Kathy Kates managed sexual reproductive health programs at a community health clinic in Brighton, Massachusetts, before being diagnosed with breast cancer.

After achieving remission, she began experiencing intense vaginal pain.

During a pelvic examination, healthcare providers identified that Kates had tight pelvic floor muscles and recommended pelvic physical therapy.

Kates felt embarrassed. With a decade spent in reproductive health, she was completely unaware of such physical therapy. “How many women did I treat while completely overlooking the pelvic floor?” she pondered.

Kates eventually found physical therapy essential for her recovery and established Pelvic Health Support, a physical therapy clinic in Boston. Nevertheless, she acknowledges that many patients still struggle to access the care they urgently require.

Pelvic floor physical therapy can help alleviate chronic pelvic pain, strengthen pelvic muscles to improve bladder and bowel control, lessen pain during sex, and support postpartum recovery.

Even though estimates suggest that one in three women experience a pelvic floor disorder, resources for pelvic physical therapy remain scarce and often overlooked. Experts are eager to address this, yet a flawed healthcare system complicates access, making care both expensive and hard to come by.

Understanding Pelvic Floor Disorders: Affecting 1 in 3 Women

According to the National Institutes of Health, 24% of women suffer from moderate to severe symptoms of at least one pelvic floor disorder, with prevalence increasing with age and the number of births.

A significant percentage of women with chronic pelvic pain also have comorbidities, including endometriosis (70%), postpartum pelvic pain (44%), bladder pain syndrome (61%), and irritable bowel syndrome (39%). A systematic review conducted in 2021 found that the yearly cost burden for women suffering from chronic pelvic pain – covering healthcare, prescriptions, physical therapy, and indirect expenses – ranges from $16,500 to $21,000.

Why Many Women Are Unaware of Pelvic Physical Therapy Until It’s Too Late

According to Tami Lynn Kent, MSPT, the primary barrier to accessing pelvic physical therapy is a lack of awareness. “Shame and the sexualization of this body part contribute to the problem,” she notes. “Much of the medical system was designed by and for men, which has overlooked many aspects of care women require, as well as potential avenues for treatment.”

Most of Kent’s patients find her services through referrals, as pelvic health discussions are rarely part of standard medical care.

“This option exists so you don’t have to endure unnecessary suffering,” Kent emphasizes.

The Shortage of Physical Therapists for Pelvic Treatment

The American Physical Therapy Association’s Academy of Pelvic Health Physical Therapy has reported a 21% rise in membership since 2019, increasing from 3,338 to 4,032, as noted by Kristi Kliebert, the APTA Director of Communications.

However, for every 4,000 individuals in need of pelvic physical therapy, there exists only one provider, as highlighted by Kates.

Lexi Meister, a pelvic physical therapist specializing in women’s health, entered the field unexpectedly when her scheduled clinical at a Veteran’s Hospital fell through and was replaced with a pelvic floor rotation – a subject she knew little about. She quickly grew passionate about this specialty, stating, “I discovered a lot about my own body that I wasn’t even aware of before, not just as a physical therapist but as a woman.”

After six years working in a pelvic physical therapy role at a hospital in Columbus, Ohio, Meister often faced situations where patients were forced to wait up to three months for their first appointment. Each time she met a new patient, she aimed to establish a connection but frequently encountered frustration over the lengthy wait times.

Since starting her own private practice in 2021, she can now schedule patients within a month and believes she can deliver better care.

The quality of patient-focused care is emphasized during hour-long appointments that evaluate symptoms comprehensively, rather than merely fulfilling insurance requirements.

Experts attribute the shortage to high costs of education and insurance policies

Meister believes that the shortage of pelvic physical therapists starts with the education system.

Students in physical therapy often miss out on specialized courses as part of their core curriculum while pursuing their doctorate. Meister found it necessary to take four additional courses and complete an extra board exam, ultimately spending around $5,500 on her education.

Moreover, she points out that working with insurance companies can be challenging, especially regarding women’s health issues.

“The limitations come from what insurance is ready to reimburse,” Meister states. “If it were simpler for insurances to reimburse for care, hospital systems could more easily recruit and educate additional pelvic physical therapists due to increased funding.”

Unlike the long waiting times, an appointment with an in-network therapist typically lasts just 30 to 45 minutes. “Patients often endure problems for an extended time, making it difficult to address everything in such a limited timeframe,” Meister explains.

Kates agrees, asserting that the shortage in pelvic floor physical therapy is a systemic issue: “If healthcare professionals like nurse practitioners, OBGYNs, and doctors are not trained to evaluate pelvic floor muscles, it will never cross their minds.”

How to obtain pelvic physical therapy

In the U.S., you can directly access physical therapy, including pelvic floor treatment, without needing a referral from a doctor, although coverage may vary based on insurance policies, according to Dr. Carrie Pagliano.

During your first appointment, you’ll start by sharing your experiences and symptoms. From there, your physical therapist will develop a joint treatment plan that may include exercises, stretches, modifications in posture and activity, and potentially internal work on the muscles.

“We are a profession that listens and validates because we know we can help,” says Pagliano.

“Pelvic health is often placed in a category of issues that people don’t discuss or seek help for unless they become severe,” she continues. “However, it should be regarded with the same importance as any other aspect of our health and care.”