This is by no means an extensive list, but these are just a few things I experienced in my search for providers who could offer real insight into my condition and my future.
Refusal to do a pelvic exam
Vocalizing discomfort with pelvic or rectal exams
Refusal to explore prolapse. What I mean by this is if a provider says you have no symptoms so I will not look or palpate to see if there is a bulge.
Not checking prolapse in a functional position like standing
Not knowing what a POP-Q score is. This is extremely easy to understand once you know what each measurement refers to. It isn’t easy to perform, so it’s okay if your provider can’t do this for you, your urogyn can. But they should know what each of the numbers means and what they indicate for you in terms of your risk
Inability to tell you what a structure or bulge is that you bring to their attention. This happened to me with both the walnut and with my transverse perineal muscles when they had fully detached and were protruding like flaps. One provider told me they were scar tissue. Again, them not knowing isn’t always a red flag, but they should encourage you to seek out answers from someone that will know like a urogyn.
A provider who doesn’t talk to you about support options. If the support from below does not match the pressure from above, descent can happen whether you have prolapse symptoms or not. Your provider should discuss internal and external support options: pessaries, period products, pelvic bra. After all how many stories do you hear of women saying: I was walking or I stood up and all of a sudden it was like something had fallen out.
A provider who tells you you can run, jump, lift heavy without a support product if you have no symptoms but they haven’t assessed your muscular and fascial strength. Again, you can have no symptoms: no leaking, heaviness, feeling like organs are falling out, but if your muscles aren’t offering enough support from below to counteract the forces of jumping, running, and lifting, then you may experience descent, which is why support products are so important.
They do not address your scar tissue
They do not examine you for pelvic tension
They do not give you a strength score (MOS)
They do not assess your fascia in standing
They do not offer you a series of tests or programming to return to running, high intensity exercise, lifting etc.
They record you without your permission
They do not change out gloves between vaginal and rectal exams
The go from rectal exam to vaginal exam with contaminated lubricant
They admit they don’t usually have people come to their clinic who are as strong as you and already know how to manage their internal pressure
They suggest that despite your risk factors, you don’t need regular PFPT check ins 1-2x per year to track changes
*Remember that even if you look fit and healthy and strong on the outside, these injuries are invisible and even PFPTs can be fooled into thinking visible strength = ability to perform activity without a brace like a pessary. Function, strength, and muscle integrity of the pelvic floor is so important to have evaluated first. If the support from below (your pelvic floor muscles + a pessary + exterior garment) does not equal or exceed the forces from above (gravity, impact, weight bearing) you may experience pelvic organ descent.
Green flags:
The opposite of everything above
They take out a mirror and point out structures to you so you know what you’re seeing
They check your bladder / rectum / cervix for movement while squatting, holding weight, performing vasalva, and blowing up a balloon
They use balloons to check internal pressure management
They offer a whole-body approach
They teach you how to release tension and scar tissue at home
They are willing to do research on your behalf
They don’t judge you for your decisions regarding resuming or restricting activity or considering surgery or another alternative therapy
When they do not know the answer, they help you find someone who does
When they do not know, they say they do not know
They are honest with you about the risks you face when it comes to carrying and delivering future children and do not weigh the desire for another child more than your desire to live a full life