Weak orgasms, incontinence, constipation, and even lower back pain can all stem from poor pelvic health. About 1 in 4 women will experience pelvic problems like these in their lifetime and roughly a third of men may say the same - if early, small studies are any indication. Physical therapy can help, but, based on the most recent 2022 data, only 120 therapists in California were certified to treat pelvic health conditions. Nevada had just one.
UC San Francisco's is closing that gap by launching a new, year-long Women's Health Physical Therapy Residency program. Most physical therapists graduate without ever taking in-depth courses on women's health or pelvic health in general. UCSF's new residency aims to train more physical therapists in women's health across the lifespan - from puberty to menopause and beyond - with a focus on pelvic health, which affects all genders. Along with working directly with patients, the residency also includes one-on-one mentoring with experts in pelvic health physical therapy.
As one of only 25 such accredited programs nationally, the residency prepares physical therapists to become highly sought-after board-certified Women's Health Clinical Specialists.
We spoke with residency director and assistant clinical professor Leah McIntyre , PT, DPT, about why pelvic health matters, common myths, and the care gap UCSF's newest residency fills.
People may have heard of the "pelvic floor," but what exactly is it?
The pelvis is a bony structure between our belly and thighs. It connects our legs to our trunk and our spine, and it also houses and protects vital organs, blood vessels, and nerves.
Our pelvic floor muscles are at the base of our pelvis and comprised of several muscle layers.
These muscles act like a hammock, cradling the organs, vessels, and nerves, which is why pelvic floor muscles play an essential part in our core stability. They also play a role in bowel, bladder, and sexual function.
What are some of the unique changes women go through in life that need specialized physical therapy?
In physical therapy, there's no one-size-fits-all approach for any person, particularly for women. Women's bodies change across the stages of their lives, and many of these changes relate to reproductive hormones. Hormones impact every system in the body and can fluctuate throughout our lives and even our menstrual cycles.
Hormone fluctuations impact women athletes' ligaments' flexibility and the stability they provide to their joints, for example. This increases the risk of certain injuries for female athletes.
Childbearing too, changes our bodies. Both physical changes during pregnancy as well as the physical demands of labor and delivery increase the risk of pelvic floor disorders and urinary incontinence, for example.
Menopause brings another major shift, marked by a decline in estrogen levels. This hormonal change affects bone density, muscle mass, and connective tissues, including those in the pelvis and pelvic floor.
If women's bodies are different from men's, why have they been treated the same for so long?
It goes back centuries. Historically, medical education has been based almost exclusively on the cisgender male body. Women were long excluded from medical research, sometimes because scientists assumed women's hormone fluctuations would introduce too much variability in results. This led to a lack of understanding about how different diseases, conditions, and life changes manifest differently in people with ovaries and uteruses.
What's one myth about aging and the pelvic floor you wish women knew the truth about?
There are so many, but I think the biggest myth is that things such as urinary incontinence, in particular, but also other pelvic issues, like organ prolapse, are just an inevitable part of having children or aging. Prolapses happen when the muscles or ligaments in the pelvic floor weaken, causing organs like the bladder or uterus to move down into the vagina.
These issues are common, but they're not things that women have to accept. They are things we can address through pelvic physical therapy. Women's health physical therapy residency programs like ours train physical therapists to specialize in those needs.
So, is pelvic health just a concern for women?
No. Bodies assigned male at birth have a lot of the same pelvic muscles and deal with a lot of the same related bowel, bladder, and sexual dysfunction struggles that cis women do. They may also have additional concerns related to conditions like prostate cancer. Pelvic physical therapy can help address all of these.
Transgender individuals and non-binary people may also have unique pelvic health needs. It's important to know that although graduates of our residency program will become certified "Women's Health" Clinical Specialists, they'll graduate with the skills to treat pelvic health problems in all people.
What sets UCSF's residency program apart?
UCSF was among the first federally designated National Centers for Excellence in Women's Health nearly 30 years ago. Today, the center houses a range of women's health research programs.
Our new physical therapy residency program is the latest chapter in UCSF's commitment to advancing women's health by meeting the critical need for specialized physical therapy for women and pelvic health.
Residency graduates generally have significantly higher first-time pass rates for board exams than physical therapists who don't pursue residencies. Our program goes beyond that to set residents up to become leaders and educators in the field of women's and pelvic health physical therapy.
Our residents get a wide range of experiences, from working alongside therapists with various specialities and teaching doctoral students to completing a community service project.
UCSF's Physical Therapy department debuts a new Women's Health Residency Program this fall, which will include training on women's bodies during and after (peri)menopause.
