Rachel Andrew MACP (left) is an APA Women’s, Men’s and Pelvic Health Physiotherapist in lutriwita/ Tasmania with a keen interest in helping women with persistent pelvic pain. 

Alongside her partner, a learning and development specialist, she has set out to help GPs and other medical professionals understand persistent pelvic pain and its management, as well as the important role that physiotherapists can play. 

Persistent or chronic pelvic pain—defined as pelvic pain for six months or more—is experienced by one in four women of reproductive age. 

The condition is associated with comorbidities such as bladder and bowel issues, pelvic floor muscle dysfunction and sexual difficulties. 

Persistent pelvic pain can have a significant impact on physical and mental health, work and relationships. 

Armour et al (2019) determined that the estimated economic burden of pelvic pain and endometriosis in Australian women is $6.5 billion annually. 

A recent survey of healthcare professionals working with women experiencing chronic pelvic pain—including GPs, gynaecologists and physiotherapists—showed that only 41 per cent of gynaecologists and 22 per cent of GPs rated themselves as having a very good or excellent understanding of pelvic pain, compared to 65 per cent of physiotherapists (Vardy et al 2024). 

Similarly, almost 60 per cent of physiotherapists were confident in managing patients compared to 41 per cent of gynaecologists and 22 per cent of GPs. 

Physiotherapists were also more likely to consider patient beliefs and goals than GPs and gynaecologists. 

Physiotherapist Rachel Andrews has developed an app to educate GPs about women's pelvic health.

Rachel says that many GPs don’t understand the scope of practice of a pelvic health physiotherapist. 

Instead, they typically refer a patient with persistent pelvic pain straight to a gynaecologist for care, who might then refer them to a physiotherapist or multidisciplinary team. 

'I used to go and talk to GPs and tell them about what we did, and they always had heaps of questions.

'Our initial messaging when talking to GPs was simple: refer patients to both gynaecologists and pelvic health physios at the same time. 

'This allows us to start treating patients while they’re waiting for a gynaecologist,’ she says. 

'Many gynaecologists understand what we do, but the GPs often don’t.’ 

Through her company Vagenius Training, she has developed two training modules on persistent pelvic pain and on pelvic organ prolapse aimed at medical professionals. 

The courses have been approved by the Royal Australian College of General Practitioners, the Australian College of Rural and Remote Medicine, the Royal Australian College of Obstetricians and Gynaecologists and the Australian College of Nurse Practitioners as a form of continued professional education. 

Rachel’s initial course was about pelvic organ prolapse, stemming from her frustration with GPs who couldn’t provide patients with the information they needed about the condition. 

'If your patient has a low-grade prolapse, it’s valid to say to them, "Don’t worry about it, you don’t need to have surgery,” and to refer them to physio. 

'However, often their GP would say, “You’ve got a mild prolapse…” and nothing else. 

'Then the patient would go home, Google it, freak out and stop going to the gym, gardening or other hobbies,’ says Rachel. 

'Part of the training focuses on how GPs should talk to people about pelvic health issues, there’s a section on validating symptoms and communicating evidence. 

'We talk through the range of physio treatments, we discuss pessaries and how to use them, how to set your clinic up and where to get extra training. 

'We also have a surgeon speak about surgery.’ 

The second course, on persistent pelvic pain, is a comprehensive course developed in collaboration with some of Rachel’s colleagues at TasWomen, a multidisciplinary women’s health clinic in Hobart. 

The course covers all aspects of care, including the therapeutic relationship, medication, trauma-informed care, sexual health, physiotherapy, nutrition and psychology. 

The presenters are clinicians—GPs, gynaecologists and allied health professionals—and patient stories are woven through the modules. 

By the time the participants have completed the course, they have a pack of resources to help them, including diaries for tracking symptoms, desensitisation programs to assist patients who have difficulty with pelvic examinations and exercise and dietary information. 

'At the start of the course about 75 to 80 per cent of our participants don’t feel empowered when treating women with pelvic pain, they feel they’re hard to manage, that their stories are hard to grasp and it’s hard to make sense of what’s going on. 

'By the end of the course, more than 90 per cent feel like they can deliver trauma-informed care well, and that they can confidently deliver care using a whole self-care plan,’ Rachel says.

'One hundred per cent of GPs and nurse practitioners who have completed the course say they have changed their practice significantly, and 100 per cent report they will recommend it to colleagues.’ 

Vagenius is working on a number of new courses, including one on perimenopause and menopause and another one looking at pregnancy and postpartum care. 

They also plan to develop a course about problematic periods, with a focus on young women, and one on vulval pain. 

While the training courses have been very well received by the medical profession, Rachel says it has been challenging to get the word out about the courses to the doctors who need them. 

She wants physiotherapists to spread the word to GPs, gynaecologists and clinicians at pelvic health clinics. In the meantime, she is lobbying governments for funding and partnering with organisations to build brand awareness. 

'I really encourage any pelvic health physios or general physios to talk to their GPs about the availability of the courses. 

'They’re all online, they’re easy to do and GPs are finding them engaging and interesting,’ she says. 

Quick links: 

• References 

Course of interest:

• Pelvic pain: what all physios need to know