“I Didn’t Agree to That”: When Pelvic Floor Physiotherapy Causes Harm
Summary
Pelvic floor physiotherapy helps many people with leaking, prolapse, pain and recovery after birth. It often involves an internal examination, which makes clear consent especially important. This guide is for people who had an internal examination or treatment they didn’t agree to or understand, who were hurt during treatment, or whose symptoms were missed. It explains what should happen, your rights, and where to go.
Quick answer · updated November 2026
A pelvic health physio should explain any internal examination, ask your permission first, and respect a no, including partway through. Consent covers only what you agreed to. If an examination or treatment went beyond that, caused pain or injury, or a serious problem was missed, you can complain, ask for your records, and get support.
A pelvic floor physio visit at a glance
- 1First appointmentQuestions about your symptoms, history and goals.
- 2Before any examWhat, why, the alternatives, and your right to say no.
- 3The examinationYou can stop it at any time.
- 4TreatmentEach new technique needs its own explanation and agreement.
- 5AfterwardsPain, bleeding or distress afterwards should be raised.
At any stage: if you were touched in a way you didn’t agree to, support is available. See support.
I went to a pelvic floor physio four months after my daughter was born. I was leaking when I laughed, and I wanted to run again. I was nervous, but my friends said it changed their lives.
He was friendly and quick. After a few questions he said, “Right, let’s have a look,” and handed me a sheet. I thought he meant an external check.
The internal exam started before I’d really understood what was happening. Then he said he’d “release some trigger points”. It hurt, sharply, and went on.
I didn’t say stop. I lay there staring at the ceiling tiles, and when I got to the car I couldn’t turn the key for a while.
A composite story, drawn from the experiences of many families I have worked with, combined and changed so that no one can be identified. It does not describe any individual client.
If something like this happened to you, I want you to know that freezing is a common response and it is not consent. Not saying no is not the same as saying yes. Your questions, and your feelings about it, are entirely valid.
This guide is also for people physically hurt during treatment, and for those whose symptoms were missed. It covers what should happen, your rights, what your records should show, and where you can go.
Why I can write this
I have been a medical negligence lawyer since 2014 and have worked on many hundreds of claims, including many involving gynaecology and care after birth. My doctorate looked at patterns of failure in medical negligence. I am not medically qualified. The clinical facts in this article are checked against named sources, listed in the references, and I explain how I work in our editorial standards.
Start with your question
- What happens at a pelvic floor physio appointment?
- Does a physio need permission for an internal exam?
- Can I stop an examination partway through?
- Are there alternatives to an internal exam?
- What if a physio missed something serious?
- How do I complain about a physio?
- Could this be negligence?
What usually happens
The Continence Foundation of Australia explains that a pelvic health physio may check the pelvic floor muscles with an internal vaginal examination, using one or two gloved fingers, to assess strength, look for prolapse and find tender or tight areas. A rectal examination may sometimes be used instead.1
Permission before any examination
The Continence Foundation says your physio will ask your permission before any examination, and that you have the right to say no.1 Consent needs accurate information about what is proposed and the alternatives, given in a way you can understand, with time for questions.2 Consent is valid only for the specific procedure you were told about and agreed to.2
Definition
Ongoing consent means agreement that continues through an examination or treatment, and can be withdrawn at any time.
In plain terms: agreeing to a check is not agreeing to everything that follows. You can stop at any point.
Saying no or stopping
You can withdraw consent at any point.2 A good physio will check in during an internal examination, explain each new step, and stop immediately if you ask. The Continence Foundation notes that saying no may limit what the physio can diagnose and treat, and that they can talk this through with you.1
Alternatives to an internal examination
Depending on your problem, a physio may be able to check the outside of the genital area, watch the muscles from the outside, assess posture and movement, or use real-time ultrasound over the tummy or perineum.1 You can ask about these.
Questions to ask before an examination
- What exactly will you do, and why?
- Is there another way to check this?
- Can I have a support person with me?
- Will you tell me before each new step?
- How do I let you know to stop?
Treatment techniques
Some treatments, such as internal trigger point release, can be uncomfortable. Each new technique should be explained and agreed to before it starts, and stopped if you ask. Pain that is severe, or continues after the session, should be raised.
