The heartbreaking testimonies of Larry Nassar’s victims have gripped the country for the past two weeks. Once a national women’s team doctor for USA Gymnastics and a highly regarded physician at Michigan State University, Nassar is now entering the final days of his sentencing hearing after more than 150 young women ― many of them current or former gymnasts ― accused him of sexual assault and abuse dating as far back as 1997.
Nassar molested his patients by performing internal vaginal and anal “treatments” that he insisted were medically necessary. As a doctor of physical therapy who specializes in women’s and pelvic health and who coached gymnastics for eight years, I find this case particularly disturbing. And I would not be doing my duty to champion women’s health if I did not speak up to set the record straight about pelvic physical therapy.
What Nassar did to these young women is absolutely atrocious and should not be confused with genuine pelvic physical therapy, which, when performed appropriately and correctly by a highly trained specialist, can have a positive impact on a woman’s quality of life, especially regarding maternal and sexual health.
Pelvic physical therapy is used to treat a variety of medical problems, including bowel and bladder leakage and chronic pelvic pain. In my own practice, young women unable to have sexual intercourse for many years due to excruciating pain were completely pain-free after pelvic PT. A young grandmother was finally able to wear white pants while out shopping because pelvic physical therapy fixed her bowel leakage problem. A pregnant mother was finally able to pick up her toddler again without experiencing severe low back pain.
It is my duty to women like these to ensure Nassar’s abuse does not, in addition to all the other damage it has done, prevent others from getting the care they need. It is critically important for women’s health professionals to ensure the horror of the Nassar case does not feed public fear and misconceptions about pelvic PT or stop women who need health care from walking through our doors.
Women’s health and pelvic health physical therapists who are part of the Section on Women’s Health (a component of the American Physical Therapy Association) undergo ongoing specialized education and training in the treatment of abdominal and pelvic issues. The pelvic health conditions these physical therapists treat include urinary incontinence (any involuntary leakage of urine); urgency or frequency of urination; bowel incontinence (any involuntary leakage of stool or gas); sexual dysfunction and painful vaginal penetration (including the inability to have an orgasm, pain with sexual activities and post-coital pain); abdominal and pelvic pain (including low back pain); pregnancy and postpartum issues; constipation; fibromyalgia; and pediatric pelvic health (bed-wetting, constipation and urinary or bowel incontinence).
Nassar’s victims have described an environment antithetical to standard pelvic physical therapy practices.
In short, there are hundreds of thousands of people, many of them women and girls, whose lives can be immeasurably improved by pelvic physical therapy. It would pile unfairness on top of injustice if the actions of one abusive doctor discouraged others from seeking the treatment they need.
The pelvic floor muscles are a significant area of emphasis in pelvic health physical therapy, and they play an important role in continence control, sexual appreciation, core stability and organ support. Pelvic floor dysfunction, or PFD, is a continually underserved area of the medical field. Research suggests pelvic floor dysfunction affects about 23.7 percent of women in the U.S., and PFDs often coexist with history of trauma and abuse. Furthermore, children who have experienced sexual abuse are at a significantly higher risk for post-traumatic stress, anxiety, depression, suicide, substance abuse and eating disorders, which can also contribute to ― and magnify ― pelvic floor dysfunction in adulthood. Patients often live with tremendous shame and pain, and do not seek help due to the stigma surrounding pelvic floor dysfunction and pelvic PT. As physical therapists, we strive to eliminate these obstacles through education, advocacy and intervention.
Nassar’s victims have described an environment antithetical to standard pelvic physical therapy practices. There was no chaperone, parent or guardian in the room during his “treatments.” He didn’t use gloves, and one athlete said she was under the influence of a sleeping pill during a “treatment” session. In many cases, Nassar performed intra-vaginal “exams” on athletes whose injuries had nothing to do with the victim’s pelvic area.
As the world learns of this man’s appalling actions, it’s important to clarify what one should expect from genuine pelvic physical therapy treatment.
A pelvic PT exam is not the kind of exam performed in a gynecologist’s office. There are no stirrups or speculum. The setting is much more comfortable and the exam much less invasive. A pelvic physical therapist will often use internal vaginal and rectal examination and treatment techniques ― all of which are evidence-based ― to help assess and correct a woman’s pelvic dysfunction. Clinics emphasize comfort and privacy, and we spend significant time getting to know our patients and their medical history.
Most importantly, any pelvic examination and treatment is performed only after thorough patient education, and only with the complete understanding and full consent of that patient. Therapists use gloves and other universal precautions during all exam and treatment procedures. The patient is always in control during pelvic physical therapy and can end the session at any time if they become uncomfortable. Internal exams are almost never performed on a minor, except in rare instances where the patient is older, sexually active or previously had internal examination from another medical practitioner. In these cases, a parent or guardian is always present to give additional consent for treatment.
For women with pelvic floor disorders, it is difficult enough to battle the stigma, shame and guilt often associated with these conditions. The Nassar case risks making it less likely that women who need pelvic physical therapy will seek it out. Those of us who care for and care about the health of women and girls must not allow predators like Nassar to further victimize women by making them fear the very interventions that can improve and enrich their lives.
Lora “Lori” Mize is a board-certified women’s health physical therapist specializing in abdominal and pelvic health. She is an assistant professor of physical therapy at Lynchburg College in Virginia and incoming vice president of the Section on Women’s Health.
Need help? Visit RAINN’s National Sexual Assault Online Hotline or the National Sexual Violence Resource Center’s website.