No reason to put yourself through this.
Alright?

There are a few different types of prolapse and your women’s physio is an expert in all of them. She knows all about the different muscles down there, what they do, and what they should feel like.

Yes. What they should feel like. There is a lot of feeling involved at the women’s physio. A good mate of mine refers to it as “getting fisted” if you’re wondering how invasive this is going to be.

I’ve seen a lot of doctors. When I was getting ready for surgery to fix my rectal prolapse, every time I saw my colorectal surgeon she put her finger up my butt. One time she did it with an audience. We had a bum party where she put a wire sensor on her finger and poked around for a while. Even that was over in half the time of physio, and this woman later put a scalpel in my butt.

My Nan used to say “leave your pride at the door when you have your baby” and that applies to basically every doctor visit after too, I reckon. There’s just no point in being embarrassed. You’ll be asked a lot of questions about how you feel, why you’re there, what you want to achieve, what your continence is like, how often you visit the bathroom, etc. Be honest and have a laugh if you can.

Think about it, these physiotherapists are up to their knuckles in vagina all day. They’ve seen them hairy and sagging and bald and scarred and everything in between. As long as it’s clean they seriously aren’t going to care, so why should you?

They do their best to make you feel comfortable. My lady always asks me if I’m okay with having a physical examination that day, always pulls the curtain and leaves the room for me to get my pants off, and provides a little towel to put over my lap so I can’t see her fingering me (and thus can pretend she isn’t? I really don’t know why the towel helps, but it totally does.)

At every physical exam she will check out all the different muscles, lots of poking and “does this hurt?”
At first most of it hurt because everything was messed up. I thought I was doing my kegals right, but turns out I didn’t know shit. Nowadays it generally doesn’t hurt, and if it does I am pro at doing the right visualisation to unlock that muscle even though I can’t feel it working.

Yep, visualisation. Not just good for spellcraft.

During this poking stage there might be a bit of small talk. She’s not just keeping her hand warm, she’s learning about how your pelvic floor reacts to your breathing, your state of mind, and is getting you used to her being in there. You won’t be very good at the exercises if you’re internally freaking out about this stranger having her hand in your shmoo.

I have a tip for making this less awkward:
Ask her questions!

Ask her about her health, her career, her family, her hobbies. Take an interest in her as a person. Get to know her a bit. You’re vulnerable, let her be a little vulnerable too. She will tell you if she doesn’t want to answer something or if you cross a line. Alternatively ask her about what she’s doing and what she can feel in there. Learn about your body and the process. Understanding makes everything bearable.

At your first visit and periodically thereafter, you’re likely to be measured. Yeah. They measure how big your snatch is, and then they tell you what risks and perks come with your size.

Okay I lied, there are no perks.

You will also do a set or three of exercises. There are lots of different ways you can move your internal muscles, including “down training” where you learn not to be unreasonably uptight. You’ll be given exercises to practice at home, and before you go you’ll need to prove you can do them.

You’ll likely be asked to cough so she can see if anything bulges out, and if you want to start going to the gym, you might be asked to so a sit up while she’s monitoring internally. Sometimes they might measure inside your vag too, particularly if you’re wanting a pessary.

All up, a good half an hour to forty minutes of internal work seems pretty standard. You might be sore the next day. If you feel like you’re an abnormal amount of sore or you have bleeding, call for a chat! You’re not being a problem patient. Speak up! These are professionals who are there to heal you not hurt you.

And that’s pretty much it. She’ll leave again, you’ll clean off the lube and get some pants on, then you’ll have another little chat. You might get given pamphlets, asked to complete a bladder diary, or you might get a print out detailing your exercises. Sometimes you’ll get bad news and have a little cry, that’s okay too. If at any point you feel unsupported, take that as a big red flag.

Women’s physio session can feel long. They are long. There’s a lot of work to be done, and if the most touching you’ve had in the last few years is a quickie between when the kids go to bed and when you pass out drooling in front of the telly then yeah, this is going to feel like a lot of touching. Compared to the gyno, the pap-smear nurse, the poop school team, and the colorectal doctor, this is quite intense. You can’t just hold your breath til it’s over, you have to participate. If you’re Wiccan like me you can take a bit of comfort in the second principle of witchcraft To Dare, because we’re brave and we own our shit (tell yourself whatever you need to hear!) Hopefully knowing what to expect helps a little as well.

Now for things that ought to concern you: If your physiotherapist belittles you, tells you others have it worse, tells you that you’re just getting old and not to worry about it, tells you that you shouldn’t have symptoms or you’re imagining things, or in any other way makes you feel like a piece of shit human, see someone else. If your concerns aren’t being heard, see someone else. How you feel about being half-naked and internally examined isn’t something she can control, but how she speaks to you is. If you feel verbally attacked, don’t put up with it.

As always, the hardest part of helping people is finding them in the big wide world, so if you’re in a women’s support group, or are brave with your friends, please give this a share.

Miriam Cumming doesn’t know why there were so many double spaces in this damn blog, but she tried to remove them all. If she missed any, please blame the internet sprites. Miriam has been the proud owner of a cystocele, rectocele, and rectal prolapse for a few years now. When she’s not getting fisted by the physio, she writes fun urban fantasy books and plays with stickers.