Perinatal Pelvic Health Referral Form – health professionals - Wirral Community Health and Care NHS Foundation Trust

Previous 3rd or 4th degree tear / forceps delivery

Previous perineal care after complex tear, symptomatic

Poor control and/or incontinence of stool/wind

Poor control and/or incontinence of urine

Persistent perineal/pain with sexual activity

Previous symptomatic pelvic organ prolapse

Pregnancy related Pelvic Girdle Pain (including SPD and sciatica with onset in pregnancy)

Perineal pain associated with FGM

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