Questions, answered

You don't need a referral for physiotherapy - you can book directly. That said, your GP or specialist may refer you to me, and a GP can refer you alongside a Medicare care plan (an EPC / CDM) that subsidises $63.40 of the appointment cost. You can't use both the Medicare subsidy and private health insurance on the same appointment. Book online through the portal or by email, and just note whether you have a referral in the "additional information" box when booking.

Your first appointment moves through four stages:

• The interview - I get the full picture of what brought you in: what's happening, why it might be happening, anything in your history that could be contributing, what makes it better or worse, and what your main goals for physiotherapy are.
• The assessment - depending on your issue, this may involve assessing movement of the back and hips (squatting, walking, jumping), breathing mechanics, or the pelvic region externally. External assessment includes palpation of the pelvic floor muscles (sometimes with ultrasound to view the deeper muscles) and looking at how the muscles work and relax, plus a visual examination for factors like muscle guarding or tightness, scar tissue, tissue atrophy, or hypersensitivity.
• Treatment - once I know what's going on, I discuss the plan and how it relates to your goals, then start treatment. That can involve hands-on work, tissue mobilisation and massage, guiding muscle activity and relaxation, breath work and co-ordination of the pelvic floor and diaphragm, or exercise-based rehab for the back, hips, sacral area, or pelvic floor - then re-assessing to see how you respond.
• The plan - I set out what to do at home, at the gym, or day-to-day between sessions, what to expect, the timeline, and what the next session will look like.

Short answer: no - but there's a lot of "it depends." Many pelvic health issues have components involving the internal pelvic floor muscles that are best assessed internally (either vaginally or rectally). A lot of useful information can be gathered with a combination of external examination and real-time ultrasound performed transperineally (the probe angled in the area between the scrotum and anus in men, and performed either or both in front of and behind the vulva in women). I'll discuss with you in the clinic whether what you've described would be better assessed and treated with an internal examination, which can also guide the treatment options.

I do - most of the pelvic health issues I see and treat are in men. While male pelvic floor and pelvic pain conditions aren't as well researched as female conditions, there's plenty of evidence supporting physiotherapy for incontinence, sexual dysfunction, pain with toileting, and painful intercourse specific to male anatomy, as well as the general pelvic pains that occur in everyone regardless of anatomy.

Absolutely. I provide evidence-based, trauma-informed physiotherapy to people of every body, orientation, and gender identity. Mace is a six-foot, tattooed, male-presenting physiotherapist - which can be a bit of a gear-change from what you might expect of a pelvic health physio - but everything in the clinic is handled tactfully, with your best interests at heart.

Quite a few - they fall into a handful of categories:

• Incontinence (bladder and bowel) - difficulty starting or stopping, not getting to the toilet in time, or not being aware that leakage occurs; plus recurrent constipation or straining with toileting.
• Superficial pain - around the vulva (lichen sclerosus, vulvodynia, vestibulodynia) and vaginal entrance (vaginismus, GPPPD), around the base of the pelvic floor (pelvic myalgia, overactive pelvic floor and sphincters), and at the rectum (anismus, proctalgia, rectodynia, scarred anal ring, haemorrhoids and fissures).
• Deep pelvic pain - in native female (vaginodynia, colpodynia, dyspareunia / painful penetration) and male (penile pain, Peyronie's disease, scrotal / orchialgia, prostatitis / chronic pelvic pain type III) anatomy, as well as anatomy unique to the post-operative trans person after gender-affirming surgery.
• Functional pains (widespread, not localised to one structure) - endometriosis, adenomyosis, PMOS (previously PCOS), and referred pain from the lower back and sacroiliac joints (SIJs).
• Male sexual dysfunction - erectile dysfunction, premature ejaculation, hard-flaccid syndrome, painful erections or orgasms, sexual headaches, and anodyspareunia (painful receptive anal intercourse / bottoming / pegging).
• Female sexual dysfunction - vaginal and anal dyspareunia / penetrative pain, GPPPD, persistent genital arousal disorder, provoked vestibulodynia (touch-triggered vaginal pain), and vaginal dryness.
• Pelvic organ prolapse - primarily in women (descent of the bladder, uterus, vaginal vault, or rectum into the vagina), and rectal descent / prolapse in men.

Yes - in a few different ways:

• Painful vaginal sex - down-training and relaxing the pelvic floor muscles to make them less sensitive to pressure and stretch, and using dilators to gradually stretch the vaginal entrance and the muscular layers of the vaginal walls.
• Painful anal sex - relaxation or down-training of the pelvic floor and anal ring / sphincter, dilators and plugs to improve accommodation with penetration, breathwork and muscle control, and modifying positions and techniques to gradually return to sex.
• Non-painful sexual dysfunction (vaginal dryness, anorgasmia, erectile dysfunction, premature ejaculation) - different approaches again, and these can have psychological factors at play alongside the anatomical and functional ones.

In-clinic session costs are in line with Fixio Physiotherapy's schedule, since in-clinic sessions are performed at Fixio: $255 for the initial session and $172 for follow-ups. That's before rebates. Private health rebates depend on your insurer and level of cover, but can range from around $30 up to 85% of the cost, and a Medicare EPC can rebate $63.40 for up to five sessions per 12-month period.

Home-visit and telehealth costs vary - get in touch and I'll discuss the options.

There's no one-size answer - it depends on the presentation, how long it's been going on, the complexity, your long-term goals, and how you respond to treatment. Most pelvic pains and incontinence take a few months to resolve. Sessions are typically weekly for the first 3–4 weeks to titrate treatment, reassess, and optimise your exercise programme as you improve, then space out as you continue to progress toward your goals.

I predominantly work out of Fixio Physiotherapy at Dee Why. I can do home visits on Wednesdays and weekends for people living south of the bridge - the CBD, inner west, and inner east. If you're north of the bridge, you're welcome in-clinic at Dee Why, and if you can't make it in person, telehealth is an option (it sounds a bit odd for pelvic health, but it can be just as beneficial as in-person sessions).