Nobody warned me the assessment was internal and I said yes before I understood what I was agreeing to

Waited a long time for this appointment and I have come home from it feeling strange in a way I did not expect, so I am going to try and write it down.

Referred for pelvic pain, long story, been going on well over a year. The letter said pelvic health physiotherapy assessment, forty five minutes, wear comfortable clothing. Nothing else. About twenty minutes in, after a lot of history and some questions I had not been asked by anyone before, she explained that the next part would be an internal examination, rectal in my case, and asked if I was happy to go ahead.

And I said yes. Straight away. Because I was already half undressed in my head, because she had been kind and thorough and I did not want to be difficult, because I had waited eleven months for this and some part of me thought saying no would mean the appointment was wasted. It was over in a few minutes and it was not painful and she talked me through the whole thing.

So nothing bad happened. But I have been sitting here all evening thinking that I agreed to something I had about four seconds to consider, and if I had known it was coming I would have wanted to think about it first. Not necessarily to say no. Just to have decided rather than been asked.

Is this normal? Is there a reason they do not tell you in the letter?

This is such a common story that I think it should be printed on the letter, and I say that as someone who had exactly the same experience in the other version of it.

Mine was vaginal and my letter also said nothing. What got me afterwards was not the examination, which was fine, it was realising that I had answered a serious question in a gown, sitting on the edge of a plinth, with somebody standing over me who had already been lovely to me for twenty minutes. That is not a neutral place to make a decision. It is not anybody being coercive, it is just the physics of the situation.

Second appointment I said I would rather not that day because I was on my period and I was braced for it to be a whole thing, and she said "no problem" and we did other stuff. Which is when I realised I had been carrying around this idea that saying no would end the treatment, and nobody had ever actually told me that. I invented it.

Ring the department the week before and ask what is usually offered at a first appointment. Ten minutes of your life and you get to decide at your kitchen table instead of on the plinth.

Mo, thank you for writing this out, because you have put your finger on the exact thing, which is that consenting and being asked are not the same event when there is no gap between them.

The honest answer to "why did the letter not say" is that there is no good one. Some services do write it in, most do not, and there is no figure anywhere for how often people are told in advance, how often chaperones are requested, or how often examinations are declined. I went looking and it does not exist as published information. I am not going to fill that gap with a friendly estimate.

What is not in doubt is what you are entitled to. It is an offer, not a condition of being treated. You can ask what exactly is proposed, what it will tell them that nothing else will, what happens if you say no, and who will be in the room. You can ask for a chaperone, meaning a third person present, and you do not have to give a reason for wanting one, because it is a routine request and not an accusation. And you can stop it once it has started, which is the part almost nobody knows and the part that matters most when you have already said yes in four seconds.

If you decline, you are still assessed and still treated. What changes is precision, not eligibility. They can still take the history, run through the red flag questions, examine externally and work from the diary and from measures they can repeat. What they cannot do is confirm by feel what the muscle is doing, so the early weeks become more of an inference, and I would rather say that plainly than sell you a version where declining costs nothing at all. The two things worth asking if you do decline are what else will be used to check the movement, and whether the reviews can be closer together rather than further apart, since the guideline asks for at least one review during a programme and one at the end and that is a floor rather than a ceiling. And "I would rather not have an internal examination today, what else can we do" is a complete sentence. Declining is not a refusal of treatment and should not be recorded as one.

Two honest boundaries on what I have written. The page on internal examination is written for women and gives men one paragraph, which says that where it is offered to men it is rectal rather than vaginal, on the same consent terms and for the same purpose. That is a thin answer for your situation and I would rather admit it than pad it out. The reason for the thinness is real: the NICE guidelines this site leans on are written for women, so male pelvic health runs on urology guidance instead, and we keep that in its own articles rather than appending men to a women's page. The other boundary is that I am not a clinician and cannot tell you whether anything found in your appointment means anything. Questions to ask at your first appointment is the practical list, and the one I would put at the top for you now is what was found and what it changes.

And Lindsey is right about the phone call. It converts a decision made under pressure into a decision made at home, which is the whole of what you were missing this week.

Mine was after prostate surgery and I got told in advance, by a nurse, in a corridor, almost in passing. Not exactly a formal process but it did the job. Made an enormous difference just knowing on the drive there.

Follow up appointment was last week. I rang beforehand and asked what was planned, which felt ridiculous for about ten seconds and then did not.

She said it would be reassessed at the review in six weeks rather than that day, and I said that if it comes up again I would like to be told at the previous appointment rather than on the day. She wrote it in the notes without any fuss whatsoever and said most people never say anything, which I found quite sad.

Still not sure how I feel about the first one. Nothing bad happened and I would probably say yes again. But I have stopped feeling stupid about minding, which is mostly down to this thread.