Women’s Health Physiotherapy Assessment
Form Filling and Clinical Assessment Guidance for Physiotherapists
Purpose of the Form
This assessment form is designed to provide a comprehensive, sensitive, and structured evaluation for women presenting with pelvic floor dysfunction, pregnancy-related musculoskeletal conditions, postnatal issues, pelvic pain, incontinence, and post-gynaecological surgery concerns. It integrates subjective history, obstetric–gynaecological context, pelvic floor assessment, functional impact, and individualized treatment planning.
The form supports:
- Accurate clinical reasoning in women’s health physiotherapy
- Safe internal and external pelvic floor assessment
- Identification of impairments, activity limitations, and participation restrictions
- Goal-oriented, evidence-based intervention planning
- Medico-legal documentation and MDT communication
S – SUBJECTIVE ASSESSMENT
The subjective section establishes patient context, symptom history, and functional impact, and is particularly important in women’s health due to the intimate and biopsychosocial nature of presentations.
Patient Identification
How to fill
- Tick the clinical setting (OPD, IPD, antenatal, postnatal, gynaecology).
- Record patient name, UHID, age, marital status, and date/time of assessment.
Clinical guidance
The clinical setting influences assessment depth and intervention focus. Antenatal and postnatal patients require pregnancy-specific precautions, while gynaecology referrals often involve post-surgical or chronic pelvic conditions.
Referral Source
How to fill
Tick the referring specialty (obstetrics, gynaecology, urology, orthopaedics, or self-referral).
Clinical guidance
Referral source provides insight into the primary clinical concern and expected scope of physiotherapy intervention.
Primary Reason for Referral
How to fill
Tick the main reason for referral (pelvic floor dysfunction, pregnancy-related pain, postnatal rehabilitation, urinary incontinence, pelvic pain, post-gynaecological surgery, menopausal musculoskeletal issues).
Clinical guidance
This field defines the dominant treatment pathway and outcome measures to prioritize.
Chief Complaints
How to assess
Allow the patient to describe symptoms in her own words before structured questioning.
How to fill
Tick all reported complaints such as urinary leakage, pelvic heaviness, pelvic or low back pain, dyspareunia, postural pain, or difficulty with daily activities.
Clinical interpretation
Multiple complaints are common and often interrelated. For example, urinary leakage may coexist with postural dysfunction and pelvic pain.
History of Presenting Complaint
How to assess
Clarify symptom onset, progression, and context.
How to fill
- Tick onset type (sudden, gradual, post-delivery, post-surgery).
- Tick course (improving, static, worsening).
- Identify triggering events such as pregnancy, childbirth, surgery, or menopause.
Clinical interpretation
Post-delivery and post-surgical onset suggest tissue trauma and neuromuscular dysfunction, whereas gradual onset may indicate chronic overload or hormonal influences.
Past Medical History (PMH)
How to assess
Use both patient interview and available medical records.
How to fill
Tick relevant conditions including endocrine disorders, pelvic pain syndromes, bowel dysfunction, recurrent UTIs, musculoskeletal or neurological conditions. Document previous non-obstetric or non-gynaecological surgeries. Tick red-flag history if present.
Clinical interpretation
Red flags (e.g., cancer, unexplained weight loss) require medical referral before physiotherapy continuation.
Obstetric & Gynaecological History
How to assess
Approach this section with sensitivity and privacy.
How to fill
- Record parity (nulliparous, primiparous, multiparous).
- Tick mode of delivery (vaginal, assisted, LSCS).
- Record weeks post-delivery if applicable.
- Tick menstrual status (regular, irregular, menopausal).
- Document gynaecological or pelvic surgeries.
Clinical interpretation
Vaginal and assisted deliveries increase risk of pelvic floor trauma, while menopausal status influences tissue elasticity and muscle function.
Subjective Symptom Assessment
How to assess
Identify dominant symptoms and their severity.
How to fill
- Tick primary symptoms (urinary leakage, urgency, pelvic heaviness, dyspareunia, pelvic/low back pain, abdominal separation, postural pain).
