Questions we answer in this article:
What does an INTERNAL rectal examination typically feel like?
What if I make a mess on the table during an internal evaluation?
Should I refuse an internal evaluation if I have hemorrhoids?
What does an EXTERNAL pelvic evaluation typically look like?
What if I get an erection during my pelvic floor evaluation/treatment?
Despite all this information and what I know now, what if I still prefer not to have an external and internal evaluation?
What embarrassing questions could my pelvic floor therapist ask me during my evaluation?
What if I feel frustrated at the end of the visit that I did not answer the questions correctly or give enough information?
Who will be in the therapy room?
My male pelvic floor therapist is female; is that weird?
I am embarrassed to sit in the waiting room, primarily if the clinic focuses predominantly on women's health.
Do you, as a therapist, ever feel weird doing an external or internal evaluation?
What exactly are the boundaries of male pelvic floor therapy when it comes to treating sexual dysfunction?
In this article, we want to show you how easy it is to visit a pelvic floor specialist by answering the 13 most embarrassing questions about male pelvic floor PT.
Those hidden body parts are just as important as your shoulder or knee, if not more so. They deserve to be pain-free and in optimum health.
We know that pelvic floor therapy is a safe, low-risk treatment option that should be the first choice in managing different types of pelvic floor dysfunction.
Not seeking help may lead to inaccurate self-diagnosis, frustration, and unanswered questions.
We understand that male anatomy dysfunctions can be daunting to deal with, and scheduling an appointment with a pelvic floor therapist in person can be challenging.
But imagine the following: At the male pelvic PT clinic, you have someone who listens to your whole story, problem-solves with you, and gets you back to your favorite activity.
Your therapist will give you solutions so that you don't have to spend hours and hours online looking for answers, just to be more confused and frustrated afterward.
Consider that seeing a pelvic floor therapist is so much easier than a colonoscopy, surgery, needles put into nerves, and months on antibiotics. Give pelvic therapy a try.
We have had partners who went through pelvic PT and brought in their guys so they could get better quicker because they experienced the benefit of it.
So, let us dive into some of the most embarrassing questions when you schedule your first male pelvic floor PT visit.
Being prepared may help, and at the end of the visit, you may be surprised to find that the experience was easy peasy.
Male pelvic floor PT - The most embarrassing questions:
We will discuss topics like the internal and external examination (should you need it), the therapy environment (i.e., the waiting room and who will be in the room with you), additional questions (like what the physical therapy boundaries are), and other questions you are dying to ask.
The external and internal pelvic floor examination:
We recommend the internal and external evaluation if you need more answers than the typical orthopedic evaluation can provide you with, especially if you are experiencing issues with bowel, bladder, sexual function, pelvic pain, or tailbone pain.
Like any other muscle in the body, the pelvic floor muscles can experience problems such as weakness, decreased coordination, tender points, nerve involvement, and asymmetries due to scar tissue or prior injuries.
And if your pelvic floor muscle is the cause of your problems, then ignoring the poor thing won't solve your problems.
1. What does an INTERNAL rectal examination typically feel like?
However, your therapist may palpate a little deeper and stay in your rectum a tad longer to examine more structures, such as tender points and your tailbone. Your therapist will use gentle techniques.
Your pelvic floor therapist will only conduct this assessment with your consent before and during the evaluation.
You will lie fully draped on your side, tummy, or back and should not experience any pain, but some discomfort may be present during the digital evaluation. Remember, your rectum is used to stuff going out, not in.
You may feel the urge to have a bowel movement during the examination, but this feeling is just due to normal reflex reactions in your rectum and does not mean you need to use the bathroom.
People usually report that it is not as bad as expected, and the valuable information they gained from the assessment made it worth it. See, easy peasy.
2. What if I make a mess on the table during an internal evaluation?
Generally, fecal matter remains in the higher part of the rectum or sigmoid colon and is out of reach during rectal examinations.
However, if you are experiencing constipation or loose stools, some fecal matter may be present in the lower part of the rectum but should not affect the assessment.
3. Should I refuse an internal evaluation if I have hemorrhoids?
Those with hemorrhoids may benefit from the internal evaluation since pelvic floor dysfunction could result in hemorrhoids.
An internal evaluation may be valuable to you, especially if you have a history of constipation, straining, and uncoordinated/ineffective pushing habits.
Rest assured that most people who visit a pelvic floor therapist have hemorrhoids.
If you have active bleeding hemorrhoids, then your therapist may postpone the internal evaluation to a later time. Voicing your concerns will help them guide you through the process and make you feel at ease.
Your therapist will be careful during the evaluation and may use additional lubrication.
4. What does an EXTERNAL pelvic evaluation typically look like?
The external pelvic assessment may extend from the abdominal wall to the thigh muscles, including the groin area, inguinal canal, genitals, muscles, ligaments, and fascial connections.
Nerves connecting to your pelvic area come from as high as your midback, so your therapist must include those areas in their evaluation.
If you need an assessment that involves your genitals, your therapist may ask you to undress from the waist down, and you will wear a hospital gown.
5. What if I get an erection during my pelvic floor evaluation/treatment?
Getting an erection during a physical therapy session seldom happens, but please don't worry if it does.
Unfortunately, the fear of having an erection during a therapy session leaves many not seeking the help they need.
Your therapist will put you at ease during your first visit, including discussing draping techniques and positioning.
