Full disclosure. I'm a middle-aged bloke, an MSK physio, and this absolutely isn't my clinical lane. But something about pelvic health training in UK physiotherapy has not been sitting right with me for a while.
Pelvic health physio is an extraordinarily important specialty, which is exactly why the educational model matters. Young physios attending pelvic health courses still commonly learn internal vaginal and rectal examination by practising on one another. I understand why historically. Physios have always learnt hands-on skills peer-to-peer. But this is not comparable to practising a mobilisation technique on a shoulder, and I keep wondering whether the profession has properly re-examined where the line should now sit.
Medicine largely moved away from peer-to-peer intimate examination years ago. Medical schools increasingly use simulation and trained teaching associates whose explicit, paid role is to participate in intimate examination teaching. Physiotherapy still allows peer examination within pelvic health training, usually defended by consent and opt-out safeguards. I'm just not sure that fully settles the ethical question.
A young physio told me recently they agreed to take part despite feeling deeply uncomfortable, because everyone just does it. That may technically be consent. But professional culture creates pressure of its own, especially for younger clinicians trying to fit in, pass courses and not be seen as difficult. Consent inside a hierarchy is not always fully free consent.
And I suspect there's another consequence. How many potentially brilliant pelvic health physios, men and women alike, never enter the specialty at all because the training model itself puts them off before they even begin? At a time when pelvic health services are desperately short of people, that feels like a serious question.
There's a practical issue underneath it too. A room full of healthy course attendees probably teaches far less about recognising dysfunction than simulation, supervised clinical exposure and trained teaching models. So if the educational gain is limited while the ethical complexity is high, shouldn't the profession at least pause and ask whether there's now a better way?
To be crystal clear, this is not an attack on pelvic health physios. The clinicians in this field do hugely valuable work and I'm questioning the training structure, not the people. But as healthcare increasingly designs around safeguarding and boundaries rather than assumed goodwill, it feels reasonable to ask whether intimate peer examination should still be the default teaching model in 2026. The fix already exists next door. Simulation for technique, trained models for live assessment, and peer practice no longer the default.
I certainly don't have all the answers here. But I'm no longer comfortable pretending the current model is beyond questioning, and I suspect I'm not alone.