What to Expect in Pelvic Therapy for Endometriosis
1. Introduction
Starting pelvic therapy for endometriosis can feel like a lot—especially if you’ve been dealing with chronic pain, endless appointments, and searching for answers for what feels like forever. If you're feeling a mix of relief, nerves, and questions... you're not alone. That’s exactly why we put this guide together—to walk you through what to expect, calm those nerves, and help you understand how pelvic therapy can actually help with endometriosis. You deserve care that feels supportive, thoughtful, and tailored to you every step of the way.
2. Medical & Symptom History: Let’s Talk About Your Story
Once you’ve scheduled your appointment, our first priority is getting to know you. Endometriosis isn’t just about pelvic pain—it can affect so many parts of life, and everyone’s journey is different. That’s why we set aside a full hour for your first session. We’ll listen to your story, dive into your symptoms, and focus on what matters most to you in your healing process.
Here’s some of what we’ll ask about (but no pressure—share what feels comfortable):
Bladder and bowel health: Any urgency, frequency, or pain?
Sexual health: Pain with penetration, arousal, or orgasm? (We know this can feel vulnerable, and we approach it with sensitivity and zero judgment.)
Menstrual cycle concerns: Pain during periods, ovulation, or other times of the month.
Digestive issues: Bloating, constipation, or discomfort.
Past surgeries: Had any? Curious about what’s involved in future ones? We’re here to discuss it.
Lifestyle factors: Stress, activity level, sleep—yep, it all connects.
Why all these questions? Because understanding your full health picture gives your therapist a roadmap for what to look for during the evaluation and how to tailor treatment to get you the best results.
3. Physical Assessment Overview: What We’re Looking For (and Why)
After learning your history, we’ll move into the physical assessment—always prioritizing your comfort and focusing on what’s most important to you.
Connective Tissue & Visceral Fascia Assessment:
Endometriosis can make tissues in the body more sensitive and less mobile. When you’re dealing with chronic pain, fascia (the connective tissue around muscles, organs, and nerves) can become more dense, which can restrict movement, decrease blood flow, and contribute to discomfort. We’ll gently assess your abdomen and pelvis to check how these tissues move—because if your organs, muscles, and fascia aren’t gliding smoothly, it can add to your symptoms.
For people with endo, we often focus on areas around the bowel, bladder, and reproductive organs, since endometriosis can create restrictions there. Improving how these tissues move can make a big difference in managing pain and other symptoms.
Core & Pelvic Assessment:
Endometriosis can lead to muscle guarding in the abdomen and pelvis, causing tightness and discomfort. This protective response can make movement feel restricted and contribute to ongoing pain. A key part of pelvic therapy is working on elongating these overactive muscles while strengthening specific muscle groups to restore balance, improve function, and help you feel better in your body. We’ll check for things like:
Muscle tension or weakness that might be contributing to pain.
Nerve sensitivity—since some nerves travel from your back into your pelvis and legs, we want to make sure they’re not adding to your discomfort.
Joint mobility in your hips, pelvis, and lower back.
Our goal is to identify anything that could be adding to your endo-related pain—because if we can reduce those extra layers of tension or restriction, your body has more space to heal.
Internal Pelvic Floor Assessment (A Core Part of Our Approach—Always Your Choice):
As specialists in pelvic health, we typically include an internal pelvic floor assessment as part of your evaluation. This helps us understand muscle tension, coordination, and function, which can be key to your progress. That said, your comfort comes first, and you always have the choice to opt in or out. Here’s why it can be helpful:
To check for tight pelvic floor muscles that might be contributing to pain with penetration, bowel movements, or bladder issues.
To assess if internal scar tissue or fascial restrictions are affecting symptoms like urinary urgency or outlet constipation.
To understand how your pelvic floor muscles coordinate, lengthen, and relax—which can be key for reducing pain during intimacy and improving overall comfort.
You’re in control the entire time. If you’re not ready or don’t want to do this part, that’s completely fine. There are plenty of ways to assess and treat externally.
4. Education & Goal Setting
After the evaluation, we’ll go over your goals and any information that can help guide your care. We’ll talk about what you can expect from future sessions and how pelvic therapy can specifically support you. This includes discussing how endometriosis affects your musculoskeletal system and how we can address it, as well as how your nervous system plays a role in pain and healing—and what we can do to help calm that response.
Endometriosis isn’t just a reproductive condition; it can impact the whole body. If we feel that involving another provider could be helpful, we’ll let you know how and when that might fit into your plan. The goal is always to create a collaborative, realistic path forward that aligns with what you need and want out of therapy.
Final Thoughts:
Starting pelvic therapy for endometriosis isn’t just about addressing pain—it’s about helping you reconnect with your body in a supportive, non-judgmental space. We’re here to meet you where you’re at, listen to your story, and guide you toward feeling better at a pace that works for you. You deserve care that feels as compassionate as it is effective.
Want to learn more? Next, we’ll explore how endometriosis affects more than just your pelvis—and what you can do about it.
