woman lying down experiencing pelvic pain

Is This Pelvic Floor Dysfunction?

A Guide for Providers

As providers working with patients who come from all walks of life, we often encounter individuals who present with symptoms that may have their roots in pelvic floor dysfunction.

And if you’re unsure or uncomfortable when it comes to addressing these issues, you run the risk of missing something pivotal in your patient’s treatment.

Pelvic floor dysfunction can manifest in a range of issues, from persistent low back pain that doesn’t respond to conventional treatments to painful sex and other related conditions.

In this blog post, we will explore the connection between these common issues and pelvic floor dysfunction, aiming to empower providers like you with a deeper understanding of this complex condition and ways to address these issues with confidence and compassion.

Recognizing Pelvic Floor Dysfunction

When assessing clients for potential pelvic floor dysfunction, it’s essential to delve into the specific aspects of their symptoms and history.

By asking the right questions and considering various factors, we can better identify potential underlying causes and offer appropriate interventions.

Let’s explore three key questions to pose during the assessment process:

1. “Does this happen in all circumstances?”

Understanding the context in which symptoms occur is crucial.

When evaluating a client’s symptoms, it is essential to explore whether they experience symptoms in all circumstances or if certain contexts trigger these issues.

One key consideration is whether the symptoms manifest exclusively during partnered sexual activities. Clients may report pain, discomfort, erectile dysfunction, etc. but specifically when engaging in penetrative intercourse with a partner.

In this case because symptoms only occur in certain circumstances, there is less likelihood that there is a biological, medical or physical issue at play.

It also provides greater insight into potential relational or psychological factors that contribute to the pelvic floor dysfunction, including the dynamics of your client’s intimate relationships, communication patterns, and emotional well-being.

Another aspect to explore is whether the symptoms also occur during solo sexual experiences. Some clients may find that they experience pain or difficulties achieving or maintaining an erection when engaging in masturbation or other forms of self-stimulation in addition to partnered activities.

This insight into the context-independent nature of their symptoms is a strong indicator that a biological, physical or medical concern may be at play and a physical evaluation could be crucial to your patient’s treatment.

It is also important to consider whether the symptoms extend beyond sexual activities. Some individuals may experience pain or discomfort during non-sexual activities that involve the pelvic region, such as tampon insertion, exercise, or even sitting for extended periods.

Assessing the presence of symptoms in non-sexual contexts helps identify potential musculoskeletal or functional aspects of pelvic floor dysfunction that may require targeted interventions from physical therapists or other specialists.

2. “If this is pain, is it provoked or unprovoked?”

Assessing the nature of the symptoms is pivotal in understanding and addressing pelvic floor dysfunction. The differentiation between pain that is provoked or unprovoked provides valuable insights into the severity of the dysfunction and helps determine the appropriate course of action for treatment.

torso of woman experiencing pelvic pain and pelvic floor dysfunction

Provoked pain refers to discomfort or pain that arises specifically during certain activities or stimuli. It may occur during sexual intercourse, pelvic examinations, or other specific triggers such as tampon insertion or physical exercise.

Unprovoked pain refers to discomfort or pain that occurs spontaneously or persistently without any apparent external trigger. This type of pain may be present throughout the day, even in the absence of activities that typically provoke symptoms.

Unprovoked pain often indicates a more complex and multifaceted underlying condition.

In such cases, a multidisciplinary approach involving medical doctors, physical therapists, and mental health professionals may be the only course of treatment that proves successful, as collaborative efforts can help address potential physiological, neurological, psychological, or systemic factors contributing to the unprovoked pain.

By assessing whether the pain is provoked or unprovoked, providers can better understand the nature and severity of pelvic floor dysfunction. This understanding guides treatment planning and helps determine the need for specialized care or referrals to other professionals.

3. “Are these symptoms lifelong or acquired?”

Determining the timeline of symptom onset leads to a more comprehensive assessment of pelvic floor dysfunction. Understanding whether the client has experienced these difficulties throughout their life or if they developed recently helps paint a clearer picture of the underlying factors contributing to their pelvic floor dysfunction.

When clients report experiencing symptoms related to pelvic floor dysfunction throughout their life, it suggests that there may be underlying anatomical or physiological factors at play.

These long-standing symptoms could indicate congenital conditions, structural abnormalities, or chronic conditions that require specialized interventions.

