What should be the “gold standard” for evaluation of the pelvic floor muscles in patients for whom you determine that an internal exam is appropriate?

Evaluation of the Pelvic Floor Muscles
We now have ample evidence that the pelvic floor can and does
interplay with other musculoskeletal structures such as the lower back,
hips, and pelvic girdle. What does the evidence say regarding how you
should determine that an internal exam is needed for these patients?
(example: should you routinely perform one on all patients with low back
pain, hip pain, SIJ dysfunction? Should you wait until a patient has
made no progress in 8 visits? Etc.)

In addition, please comment on:
What should be the “gold standard” for evaluation of the pelvic floor
muscles in patients for whom you determine that an internal exam is
appropriate? Is an internal exam enough, or should special equipment be
used?

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