- Record pain presence, intensity (VAS/NPRS), location, and aggravating factors.
Clinical interpretation
Aggravating factors such as coughing or lifting indicate pressure-management dysfunction and guide exercise prescription.
Bladder, Bowel & Sexual Function Screen
How to assess
Use clear, non-judgmental language and obtain informed consent for sensitive questioning.
How to fill
- Bladder: tick type of incontinence, frequency, nocturia.
- Bowel: tick constipation, urgency, or incontinence.
- Sexual function: document pain, fear, avoidance, or reduced satisfaction if applicable.
Clinical interpretation
Dysfunction in these systems often reflects impaired pelvic floor coordination rather than strength alone.
O – OBJECTIVE ASSESSMENT
The objective section identifies postural, musculoskeletal, and pelvic floor impairments through observation and palpation.
Postural & Musculoskeletal Assessment
How to assess
Observe standing and sitting posture and assess mobility.
How to fill
- Tick postural deviations.
- Assess abdominal wall tone and presence of diastasis recti.
- Record diastasis width using finger-width method.
- Assess lumbar and pelvic girdle mobility.
Clinical interpretation
Diastasis recti and postural dysfunction often coexist with pelvic floor weakness and poor pressure management.
Pelvic Floor Muscle Assessment
Important note
Internal examination must only be performed with informed consent, appropriate training, and adherence to ethical and institutional guidelines.
How to fill
- Document assessment method (observation, external palpation, internal examination).
- Note findings at pubic crest and vaginal canal.
- Record visible bulging, superficial contraction, and palpation tone.
- Document tenderness location if present.
- Grade muscle strength using Modified Oxford Scale.
- Record endurance, coordination, and ability to relax.
Clinical interpretation
Hypertonicity with poor relaxation requires down-training, whereas hypotonicity with poor endurance requires graded strengthening.
Outcome Measures (Core Component)
Pelvic Floor Impact Questionnaire – Short Form (PFIQ-7)
How to fill
Record sub-scores for bladder, bowel, and pelvic domains and calculate total score.
Clinical interpretation
Higher scores indicate greater functional impact and guide goal setting and outcome tracking.
Pain & Function Measures
How to fill
Document scores for VAS/NPRS, Oswestry Disability Index, or Pelvic Girdle Questionnaire where applicable.
Functional Interpretation
How to fill
Tick mild, moderate, or severe functional limitation based on combined symptom severity and outcome measures.
A – ASSESSMENT
Integrated Clinical Assessment
How to fill
Identify primary impairments such as pelvic floor weakness, poor coordination, core instability, postural dysfunction, or pain-dominant presentation.
Clinical interpretation
This synthesis drives intervention selection and sequencing.
Physiotherapy Clinical Impression & Rehabilitation Potential
How to fill
Provide a concise narrative summary and assign rehabilitation potential (good, fair, guarded).
Clinical interpretation
Potential is influenced by tissue healing stage, chronicity, psychosocial factors, and adherence capacity.
P – PLAN
Treatment Goals
How to fill
Tick relevant short-term and long-term goals aligned with patient priorities.
Women’s Health Physiotherapy Plan
How to fill
Tick all applicable interventions including pelvic floor training, stimulation, core stabilization, breathing and pressure management, postural correction, relaxation, and education. Document EMG modes, exercise parameters, frequency, and duration.
Clinical interpretation
Interventions must be individualized; strengthening without relaxation training may worsen symptoms in hypertonic presentations.
Education, Counselling & MDT Inputs
How to fill
Tick all education provided and record MDT referrals if required.
Clinical interpretation
Education and self-management are critical determinants of long-term success in women’s health physiotherapy.
Assessor Authentication
Record physiotherapist name, signature, and date/time to ensure professional accountability and medico-legal validity.
Clinical Summary
The Initial Women’s Health Physiotherapy Assessment form functions as a comprehensive clinical reasoning tool, integrating sensitive history taking, objective pelvic floor assessment, functional impact measurement, and structured treatment planning. Accurate and thoughtful completion of this form is essential for delivering safe, ethical, and effective women’s health physiotherapy care