Recently a local provider slid into my DM’s to chat about a letter she received from her insurance boasting “no-cost digital pelvic PT” and her response is exactly the same as mine: WTF?

I’m sure we’ve all seen some form of this by now either on social media or directly from our insurance providers. Especially since one of the largest insurance companies is sending emails out to all of their customers to introduce them to this ‘service’ which includes working with a pelvic health specialist and an intravaginal device to monitor pelvic floor contractions and relaxation. 

So is it worth it? Does this truly replace in-person pelvic floor therapy? Let’s break it down! 

First we have to address if the device actually works and how. The intravaginal device they send out is a form of biofeedback that will monitor for pelvic floor squeezes and relaxations. So if you truly only have an issue with weakness this MAY be helpful. 

But let’s be honest, in the 12 years I have been a pelvic floor therapist and doctor of physical therapy, most of the patients I and my colleagues have seen are not dealing with a simple issue. 

Most patients aren’t properly diagnosed or referred to pelvic floor therapy until six years after symptoms start. On top of that, many patients wait months to years to get help and sometimes go through a few therapists before they find the right fit! This means they likely have picked up a few more contributing factors to their symptoms beyond weak muscles.

So for those with a more complex diagnosis or layers of tissue issues that need to be addressed, sticking a device internally and following along as it cues you to squeeze and release will not fix the issue. We actually end up seeing symptoms get worse and if the patient is not already experiencing pain, this may kick start it!

Knowing that the device is just intended to make you squeeze and release, let’s cover what this device does NOT do.

• It does not monitor for compensation of accessory muscles (aka cheating with your abdominals, adductors, or glutes).
• It does not assess your breathing and pressure management within the core canister.
• It does not differentiate between engagement of the front pelvic floor muscles (responsible for urinary leakage) and the back pelvic floor muscles (responsible for fecal leakage). 
• It does not help pelvic floor tightness, in fact it will make it worse!

So does the device work? Kind of, maybe, for a small subset of patients? 

How about the care from the provider via telehealth or over an app?

While working with a pelvic health specialist will be beneficial there are limitations to doing pelvic floor therapy exclusively online. During an in-person session your therapist will be able to perform a comprehensive assessment which may include a hands-on pelvic floor exam. 

At this time, we are feeling for muscle tightness and guarding, compensations from surrounding musculature, and picking up on the nuance of your movements with functional activity. We are also checking in on muscle strength and coordination which includes muscles far beyond the pelvic floor.

To do this we perform an exam called a manual muscle test where we provide graded resistance from our own hands against a muscle to test how strong it is. We then grade it on a scale of 0-5 and this helps guide our exercise prescription. During this testing we are able to pick up on common compensation patterns and areas of weakness that may be contributing to your symptoms which we are able to address and correct for.

This is important because the pelvic floor works in a system with the rest of the body including the hips, the feet, the diaphragm, and even the jaw. When we prescribe exercises for pelvic patients we are not just doing kegels, we are treating the whole system. This requires a comprehensive exam that goes far beyond the data collected from an intravaginal device. 

Within this exam, we are also monitoring for both verbal and non-verbal feedback about what is happening in your body. Oftentimes there are small signs like a twitch in a muscle or a slight weight shift during an exercise which clue us into the true source of your symptoms. But we are also vigilant throughout our appointments to pick up on cues that the patient may be nervous to do a pelvic exam, or showing signs of an upregulated nervous system which is common with patients experiencing chronic symptoms or with a trauma history. 

The other obvious big limitation here is that the device is only for those with a vagina - and those who can tolerate inserting something into their vagina. Patients with pelvic pain cannot necessarily do this! This method of providing online or AI-based treatment excludes millions of patients who suffer with pelvic floor dysfunction every day, namely those with a penis. Since this device is not designed to be inserted rectally, men, penis-owners, and those with vulvas who cannot tolerate vaginal penetration are not able to benefit from this treatment. But they can benefit from seeing a pelvic floor therapist in-person!

As our world continues towards more integration of AI into our everyday lives, this is a major area where human connection will always reign supreme over technology. This would be like trying to deliver your baby with your providers over Zoom. Sound crazy? Exactly! You would rather have the provider right there to support you and provide the skilled hands-on care they are the medical experts at providing. Pelvic floor therapy is the same - a skillset that deserves to be in-person and hands-on as much as possible to ensure top level care. 

While the convenience factor is very enticing and the thought of a quick fix with some kegels while a device tells you what to do seems low stakes, the outcomes are not what you are hoping for.  When your body has a history of pain, tension, guarding, trauma, weakness, or anything else contributing to dysfunction, a quick fix is not a lasting solution!