When in physical therapy school, we learned about all of the muscles, their origin, and their attachment. When looking at the pelvic floor, it resembles a bowl full of muscles. To make documentation more consistent and communication between practitioners and patients easier, a clock analogy was given. I teach all of my patients to view their pelvic floor as a clock so that they can be much more precise with me what they are feeling and where; especially when using a dilator. When visualizing this, you can either visualize looking down inside your pelvis, or being underneath and looking up at your pelvis. Just pick one, and stick with it for consistency. For me, I am looking straight at the pelvic floor as the practitioner, so this is how I view my, or your, clock. The pubic bone (the place where your bony pelvis meets in the front) is going to be your orientation for 12 o'clock. Therefore, when internal, your urethra is where your 12 o'clock region of your pelvic floor is. Also, your tailbone, or coccyx, and rectum are your orientation for 6 o'clock for your pelvic floor. Your sit bones -- the bones that dig into someones lap when you sit on them, represent 3 and 9 o'clock. There are also different layers within your bowl of pelvic floor muscles. To be specific, there are three different layers of muscles. Once I educate my patients in the office, then they can tell me, for instance, that the dilator feels fine except for layer two at 7 o'clock, and that helps me greatly. Or, sometimes they say that sex was fine except for in the missionary position, it hurt really deep along 8 o'clock. I also feel that it lets women re-identify with their pelvic floor and learn more throughout their healing process. It isn't so scary. They can identify the sites of discomfort, and we can address it together. Also, sometimes, the pelvic floor isn't contracting equally. Sometimes, I may have to draw their attention to a specific site, and it helps them visualize and connect by knowing the clock. I believe an educated patient is the most helped patient, and learning the clock has been key for many!
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