Internal pelvic examinations explained

The idea of an internal pelvic examination can understandably feel intimidating. especially if you don’t know what it involves, why it might be suggested, or whether you can say no.

This page explains what an internal pelvic examination involves in pelvic health physiotherapy, why it may (or may not) be recommended, and how it is conducted in a respectful, step-by-step way.

Nothing on this page is something you are ever required to do. Internal examinations are always optional, and your comfort, consent, and sense of safety are prioritised at all times.

Why might an internal examination be suggested?

An internal pelvic examination can provide valuable information about how the pelvic floor muscles are functioning. Depending on your symptoms, it may help assess things such as:

  • Muscle tone (overactive, underactive, or balanced)

  • Strength and endurance

  • Ability to fully relax

  • Coordination with breathing and movement

  • Areas of tenderness or pain

  • Prolapse movement

  • Defaecation technique (for bowel symptoms)

That said, not everyone needs an internal examination, and it is never done routinely or automatically.

For some people, enough information can be gained through:

  • A detailed history

  • External examination

  • Musculoskeletal assessment

  • Symptom response to initial treatment

For others, an internal examination may help guide treatment more accurately.

Read more about which conditions may benefit from an internal examination.

Consent and choice come first

If we think an internal examination may be helpful, we will always discuss:

  • Why it may be useful in your specific situation

  • What information it can (and cannot) provide

  • What the examination involves

  • Your alternatives, including choosing not to proceed

You can:

  • Say no

  • Ask to delay it to a later appointment

  • Change your mind at any point

  • Ask questions at any stage

Your consent is ongoing and can be withdrawn at any time, including during the examination itself.

Preparing for the examination

If you choose to proceed:

  • I will explain each step again before we begin

  • The physiotherapy table will be set up with a towel for coverage

  • I will leave the room while you undress from the waist down

  • You can take as much time as you need

  • I will only re-enter once you let me know you are ready

Your privacy and dignity are respected at all times.

The external examination (always first)

An internal examination never starts internally.

We begin with an external assessment, which involves examining the tissues of the:

  • Vulva (for vaginal examinations)

  • Anus (for rectal examinations)

This may include:

  • Visual observation of the tissues

  • Gentle palpation

  • Checking for areas of sensitivity using light touch

  • Asking you to perform simple actions such as:
    Gently squeezing
    Fully relaxing
    Coughing
    Bearing down

This helps assess:

  • Tissue health

  • Sensitivity

  • How the pelvic floor muscles move and respond

  • Initial coordination and control

At this point, we may decide that enough information has already been gathered in which case no internal examination is required.

Vaginal examination: what it involves

If appropriate, and only with your consent, a vaginal examination may be performed.

This involves:
- A single finger (sometimes we may proceed to two fingers to compare the left and right side of your pelvic floor if you’re comfortable)
- Wearing a glove
- Using lubricant for comfort

During the examination, I assess several key things.

Muscle tone

  • At the vaginal entrance

  • In the deeper pelvic floor muscles

This helps identify whether muscles are:

  • Overactive / tense

  • Underactive

  • Balanced but poorly coordinated

Tenderness or pain

  • Identifying specific muscles that are sensitive

  • Noting whether pain is superficial, deep, or both

If pain is present, we may explore whether:

  • Breathing

  • Positioning

  • Gentle techniques
    can change or reduce symptoms during the assessment.

Muscle function

This includes assessing:

  • Ability to squeeze

  • Ability to fully relax

  • How long a contraction can be held

  • Ability to perform quick contractions (“fast squeezes”)

  • Coordination

We also look at how the muscles are working, including:

  • Overuse of abdominal muscles

  • Overuse of gluteal muscles

  • Ability to coordinate a pelvic floor contraction with a cough or movement

This information helps guide both treatment and exercise prescription.

Prolapse assessment

If prolapse is suspected, you may be asked to:

  • Bear down maximally for 5 seconds

This allows assessment of:

  • Movement of the vaginal walls (anterior, posterior, or apical)

  • Whether there is excessive descent

In some cases, prolapse may not be clearly visible lying down. If appropriate and with consent, a standing assessment may be suggested to give a clearer picture.

Rectal examination: what it involves

A rectal examination follows a very similar process and is often used when symptoms relate to:

  • Bowel dysfunction

  • Difficulty emptying

  • Pain with bowel movements

  • Certain pelvic pain conditions

  • Male pelvic health concerns

As with a vaginal examination:

  • A single gloved, lubricated finger is used

  • External examination is always performed first

  • Consent is required throughout

In addition to assessing muscle tone, tenderness, strength and coordination, a rectal examination allows assessment of:

  • Defaecation technique

  • Ability to lengthen and relax appropriately during bearing down

This can be particularly helpful for people experiencing straining, incomplete emptying, or paradoxical muscle activation.

Some things that are considered ‘normal’ during an internal examination

It’s important to know that some experiences during an internal examination are very common and completely normal.

These include:

  • Urinary leakage

  • Passing wind (flatus)

  • Difficulty coordinating movements initially

These are nothing to be embarrassed or concerned about, and they provide useful clinical information.

Pelvic health physiotherapists are trained to expect and manage these situations professionally and calmly.

For people with pelvic pain or a history of trauma

If you have:

  • Pelvic pain conditions

  • A history of trauma

  • High levels of anxiety around examinations

An internal examination is rarely performed at the first appointment.

In many cases:

  • Several appointments are spent building safety and trust

  • External techniques and education are prioritised

  • An internal examination may be delayed or not required at all

There is no expectation that an internal assessment must happen to “progress” your care.

After the examination

Once the examination is complete I will leave the room again while you get dressed.

We will then discuss:

  • Findings

  • What they mean

  • How they relate to your symptoms

  • What management options may help

You’ll have the opportunity to ask questions and decide how you’d like to proceed.

A final reassurance

An internal pelvic examination is simply a tool, one that can be helpful for some people and unnecessary for others.

It is:

  • Never compulsory

  • Never rushed

  • Never done without consent

Your comfort, autonomy, and sense of control are central to pelvic health physiotherapy.

If you’re unsure whether an internal examination is right for you, that conversation can happen at your pace and revisited whenever you’re ready.

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