Can We Talk About the Pelvic Health Drama?
I'm writing a little differently this week because there has been a lot of "drama" unfolding in the pelvic floor physical therapy world online. I felt it was important to address it because, if I'm seeing it, many of you probably are too.
As many of you know, pelvic health physical therapy has grown tremendously over the past several decades, and that's something worth celebrating! More therapists are choosing to specialize in this field, which means more people have access to care they may not have had in the past.
Within physical therapy, there isn't just one way to treat a patient. We all complete the same foundational education: earning a bachelor's degree, followed by a doctoral degree (in years past, a masters degree) in physical therapy. After approximately seven years of education, we graduate as general practitioners. From there, we pursue continuing education that shapes our clinical approach. There are hundreds of courses, certifications, and treatment philosophies available, and experienced orthopedic physical therapists, for example, may treat the same condition in very different ways while achieving excellent outcomes. That diversity has always existed within our profession.
Pelvic health physical therapy has traditionally been rooted in a few primary treatment philosophies, many of which include the option of an internal pelvic floor assessment. More recently, however, some online educators and clinicians have begun questioning whether internal examinations are always necessary or appropriate. As you can imagine, that has sparked significant debate within our profession.
As a pelvic floor physical therapist who has been practicing for many years, I personally agree with many of the leaders in our field: when clinically appropriate and with a patient's full consent, an internal assessment can provide valuable information that helps us better understand what is contributing to someone's symptoms. We have the education, training, and skills to perform these assessments safely, so when they are indicated, I believe they should remain one of the many tools available to us.
That said, I also recognize that every patient is different. Not every patient is comfortable with an internal assessment, and not every therapist practices in the same way. There is room for different approaches, and there is certainly room for patients to choose the provider and treatment style that feels right for them.
What has been incredibly disappointing to watch, however, is the way some professionals are speaking about one another online.
Statements like, "If your therapist doesn't do this, run," or "If your therapist prescribes this, find a new PT," don't educate patients—they create fear. They undermine trust, sow confusion, and suggest that there is only one "right" way to provide care. That's simply not true.
I can assure you, truly assure you, that the overwhelming majority of pelvic floor physical therapists entered this profession for one reason: to help people. We spend countless hours pursuing advanced education, refining our clinical skills, and trying to provide the best care possible for every person who walks through our doors. We may not all practice identically, but that doesn't mean one therapist is caring while another is careless!
As patients, I hope you feel empowered and comfortable to ask questions. Ask why a therapist recommends a particular treatment. Ask about alternatives. If something doesn't feel right, speak up. You deserve to understand your care and to be an active participant in the decisions being made.
At the same time, I encourage you to be cautious of absolute statements on social media. Healthcare is rarely black and white. The best treatment is the one that considers the whole person sitting in front of us—not just a trend, a viral post, or a single treatment philosophy.
At the end of the day, my commitment has always been the same: to listen, to educate, to respect your choices, and to provide evidence-informed care that is individualized to your goals and your body, in the way I am trained and have seen work.
Let's spend less time tearing each other down and more time doing what we all entered this profession to do: helping people heal.
Yours Truly,
Dr. Jamie Bennett, PT, DPT