By recognizing lifelong symptoms, you can assess the need for thorough medical evaluations, bloodwork and hormone testing, or consultations with relevant specialists.

On the other hand, acquired symptoms refer to those that developed at a certain point in the client’s history.

Exploring the timeline of symptom onset helps identify any significant events, illnesses, injuries, or lifestyle changes that preceded the emergence of pelvic floor dysfunction.

Such events could include surgeries, traumatic incidents, hormonal changes, childbirth, menopause, or even changes in exercise routines. 

For example, a client reporting low back pain that doesn’t respond to conventional treatments may benefit from exploring the connection between their symptoms and a previous traumatic injury. Similarly, a client experiencing painful sex may have developed the symptoms after a gynecological procedure.

assessing for pelvic floor dysfunction

Sometimes the line between lifelong and acquired symptoms can be murky and doing a thorough evaluation becomes increasingly important.

One example of this is, if a client does not use the bathroom when they feel the urge to do so, instead waiting far past the point they need to relieve themselves, the muscles of the pelvic floor may be trained in a way that could cause dysfunction. This could appear lifelong, especially if this behavior started at an early age (which it often does), but would be considered acquired.

Conversely a congenital hormone deficiency might not show up until after puberty, but this does not necessarily mean that the condition was acquired, because the physiological components of the deficiency were there since birth.

The reason it is important to ascertain this information is because the course of treatment can vary widely – the first scenario would do best with psychotherapy and pelvic floor physical therapy, while the latter would require medical intervention.

Ultimately, recognizing these connections allows you to collaborate with other providers or specialists to address the multifaceted aspects of pelvic floor dysfunction.

By gathering comprehensive information about the timeline of symptom onset, you can gain insights into the duration, progression, and potential causes of pelvic floor dysfunction, this enables you to tailor interventions, refer appropriately, and address the root causes effectively.

The Importance of

Collaboration and Referrals

You’ve probably gathered that pelvic floor dysfunction is a complex issue that often requires a multi-disciplinary approach for comprehensive care.

Providers in different fields play vital roles in addressing the various aspects of this condition. This is why collaboration between counselors, physical therapists, and medical doctors is essential to ensure holistic and effective treatment.

Sex Therapists (and other mental health providers)

Create a safe and non-judgmental space for clients to discuss their sexual health concerns. Recognizing the potential impact of pelvic floor dysfunction on emotional well-being and intimate relationships can guide therapeutic interventions and support clients in navigating these challenges.

Pelvic Floor Physical Therapists

Offer valuable expertise in assessing and treating pelvic floor dysfunction. Through targeted exercises, manual therapies, and other techniques, they can address muscular imbalances, improve pelvic floor function, and alleviate symptoms.

Medical Doctors

Particularly those specializing in sexual health, gynecology and urology, bring essential medical expertise to the table. They can conduct comprehensive evaluations and provide medical interventions, such as medication and surgery, if necessary, helping to ensure holistic management of pelvic floor dysfunction.

Other providers who could add expertise to the treatment team are acupuncturists, sex coaches, dieticians and nutritionists, massage therapists, yoga therapists, etc.

Knowing who to refer to gives us as providers the best chance of delivering a comprehensive and tailored approach to our clients’ pelvic floor dysfunction. This aids in improving outcomes and enhancing the overall well-being of those under our care.

If you’re eager to deepen your knowledge and enhance your skills in addressing pelvic pain holistically, we invite you to join us for the “Holistic Approaches to Pelvic Pain: A Multi-Disciplinary Workshop for Providers.”

This workshop offers an invaluable opportunity to learn from experts in the field, engage in interactive discussions, and gain practical tools and strategies to better serve your clients/patients.

Visit our workshop page to learn more and secure your spot. Together, let’s empower ourselves with the knowledge and skills to provide comprehensive care for individuals struggling with pelvic pain. Join us in making a positive impact on their lives and well-being.

Remember to ask the pertinent questions during assessments, collaborate with other professionals, and provide comprehensive care in your scope of practice to optimize outcomes!

Rebecca, a white woman with long, light brown hair smiles into the camera.

Rebecca Slape

Doctor of Physical Therapy


Rebecca is a licensed Physical Therapist specializing in pelvic health. She works with adults of all genders and body types to maximize well-being and give her patients the tools they need for on going self management.