Overview and Introduction to Women's

Pelvic Health
Introduction
When introducing women's pelvic health physiotherapy, it is important to understand the
distinction between a “women’s health physiotherapist” and a “pelvic health physiotherapist”.

Women’s health physiotherapists typically treat female issues such as

Breast rehabilitation
Lymphoedema
Osteoporosis
Fibromyalgia
Eating disorders
They may or may not treat pelvic health conditions.

Pelvic health physiotherapists may take a whole-body approach, but they also work directly over
the pelvic floor structures. They may treat men, women, children, and diverse genders.[1]
This page focuses on introducing women’s pelvic health physiotherapy. In particular, it explores:
Who do women’s pelvic health physiotherapists work with?
Why do they do what they do?
How do they best serve women who present with pelvic health concerns and conditions?
Who Do Women’s Pelvic Health Physiotherapists Work With?
Women’s pelvic health physiotherapists treat a range of clinical conditions that are classically
categorised as

Urological
Gynaecological
Gastroenterological
Oncological
Geriatric
Surgical
Overview and Introduction to Women's
Pelvic Health
Orthopedic
Obstetric
Chronic (i.e. persistent pain conditions)
However, these categories are somewhat arbitrary as women might present with conditions that
fall into a number of different areas. For instance, a pregnant woman who has vaginismus and
pelvic girdle pain would fall into the orthopedic, obstetric, chronic pain, and gynecological
categories. Pelvic health physiotherapists must, therefore, consider the woman as a whole

Women might seek pelvic health physiotherapy for a number of reasons, some of which are
discussed below.

Urinary incontinence
An involuntary loss of urine, which affects millions of people around the world
Faecal incontinence
An involuntary loss of stool (either liquid or solid)
Constipation
Bladder urgency and frequency
Urgency is defined as: "An abrupt, strong, often overwhelming, need to urinate”[
Frequency is defined as: “Abnormally frequent urination”
Bladder hesitancy/underactive bladder
Patients with bladder hesitancy experience “a slow urinary stream, hesitancy and straining to
void, with or without a feeling of incomplete bladder emptying and dribbling, often with storage
symptoms”
Bladder pain
Pelvic organ prolapse (POP)
Occurs when there is descent of one or more parts of the vagina and uterus, which enables
other organs to herniate into the vaginal space (cystocele, rectocele, or enterocele)[5]
Chronic pelvic, vulvar or vaginal conditions in women, which include:[1]
Polycystic ovarian syndrome (PCOS)
PCOS is considered the most common hormonal disorder in women of reproductive age
Overview and Introduction to Women's
Pelvic Health
Individuals experience at least two of the following: irregular periods, hyperandrogenism (i.e.
high levels of androgens), and polycystic ovaries
Dysmenorrhea / period pain
Affects around 75 percent of women during their reproductive life
It is particularly common during teenage years and early adult life
Interstitial cystitis or painful bladder syndrome
A chronic condition that causes pelvic pain, pressure or discomfort that the patient perceives is
associated with the bladder
Other urinary symptoms associated with interstitial cystitis include a persistent urge to void /
urinary frequency without any other cause/condition being present
Endometriosis
The most common cause of chronic pelvic pain in women
It is a complex condition associated with an "estrogen-dependent chronic inflammatory
process", which largely affects the ovaries and other pelvic structures
Associated with infertility
Coccydynia / coccyx pain
Has many traumatic and non-traumatic causes
Middle-aged women are most often affected, but it can occur in anyone at any age
Vulvodynia
Vulva pain that occurs during sexual and non-sexual activities
Affects 8 to 10 percent of all women
Provoked vestibulodynia
Vulva pain, localised to the vestibule, which has been present for three or more months
There is no clear cause, but pain is provoked by touch and sexual activity

Female sexual health concerns, which include

Dyspareunia: Dyspareunia is recurrent/persistent genital pain, which is associated with sexual

intercourse - both men and women can have dyspareunia, but it is more common in women
Primary or secondary vaginismus: Vaginal spasms prevent penetration during sexual
intercourse
Overview and Introduction to Women's
Pelvic Health
Anorgasmia
Diminished or painful orgasm
Sexual trauma
Women of childbearing age may present with
Prenatal or pregnancy concerns such as:
Low back pain
Pubic symphysis or pelvic girdle pain (PGP)
Vulvar varicosities
Varicose veins of the vulva are dilated veins in the labia majora and labia minora
They occur in between 22 and 34 percent of women who have varicose veins of the pelvis and
in 18 to 22 percent of women who are pregnant
They are linked to venous thromboembolic events, superficial dyspareunia, and vulvodynia, as
well as psycho-emotional and social issues
Sciatic pain
Postural concerns
Other orthopaedic conditions
Intrapartum care - i.e. during the actual labour and delivery
Postnatal care including breastfeeding-related assistance
Abdominal rehabilitation
Caesarean rehabilitation
Fertility challenges
Return to sports, athletics and exercise
Women approaching or at menopause
Women facing cancer rehabilitation, particularly breast and pelvic cancers, may come for
Pain issues
Sexual dysfunction
Movement therapies
Lymphoedema etc
Overview and Introduction to Women's
Pelvic Health
Female athletes of all ages who participate in all kinds of sports, but particularly those
associated with high load or impact (e.g. running, weightlifting, CrossFit etc)
Pre-and post-surgery:
Caesarean section
Hysterectomy
Procedures for prolapse or incontinence
Fistula repair
Myofascial dysfunction
Scarring and adhesions
Pain
Mobilisation
Strengthening etc
Why Do Women's Pelvic Health Physiotherapists Do What They Do?
Women around the world experience bias and barriers to healthcare by providers, institutions
and systems. They are more likely to be dismissed, have their concerns minimised, or
experience delays in getting an accurate diagnosis.

The need for women’s pelvic health care is significant:

1 in 3 women live with urinary incontinence

1 in 8 women experience faecal incontinence
At least 50 percent of women aged over 50 years have some degree of POP
30 to 50 percent of surgeries for POP are reported to fail within 5 years
25 to 35 percent of women report that childbirth was traumatic
1 in 5 women have pain with sex
64 percent of women report sexual dysfunction in the first year postpartum
10 to 15 percent of women live with chronic pelvic pain
These conditions can affect a women's
Overview and Introduction to Women's
Pelvic Health
Confidence
Self-image
Mobility and strength
Mental, emotional and physical health
Participation in activities of daily living, work, hobbies, and social activities
Sexual health and freedom
Relationships
How Do Women's Pelvic Health Physiotherapists Best Serve Women Who Present With Pelvic
Health Concerns?
There are many different approaches to clinical care for physiotherapists and other health
professionals. Ibukun Afolabi shares ten approaches that she uses in her pelvic health practice

Biopsychosocialspiritual framework (i.e. a holistic and integrative approach)

A trauma-informed lens
Evidence-based practice
Client-centred care - compassionate, client-directed care using motivational interviewing
Preventative and proactive perspective - particularly during childbirth
Collaborative treatment (i.e. working with the multi-disciplinary team)
Educational approach, including the education of clients, the community, other health
professionals and the therapist
Advocacy (for women, health, access, care, etc and teaching clients to advocate for
themselves)
Adopting a creative clinician lens
Humility