26/03/2026
I think it’s time to rethink how we talk about the internal exam in pelvic health.
The truth is, healing starts with creating a space where our clients feel safe, empowered, and fully in control of their own bodies. If the nervous system doesn’t feel safe, no deeper work can begin.
In the latest update of OT Pioneers, we’ve redefined how we approach internal exams and pelvic health, empowering therapists to offer a more client-centered, consent-driven experience that prioritizes safety and choice every step of the way.
Many still refer to the internal exam as the “gold standard,” but there are actually FOUR equally valid ways to work with pelvic health.
And here’s the key: each approach enables the client to choose what feels right for them. Whether they remain fully clothed or opt for an internal exam, each path is respected and the client is always the one in control.
When presenting the internal exam as an option, it’s critical that we make all choices clear and explicit. Clients must know they have the power to give—and revoke—consent at any time, and that all options are valid.
The true “gold standard” is the one that helps the client feel safe and regulated in their nervous system.
No longer should an internal exam be reduced to a checkbox or a quick nod of agreement. Instead, we need to provide clear details: where we might touch, for how long, and how clients can stop at any point, whether verbally or with a simple gesture.
Ask: Does any part of this feel uncomfortable for you? And...
Are you confident in your ability to communicate that?
You might also offer, “If using your voice feels hard, another option is to simply raise your hand.”
Why does this matter? Because if the nervous system isn’t regulated, even the most finely-tuned exercise program or manual therapy will fall short.
This is the care every person deserves—full agency and empowerment over their pelvic health journey.
functionalpelvis Want to dive deeper? In OT Pioneers and Level 1 Functional Pelvic Health Practitioner (™) program, we break this down even further, and include scripts you can use with your clients. Your clients deserve this level of care, and so do you.
