The True Requirements for Ethical, Effective Internal Pelvic Floor Treatment

Intravaginal work is not just a skill – it’s a responsibility.

In this episode, Lynn challenges some of the most common (and limiting) approaches to internal pelvic floor treatment and outlines what actually needs to be in place for intravaginal work to be effective, ethical, and transformative for your clients.

If you’ve ever felt like:

• Your internal work isn’t creating lasting change
  
  
  
• Clients plateau despite “doing everything right”
  
  
  
• You were taught what to assess but not how to truly create change
  
  
  

…this conversation will expand the way you think about internal pelvic floor treatment.

✨ What You’ll Learn in This Episode

This episode outlines three essential prerequisites that should be present before performing intravaginal work – yet are rarely clearly taught in traditional pelvic health education.

1. Why pelvic bones – not just muscles – must be addressed first
2. How to listen for the body’s “yes” (not just verbal consent)
3. Why standing internal assessments should be a clinical standard

Pelvic health practitioners are uniquely trained to understand biomechanics, joints, and soft tissue – but much of pelvic floor education still underutilizes this skill set.

This episode bridges:

• Biomechanics + intravaginal technique
• Trauma-informed care + clinical effectiveness
• Bone-based treatment + muscular release

…and offers a clearer, more respectful path forward for internal pelvic floor work.

🎓 Featured Education: Internal Pelvic Floor Treatment Course

This episode kicks off January’s course spotlight, highlighting the Internal Pelvic Floor Treatment course, a 5-hour, self-paced online program designed to help practitioners:

• Improve outcomes with a respectful approach
• Work with pelvic bones and muscles together for easier and more effective treatments
• Confidently assess and treat the sphincter complex
• Create change without pain, pressure, or force

Whether you’re newer to pelvic health or have years of internal work experience, this course offers a fresh, highly effective approach that will enhance the success of your internal pelvic floor treatments.

👉 Learn more about this course and get $50 off in January 2026

Have a comment or question about today’s episode? Message Lynn on Instagram or Facebook, or Email Lynn.

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Transcript

Today, we're going to be talking about requirements for doing intravaginal work, but before we do, I just want to note that we are taking the month of January, and we're going to be highlighting different courses each month this year.

So January, it's going to be about the internal pelvic floor course, and I just wanted to let you know that we're going to be highlighting different courses throughout the years and talking about them and just helping you to understand how those courses can impact and help you in your clinical practice.

So January is about the internal pelvic floor course, and this episode is going to be talking about requirements for doing intravaginal work and what is going to help us to be more effective when we do intravaginal work.

So there's three things that I'm going to be talking about today, and the first piece to it is when we are going to do any intravaginal work, I truly do not believe that we should be doing internal work without doing external work first, and the external work needs to be on the pelvic bones.

The pelvic bones are the foundation that the pelvic floor muscles attach to, and they must be in their proper alignment for the pelvic floor muscles to function optimally, and this goes beyond anterior and posterior rotations of the ileum.

Okay, so if I say, well, we've got to work on the bones first before doing it. Internal work. Most therapists are like, well, I do.

And I'm like, no, you don't. If you're only addressing anterior and posterior rotation of the ilium in flare out flare, you are missing the biggest piece to the puzzle where the pelvic floor muscles attach.

And this could be from someone who it's definitely for someone who's given birth vaginally, but it's also from someone who could have had an injury or a fall or impact on their sit bone, their tailbone.

Or anything. Okay. So if you are, if your clients are having issues with their pelvic floor muscles, we must address the pelvic bones first, and we need to address the pelvic outlet, not just anterior and posterior rotations of the ilium.

It's not enough when we're doing internal work. The pelvic floor muscles attach from the pubic bone back to the tailbone and along the walls of the issue.

Thank The ischial tuberosities and from birth, the baby can impact the position of the pelvic outlet. When it comes out, sacrum goes backwards into flexion.

So tailbone goes away from the pubic bone. Ischial tuberosities splay apart, depending on the position a person was in when they gave birth when the baby came out will impact how much tension and pressure is placed on those pelvic bones.