When something serious is missed
Pelvic floor symptoms can sometimes point to a problem that needs a doctor, such as a significant birth injury. A physio who finds signs of a serious problem should refer you on. Our guides to levator avulsion, missed and misgraded tears and bowel urgency after a tear explain injuries that are sometimes missed.
Afterwards
Write down, while it is fresh, what you were told, what happened, and how you felt. Keep any messages or receipts. You can ask the clinic for your records. Our guide to getting your medical records explains how.
If you were touched without consent
An examination or touching you did not agree to can be deeply distressing, and it may be a matter for police as well as for health regulators. 1800RESPECT (1800 737 732) offers free, confidential support, and you can speak to them without deciding on any next step.
Complaints
Physiotherapists are registered health practitioners. You can check a physio’s registration on the Ahpra public register.3 In NSW, complaints can go to the Health Care Complaints Commission.4 Our guide to complaint or claim explains the difference.
I didn’t tell anyone for weeks. Then I had pain with sex and with tampons that hadn’t been there before, and my GP gently asked what had changed.
She referred me to a different pelvic health physio, a woman who spent the whole first appointment just talking. She explained each option. She offered an ultrasound instead. She said I could stop at any time, and showed me how.
Later I asked the first clinic for my notes. They said: “Consent obtained. IVE. Internal TrP release L levator.” No mention of what I’d been told, or of pain.
My partner read it with me at the kitchen bench while our daughter napped. “Consent obtained,” he said. “By what?” I’m running again now. But I wanted the first clinic to know that two words in a note weren’t a conversation.
A composite story, drawn from the experiences of many families I have worked with, combined and changed so that no one can be identified. It does not describe any individual client.
What to look for in the records
Your records are often where the story becomes clear. You have a right to access your own health information. In NSW the Health Records and Information Privacy Act 2002 covers both public and private providers, and the Information and Privacy Commission explains how to ask.5 Our step-by-step guide to getting your medical records in Australia walks you through it.
| Record | Why it matters |
|---|---|
| Intake form | Shows what symptoms and concerns you described. |
| Consent record | Shows what the notes say was explained and agreed, and when. |
| Examination notes | Show what examination was done and what was found. |
| Treatment notes | Show which techniques were used, and any pain recorded. |
| Referral letters | Show whether you were referred on for a medical problem. |
| Your own notes and messages | Show what you remember, written close to the time. |
| Your own diary, photos and messages | Notes made at the time are evidence too. Keep them. |
How the law looks at it
Discomfort during pelvic floor physiotherapy is not automatically negligence. Some examinations and treatments are uncomfortable even when done well. The legal questions are whether you gave valid consent to what was done, whether the treatment met the standard expected of a physiotherapist, and whether any shortfall caused harm.
A claim usually turns on three questions: whether the care fell below what peers would widely accept as competent practice (section 5O of the Civil Liability Act 2002 (NSW))6, whether that shortfall probably caused harm you wouldn't otherwise have had (Tabet v Gett)7, and, where it matters, whether you were told the material risks first (Rogers v Whitaker)89. Our guide to how a medical negligence claim works explains each one in plain terms.
In a pelvic floor physio case, the questions might be: was the examination explained, with alternatives, before it began? Did consent cover what was actually done? Were you checked on during the examination? Was a technique used with excessive force, or continued despite pain? Were signs of a serious problem referred on?
In plain terms, the question is whether, with proper explanation and care, the injury or distress would probably have been avoided.
For pelvic floor physiotherapy, that would usually include what an internal examination involves, why it is suggested, the alternatives, and your right to stop at any time.
Who can claim, and when
The person who had the treatment can claim. In NSW, time usually runs from when you knew, or ought to have known, enough to claim, not from the treatment itself, and courts can sometimes extend it, so an old injury may still count. See time limits in NSW or other states, and ask early.
More: complaint or claim? · how a claim is paid for · what a claim can cover
In my practice
In files about pelvic floor physiotherapy, the record of consent is often a single line, such as “consent obtained”. What the person remembers is very different: a sheet handed over, an examination that started before they understood, and a technique that went on despite pain. People often blame themselves for not saying stop. Reading the notes against their account usually shows how little was explained.
