NO, an internal exam is not mandatory. It is the gold star assessment when it comes to pelvic dysfunction.
We liken it to going to the dermatologist for a rash and not removing the clothing covering the rash. However we can often get a pretty good idea of what is happening through our history and evaluation. We will gather as much information as we can to adequately treat you. It may require a few additional visits, but your overall comfort and compliance with treatment is our biggest concern.
Remember you may give or remove consent at any time. If you are concerned with having an internal, speak to your physiotherapist, together you can decide when the best time would be, if at all. We have treated many women whose pain conditions have required starting with external treatment.