If a person is side lying on the left side, the right side ischium has to open up more for that baby to come on out because the left side can't move as much.

So keep that in mind. As therapists, we are prime medical professionals to address this because we understand mechanics and we understand the bones and the muscles and the joints and everything.

But this goes, birth goes beyond the sacred area. And it goes into what's happening to the pelvic outlet. And I think that this pelvic outlet is just an area that nobody has specifically addressed it well enough to make effective change in the pelvic floor muscles.

And I just love hearing from my students after they've taken a course and they go back and start applying what they learned in the clinic.

And there's like, oh, all my clients that were plateauing, they're getting so much better now because they're addressing the bones in the way that impacts the pelvic floor muscles in the greatest way possible.

So knowing how to affect change to the sacrum, to the tailbone, to the ischial tuberosities is imperative if you want to get greater function in the pelvic floor muscles.

Okay. So that's number one, when the prereq, you know, the requirements for doing internal work also should include making sure the body.

Our has a yes to doing intravaginal work. This is trauma care. This is making sure that we are not just performing internal work because it's a checklist that we have to do, and the client says yes from the head, but what is their body saying?

Their body could be on a totally different page than what their head is. And we, as practitioners, need to be able to attune to what the body's response is, and the body needs to say yes to it as well.

And I have a case where a client came to see me, and she had a ton of in vitro fertilization trauma from trying to get pregnant.

And I, she was also a really Southern woman, A good girl, a good girl, Southern girl. Okay. She, she had the good girl persona in her and the way I teach approaching intravaginal work in this internal pelvic floor course, there's four different check-in points that we must do so that we can make sure that the body is saying yes at each of these check-in points.

And because of her good girl persona, I did not catch the body's no until I got to the second check-in point.

And, um, I was shocked because it's the first time it's happened to me because usually I'm, I'm sensing from the very first time I touched my clients, which usually starts in standing with my hands on their shoulder.

I am asking that body, do you, what do you think about doing internal work today? Are we, we open to this?

Like I'm saying it subconsciously. Okay. But then I do all my work externally and I can't tell you that.

Number of clients that have come into my practice and saying that there's therapists out there that are just jumping right in to doing internal work.

And we are missing a big, big piece of the puzzle and the body needs to get used to our touch.

We need to do, we need to be working with the pelvic bones first before just going in internally and tuning in by doing all that, by working with the body externally, the body's getting used to our touch.

It's getting used to us and it can get a sense of safety, hopefully, from what you're doing. And that's why I'm a huge fan of never creating pain when I'm working on the body because pain is a sign the body doesn't like what I'm doing to it.

So why would the body trust me if I keep producing pain, pain, pain? And yes, there are different types of pain and I clarify that with my clients, but I want to be respectful of those tissues at all time and especially respectful of this intravaginal space and whether I enter.

So with this client that had all this IVF trauma, I got to the second check-in point in her body.

I just got this, like, I have a, knowingness is my sense of intuition, that's the greatest way that I get intuitive information, and I just got this huge no in my body, and I was just like, oh my gosh, we can't do it.

So I had gotten her undressed, and she was draped, and I went to touch her body where I teach it in this course, and it was just like, no, and I told her, I go, whoa, your body's telling me no, and she was like, oh, but please, please, please, that's why I'm here, that's why I want to be here, I really want this, and I was like, yes, I get that, and your body's telling me no, and I need to respect your body today.

So I just kept her, you know, draped, but I continue just doing external work with her for the rest of the session instead of doing internal work.

And when she... And back for a follow-up session, the first thing she said to me was, Lynn, that was the most powerful experience that I have ever had in a medical setting because I've never been able to listen to my body.

It's always had to perform when the timing was right and even if the body wanted to or not. But I gave her body an opportunity to say no and I listened to it and that really helped her to feel more empowered.

And I really would love everybody doing intervaginal work to have the skill to be able to listen to the body's yes and listen for the body's yes.

