Barriers to Care

Published January 1, 2026

What You Need to Know

To understand barriers to accessing pelvic health physical therapy, it’s important to distinguish between intrinsic (internal, personal) and extrinsic (external, systemic) barriers, and how these vary across populations and care delivery models. 

• Intrinsic barriers include misinformation, downplaying symptom priority, and factors like denial or fear. 

• Extrinsic barriers include financial restraints beyond insurance coverage (e.g., childcare, time off work), long wait times, limited provider access, travel distance, and delays in referrals from other providers.

• Adolescents may face unique hurdles, such as mental health struggles or reliance on family for transportation.  Due to limited research, little is known about the value that pelvic health physical therapy brings to this population. 

• Telehealth-specific barriers center on privacy concerns, limited tech access, and a preference for in-person care, particularly for initial visits.  

While both intrinsic and extrinsic barriers to seeking physical therapy for pelvic health-related concerns are well-documented in the literature, most identified barriers are extrinsic in nature. Unsurprisingly, factors like financial restraints (Zoorob et al., 2017) and limited insurance coverage (Gustafson, 2025; Washington et al., 2011) are widely reported, as well as limitations in accessibility and availability of appointments. Upon closer examination however, it appears that the financial restraints commonly experienced by patients are not solely related to a lack of insurance coverage, as patients also report difficulty in attending these appointments due to a lack of childcare and inability to take time off work (Gustafson, 2025; Zoorob et al., 2017). Similarly, while long wait times (Brennen et al., 2022), long distance travel (Aguirre et al., 2019; Brennen et al., 2022; Snyder et al., 2022), and limited provider access is cited as accessibility barriers, many patients report a significant delay in getting a referral to physical therapy by their primary providers or midwives (Brennen et al., 2022), noting a high reliance on these providers to share pelvic health-related treatment information (Snyder et al., 2022). Patients describe their interactions with these providers as limited, reporting that visits are brief and their symptoms are often dismissed as normal (Jouanny et al., 2024). Additionally, patients speaking English as a second language report difficulties in communicating their symptoms with providers, citing inadequate knowledge of pelvic floor vocabulary from interpreters (Brennen et al., 2022; Gustafson, 2025). 

Similar intrinsic barriers have been identified by patients regarding limited accessibility. Many patients report a lack of confidence in the use of exercise for pelvic health-related symptoms, citing incorrect information found in online forums, inaccurate information provided by primary providers or midwives, and an overall denial of how symptoms have impacted their lives (Jouanny et al., 2024; Snyder et al., 2022; Washington et al., 2011; Zoorob et al., 2017). This low impact quality is also apparent in other patient reports, where symptoms are deemed not severe enough to justify treatment and an overall de-prioritization of self-care due to the demands of caring for other children (Jouanny et al., 2024; Snyder et al., 2022). Surprisingly, despite this lack of knowledge, the literature is mixed regarding patient’s fear of treatment with some reports citing limited fear in attending physical therapy and others reporting fear due to an inaccurate understanding of their condition and long-term consequences (Zoorob et al., 2017).

Special Adolescents’ Barriers

Barriers faced by adolescents regarding pelvic health physical therapy are variable. Intrinsically, some reports have found that mental health struggles and failed previous management are significant barriers for patients (Green et al., 2024). Further, due to the limited information available, there is a poor understanding of the value pelvic health physical therapy brings to adolescents (Green et al., 2024). Conversely though, when adolescents are referred and managed appropriately, it has been reported that they may become dependent on the physical therapist for pain management, which could place an added burden to practitioners (Green et al., 2024). Extrinsically, adolescents largely rely on familial support for transportation, which, paired with the lengthy referral process, can cause delays in care (Green et al., 2024). Ultimately, more research is required to understand this population further as it pertains to their experiences in pelvic health physical therapy.

Telehealth Barriers and Solutions

The barrier most often cited in literature regarding the use of telehealth for pelvic health-related physical therapy appointments is privacy concerns (Khalid, 2025; Zoorob & Hasbini, 2023; Zoorob et al., 2023). Specifically, the patient having limited access to a private space for their appointments (Zoorob et al., 2023). Some reports indicate that patients also experience technical issues or have limited access to technology and internet and have difficulty learning from narration over in-person, hands-on care (Khalid, 2025). As a result of these barriers, patients largely prefer in-person care to remote appointments, particularly for the first visit (Zoorob et al., 2023).

References