What to Expect During a Pelvic Floor Physical Therapy Vulvar Assessment: A Patient’s Guide 

Pelvic floor physical therapy (PFPT) is a highly specialized area of care aimed at treating a variety of pelvic health concerns, including pain, urinary or bowel dysfunction, and symptoms related to hormonal changes. One of the most important—and often least understood—components of PFPT is the visual vulvar assessment. For many patients, especially those new to pelvic health care, this part of the evaluation can feel intimidating. Understanding what to expect can help reduce anxiety, promote informed consent, and empower patients to engage fully in their care. 

Before any examination begins, your pelvic floor physical therapist (PT) will explain the purpose, process, and components of the vulvar assessment in detail. You will be asked for informed consent, meaning you agree to the exam voluntarily after receiving all relevant information. You’ll have the opportunity to ask questions, voice concerns, and decline any part of the assessment at any time. 

This step is crucial—it establishes trust and ensures that your care is collaborative and patient-centered from the beginning. 

The vulvar assessment helps the therapist understand the external anatomy and tissue health of the pelvic region. This is particularly important for identifying issues such as: 

• Genital atrophy (thinning or drying of tissues, often related to hormonal changes) 

• Dermatologic conditions 

• Signs of infection or inflammation 

• Pelvic organ prolapse 

• Sources of pain, including vestibulodynia or scarring 

Understanding the anatomy and how it may contribute to your symptoms allows your PT to develop a more precise and effective treatment plan. 

Before the visual exam, your PT may provide a brief overview of the pelvic anatomy, which includes: 

• Pelvic floor muscles: These muscles support the pelvic organs and help with bladder, bowel, and sexual function. 

• Organs: Bladder, rectum, uterus in women, and prostate in men. 

• Surrounding tissues: Including skin, fascia, and connective tissues of the vulva and perineum. 

Many therapists use diagrams or models to help patients visualize how the muscles and tissues work together and what may be causing discomfort or dysfunction. 

The assessment will take place in a private, quiet treatment room with your physical therapist.  Once consent is given, the patient is positioned appropriately with appropriate draping and leg support, the PT will begin the visual assessment. Here’s what is typically included: 

1. Vulvar Tissue Assessment 

The PT will examine the external vulvar area, including: 

• Labia majora: Assessing for atrophy (thinning), changes in pubic hair distribution, and skin integrity including tissue color. 

• Labia minora: Looking for absorption of the tissue into the labia majora, redness, or abnormal tissue appearance. 

• Inter-labial space: Observing the skin between the two labia for signs of irritation, dryness, or inflammation. 

2. Vestibular Examination 

The vestibule is the area surrounding the vaginal opening. The therapist will inspect: 

• Redness, dryness, or fissures medial to Hart’s line, the boundary between the inner labia and vestibule where the tissue changes from normal skin to mucosal tissue 

• Vaginal moisture levels and skin integrity 

• Bartholin’s glands (located near the lower vestibule) and Skene’s glands (near the urethra), checking for swelling, pain, or abnormal discharge 

• Prolapse, such as bulging of the vaginal walls 

3. Q-Tip Test 

This is a gentle test in which a sterile cotton swab (Q-tip) is used to lightly touch different areas of the vulva and vestibule. The PT will ask you to report any pain, burning, or sensitivity in response to light touch. This test is especially helpful in diagnosing vestibulodynia or localized pain syndromes. 

4. Urethral Meatus Inspection 

The urethral opening is evaluated for: 

• Redness or irritation 

• Caruncles: small, benign growths near the urethra that can become inflamed 

• Signs of urethritis or other causes of urinary symptoms 

5. Palpation of Key Structures 

• Ischial tuberosities (sit bones): Pressed gently to assess for muscle tension or referred pain. 

• Posterior fourchette: The area at the bottom of the vaginal opening is examined for fissures, tenderness, or scarring. 

• Perineal scars: If there is a history of episiotomy, tearing, or surgical incisions, the PT will gently palpate to assess scar tissue mobility and pain response. 

6. Functional Movements: Coordination and Muscle Control 

To evaluate pelvic floor muscle function, your PT may ask you to perform several basic movements: 

• Contract your pelvic floor, as if stopping the flow of urine 

• Relax the pelvic floor muscles fully 

• Bear down similarly to starting a bowel movement 

• Cough, to observe muscle engagement and coordination 

These tests help the therapist assess: 

• Strength 

• Mobility 

• Coordination 

• Tissue response to intra-abdominal pressure 

This functional evaluation is crucial for diagnosing issues such as muscle overactivity, prolapse, or pelvic floor weakness. 

After the visual and functional exam, your PT will discuss the findings with you. This includes: 

• What was observed and what it might mean 

• How your symptoms relate to tissue or muscular findings 

• A collaborative discussion of next steps, including treatment goals and options 

You’ll also have an opportunity to ask questions, share preferences, and discuss how you’d like to move forward with care. 

While the vulvar assessment is a medical and clinical procedure, your comfort and consent are always the top priorities. If at any point you feel uncomfortable or would like to pause or stop, you can absolutely do so. Your PT is there to support—not pressure—you. 

The visual vulvar assessment is a vital tool that provides detailed insight into pelvic health conditions and helps guide safe, personalized, and effective care. With open communication and mutual respect, this part of your pelvic floor therapy can be an empowering step toward healing and comfort.  You are an essential part of your healthcare team. Your knowledge, experiences, and voice are critical to your recovery and wellness. 

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Disclaimer: This blog is here for your help. It is the opinion of a Licensed Physical Therapist. If you experience the symptoms addressed you should seek the help of a medical professional who can diagnose and develop a treatment plan that is individualized for you.