Both things can be true
Pelvic floor physiotherapy can be life-changing, and this physio may have helped others. And your care may still have fallen short. You can believe in the treatment and still say that what happened to you wasn’t right.
The bigger picture
Pelvic health physiotherapy has grown quickly, and professional bodies have published guidance on consent and boundaries. Our endometriosis and gynaecology page brings together related guides, including pelvic floor Botox and endometriosis laparoscopy.
Support
You don't have to work through this alone. These services can help:
- Lifeline, 24-hour crisis support: 13 11 14 (listed on healthdirect's helplines page)10
- Beyond Blue, anxiety and depression support: 1300 22 4636
- Medicare Mental Health, help finding mental health support: 1800 595 212
- healthdirect, 24-hour nurse advice: 1800 022 222
- Health Care Complaints Commission (NSW): 1800 043 159
A new mother who froze on a treatment table now knows that freezing wasn’t agreeing. You deserve that understanding too.
With care,
Rosemary
Frequently asked questions
Does a pelvic floor physio need permission for an internal exam?
Yes. They should explain it and ask your permission first, and you can say no.
Can I stop an internal exam partway through?
Yes. You can withdraw consent at any time.
Are there alternatives to an internal pelvic floor exam?
Sometimes, such as an external check or real-time ultrasound. Ask your physio.
Is pain during pelvic floor treatment normal?
Some discomfort can be, but severe or lasting pain should be raised and treatment stopped if you ask.
How do I complain about a physiotherapist?
In NSW, contact the Health Care Complaints Commission. Physios are also registered with Ahpra.
Can I claim for harm from pelvic floor physio?
You may well have a claim if you didn’t give valid consent or the treatment fell below the expected standard and caused harm.
Questions about your pelvic floor treatment?
When you're ready, and not before, I can look at what happened and help you understand your options.
Contraception and gynaecology guides
- “I didn’t agree to that”: When pelvic floor physiotherapy causes harm (you are here)
- “I can’t feel my implant anymore”: Nexplanon (Implanon NXT) problems
- “Was that pain normal?” When an IUD insertion goes wrong
- “The Botox made it worse”: Pelvic floor Botox side effects
- Depo-Provera and brain tumours: delayed warnings and harm
- Can you sue a doctor for delayed diagnosis of endometriosis?
Part of our guide to endometriosis and gynaecology. Not sure where you stand? Try the free claim checker.
References
- Continence Foundation of Australia. What to expect when seeing a women’s pelvic health/continence physiotherapist.
- Harris Ingall A. Patient-centred care starts with consent. InMotion, Australian Physiotherapy Association. 2 April 2024.
- Australian Health Practitioner Regulation Agency. Register of practitioners.
- Health Care Complaints Commission NSW. Home page.
- Information and Privacy Commission NSW. Fact sheet: Accessing your health information in NSW.
- Civil Liability Act 2002 (NSW) s 5O, Standard of care for professionals.
- Tabet v Gett [2010] HCA 12.
- Rogers v Whitaker [1992] HCA 58; (1992) 175 CLR 479.
- Australian Commission on Safety and Quality in Health Care. Informed consent.
- healthdirect Australia. Mental health helplines.
Stories in this article are composites, drawn from the experiences of many families I have worked with, combined and changed so that no one can be identified. They do not describe any individual client.
Dr Rosemary Listing, PhD (Law), Medical negligence lawyer since 2014 · Of Counsel, Peter Evans & Associates. Rosemary's doctorate examined patterns of failure in medical negligence, and she teaches health law at the University of Newcastle. She is not medically qualified. About Rosemary.
Last updated: 10 November 2026 · First published: 10 November 2026 · Next review: May 2027
Cite this article: Listing R. “I didn’t agree to that”: When pelvic floor physiotherapy causes harm. Reframe Legal. Published 10 November 2026. https://reframelegal.com/pelvic-floor-physiotherapy-harm/
This article is general information, not legal or medical advice. It does not create a lawyer–client relationship. Speak to your treating clinicians about your health, and get legal advice about your own situation.
If you are in danger or need urgent medical help, call 000. For crisis support, call Lifeline on 13 11 14.
Legal services are provided by Peter Evans & Associates.