You can also ask for treatment to stop at any time, and your therapist will step out until you are ready for the treatment to proceed.
The environment is medically based, and your therapist's primary focus is finding the root/cause of your problem.
6. Despite all this information and what I know now, what if I still prefer not to have an external and internal evaluation?
If you still feel uncomfortable undergoing internal or external evaluations, you can decline or postpone them.
Your therapist suggests external and internal evaluations when necessary because they can enhance the effectiveness of therapy by accurately identifying issues and helping your therapist provide you with a more detailed plan and straightforward answers.
Remember, your therapist will not perform these evaluations without your consent, and your therapist can still gather helpful information through conversations and orthopedic assessment.
The talking part of the pelvic floor evaluation:
7. What embarrassing questions could my pelvic floor therapist ask me during my evaluation?
During your evaluation, your therapist may want to know details about your bowel, bladder, and sexual functions based on your symptoms.
Each question asked is purposeful.
They may ask about the frequency and consistency of your bowel movements, how often you urinate, and your dietary and fluid intake.
If you are experiencing sexual difficulties, they may ask about the positions that worsen your problems or help them.
Please know there is no need to feel embarrassed during this process - take advantage of this opportunity to ask questions.
Your therapist is well-versed in this process and will not judge you.
8. What if I feel frustrated at the end of the visit that I did not answer the questions correctly or give enough information?
Rest assured, you will have many opportunities to address questions or concerns and add additional information.
Pelvic health concerns can sometimes have several contributing factors, and the evaluation process may involve more than one visit.
The environment where the pelvic floor evaluation will take place:
9. Who will be in the therapy room?
It may be just you and your therapist, but you can bring someone with you, or the therapist can arrange for someone else to be present if you prefer.
Your therapist will discuss this with you before the visit and any HIPAA precautions should you bring someone in.
It also depends on the clinic, but feel free to ask beforehand.
10. My male pelvic floor therapist is female; is that weird?
It ultimately comes down to personal preference.
Choose a therapist you feel comfortable with, whether male or female.
Consider seeing a pelvic floor therapist specializing in men's health, as they will have undergone additional training.
11. I am embarrassed to sit in the waiting room, primarily if the clinic focuses predominantly on women's health.
When scheduling your appointment, feel free to inquire about the layout of the waiting room. You can always stay in your car and have them text you when they are ready.
At our pelvic floor therapy clinic in Albuquerque, the waiting room serves several other diverse health professionals, so no one knows whom you are there to see.
When you want to dig a little deeper with your questions:
12. Do you, as a therapist, ever feel weird doing an external or internal evaluation?
No, we do not feel weird doing the internal or external evaluation. Doing these evaluations is part of our job; we do it all day.
We are here to help people with sensitive issues that are often difficult to discuss.
As pelvic floor specialists, we focus on finding the root cause of your problem and providing practical solutions.
13. What exactly are the boundaries of male pelvic floor therapy when it comes to treating sexual dysfunction?
Pelvic floor therapists identify problems with the muscles, nerves, and organs and give exercises, advice, and treatment regarding physical problems or pain.
Some activities, such as those requiring an erection, will not be done in the physical therapy clinic but can be given to you as homework and for you to report back on.
We do not perform prostate massage, but assessing prostate mobility during an internal examination may be part of the evaluation.
Pelvic floor therapists do NOT provide sexological bodywork, sexual surrogacy, or sexual healing.
For more information about these services, please visit the International Professional Surrogates Association or the Association of Certified Sexological Bodyworkers.
In summary:
We feel that knowledge is power, so considering the 13 most embarrassing questions may help you prepare for your first pelvic floor visit.
We propose that the visit is no big deal and that you leave our office focusing on the new information you gained and feeling more empowered to deal with your problem.
Your pelvic floor therapist will become someone with whom you can problem-solve. They will help you find solutions so you can return to doing what you like sooner rather than later.
We hope this article made you feel more comfortable seeking the help you deserve.
We also encourage you to use these questions as a resource during your discovery call with a potential new pelvic floor therapist.
Last but not least:
Please share your stories in the comments below and let us know if providing you with these questions and answers was helpful.
Also, let us know what embarrassing questions we should add to our list.
References:
The article aims to be fully inclusive, covering not only individuals who identify as cis-gender men.
I want to thank Dr. Susie Gronski for the information from her course (particularly questions #8, #11, and #13) and our patients' questions, which helped me write this article.
Wix Media provided the pictures.
Also, thanks to those in the Land of Enchantment who trust us for male pelvic floor physical therapy in Albuquerque.
Local NM resources: https://numalemedical.com/; https://www.mdformen.com/
About the author:
Dr. Sunel Vanderwalt owns Trailhead Pelvic & Visceral Physical Therapy in Albuquerque, NM, where she provides pelvic floor therapy for those with male anatomy in person and through telehealth.
She combines orthopedic, pelvic, visceral manipulation, and manual physical therapy. Her clinic specializes in male pelvic health but treats all genders and ages.
Dr Sunel is also a founding member of IPC - Clinical Excellence Network for Male Pelvic Health, where international therapists collaborate to provide excellent care for male pelvic floor PT.
The content on this site is provided for informational purposes only and should not be used as a substitute for direct medical advice from your doctor or another qualified clinician.
Nicely done. Good article!