How to Evaluate Your Pelvic Floor

How to Evaluate Your Pelvic FloorIf you suspect something is not quite right “down there,” what should you do?

I always recommend seeing the vagina expert, also known as your gynecologist. However, it’s your vagina, so you should do a little recon ahead of time. Going into a doctor’s appointment with a good idea of what ails you will help get you the best care.

Pelvic Floor Questionnaire

Although not all questions equally apply, this questionnaire can be used by any woman, from your 12 year old daughter to your 99 year old grandmother.

  1. Get a handheld mirror and take a peek. Do you know the parts of your pelvic floor? Read Say Hello to Your Pelvic Floor if you need a refresher.
    • Do you notice any obvious bulging in the vagina?
    • Is your vulva easily irritated? (Remember, your vulva includes the opening of the vagina, the labia majora, the labia minora, and the clitoris)
    • Insert a finger into your vagina. Contract your pelvic floor muscles. Can you feel the contraction around your finger?
  2. Do you have any problems inserting and retaining a tampon or menstrual cup? If so, what kind of problems? For example,
    • Is inserting a tampon painful? You might have overly-clenched muscles inhibiting proper relaxation of the vaginal opening.
    • Conversely, do tampons fall out of place or even out of your body completely? You might have weak pelvic floor muscles and/or pelvic organ prolapse.
  3. If you are sexually active, do you have pain during sex? If so, what kind? This might be a muscular problem, or might be related to a different medical condition. Some possible causes include, but are not limited to:
    • Vaginismus (spasming of the pelvic floor muscles)
    • Infection
    • Endometriosis
    • Ovarian cysts
    • Pelvic inflammatory disease
    • Menopause
    • STDs
    • Vulvar or vaginal injury (especially soon after childbirth)
  4. Do you leak urine? Can you tell the difference between urine leakage, normal vaginal discharge, and vaginal discharge related to an infection? You’d be surprised how many women can’t, especially girls just entering puberty. Talk to your daughters about this.
    • If you leak urine, how often and what causes it?
    • Do you have difficulty controlling the passage of gas? This can mean an inability to stop the passage or an inability to start the passage.
  5. Do you strain when urinating or having a bowel movement?
    • Do you ever feel like you can’t completely empty your bladder or bowels? This could be the result of pelvic floor muscles that can’t fully relax or may be the result of other conditions. Talk to you doctor.

Some common pelvic floor disorders are caused by or aggravated by pelvic floor muscles that either can’t generate enough tension, can generate enough tension but generate it at the wrong time, or generate too much sustained tension.

If your muscles are aggravating your pelvic floor disorder, you need to know how to Kegel. Yes, I know you are familiar with Kegels. But, you might have also heard the Kegel is evil. The Kegel’s ability to bestow favor depends on, well, a lot, so read “In Defense of the Kegel” to learn more.
Stewart, Elizabeth Gunther, and Paula Spencer. The V Book: A Doctor’s Guide to Complete Vulvovaginal Health. New York: Bantam Books, 2002. You can buy it HERE.

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