And there are several different things that I teach in the internal pelvic floor course, which are really simple signs that you can learn to listen to for the body to talk to us and help us to understand whether it's a yes or a no in doing that.

Okay, so that's the second prerequisite for doing. And the third one is actually that we just need to make sure that when we do internal work, that we include a standing assessment.

And the reason I share this is because I truly believe that it should be done on every single person, not whether you are affecting, whether you are seeing if someone has prolapse.

Because with prolapse, obviously a standing assessment is 100% necessary. Yet it's also really important to get a sense of how are the pelvic floor muscles functioning in an upright position.

It will be a completely different game than what they do laying down on their back. And so I just feel like it's important for us that it should be just a part of every single patient's assessment to do a standing assessment.

To see how do those pelvic floor muscles function in an upright position with gravity, with the organs being in a different position, and seeing what really happens.

And for us to get comfortable with the orientation of things, because when you're actually working internally and standing, the pelvic floor muscles are in the back wall.

You know, it's not down low. It's your fingers almost pointing, you know, back to them. So, um, that is, that can be a little disorienting for some people and when we get them in that upright position, but knowing how to do that in that standing position should be a requirement for every single person that we're working with.

If we want to know what their strength and their function is like, and then we can do some functional activities with them, do a squat, have them lift a leg.

See, are we getting that automaticity of those muscles kicking in, in that standing position. getting that. are are Um, I've just been, I've been fooled too many times over the years in not doing a standing assessment, especially when my clients are dealing with, um, symptoms of prolapse because you assess them in supine and it's like, nothing feels out of the ordinary in supine, but then you get them standing up and boom, that bladder is just right there.

So it's, it's really, really interesting. I hope that you, if you're not currently doing these things or understand how to do these things, please consider taking my internal pelvic floor course.

It's, uh, five hours of content, it's $350 and it will really improve your results with your intravaginal work. For those of you that are newer to pelvic floor work and you've only taken the Herman and Wallace's first couple of courses or even the APTA's course.

I know a lot of therapists are left. Kind of like, what do I do now? How do I make effective change?

They teach beautiful theory and research, yet I hear over and over from students that they just don't really know what to do.

Well, this course will teach you what to do and how to work with the muscles and the bones together, because I truly believe that we should not be trying to release the pelvic floor muscles without having our hands on the pelvic bones.

And there's a Schulte hold that I teach that is super effective in helping to get the muscles to let go without offering further pressure and tension and forcing something to happen, because that's truly all we've been taught early on in doing internal work is like, yeah, just force and make the muscle let go.

But yet there's so much more to it. And I invite you, instead of offering more force, you can learn to make more offer more force to the bones.

If If If do that in the correct way, and I encourage you to offer greater curiosity to what are those muscles having that tension for in the first place?

What is that tension about? And if we get curious with that, then we can help it to let go without having to force anything to happen.

So hopefully you've learned something from this episode and you can start implementing it. And if these are things that you're not currently doing, please make sure that you check out this course.

I've had practitioners who've been doing internal work for many, many years take this course and found it super, super helpful in just taking their internal work to the next level.

And so this course is really good for the beginners and the advanced practitioner alike in learning some new concepts, a new way of working with the pelvic floor muscles internally.

And the other key The that I cover in this course is the sphincter muscle, how to assess it and how to treat it because it is a major player and nobody else, no other educational course is teaching how to release the sorry, sphincter complex, both internal and external in the way that I do in this course.

And it is so incredibly effective and so important and so needed for our clients. So please learn how to release the sphincter complex and this course can, can teach it to you.

Okay. So thanks everybody for listening in. Hopefully you will start addressing the bones, listening for the body. Yes. And always doing a standing assessment with your clients.

Okay. So that we can do better intravaginal work with our clients. All right. Thanks everybody for listening into this episode and we will see you all in the next one.

Please. Please. Please. Share this episode with as many colleagues as you can, so let's start shifting the way intravaginal work is done all across the board.

All right. Thanks, everybody. Take care. Who's to smoother births, faster recoveries, and better intravaginal work done by all. Take care, everybody.

Bye-bye.