Gynaecologist, Pelvic Physio, Psychologist: Who Does What

In the UK, different professionals hold different parts of women's health. A gynaecologist diagnoses and manages medically. A pelvic health physiotherapist treats the pelvic floor. A practitioner psychologist, psychotherapist or psychosexual therapist treats the psychological and sexual side. Only some of these job titles are protected by law.

Almost every woman who sits down in my room has already paid two or three people. Rarely the wrong people — usually the right people in the wrong order. A pelvic floor app. A saliva test kit. Sometimes couples therapy. Nobody had told her what the problem actually was, so each treatment was a guess with a price on it.

Diagnosis is one job. Treatment is a team. Below, route by route: what each professional treats, whether the title is protected by law, which register to check, and whether there's a free NHS route.

Start here: what you're experiencing, and who to see first

For most gynaecological symptoms the right first appointment is a diagnostic one — with a GP or a gynaecologist — because the treatments differ completely depending on what is actually causing them.

Read that as a starting point, not a diagnosis. It tells you which door to knock on, not what is behind it. And starting with a GP is not a fobbing-off: RCOG's guideline on premenstrual syndrome says in terms that general practitioners should deal with most cases of PMS.

One habit I've picked up: when I refer a woman on, I write the profession in full, the regulator, and the exact search to use. Never "see a physio". Say that in London and there's a fair chance she ends up in a sports clinic having her hip assessed, because pelvic health physiotherapy is a separate specialty most people have never heard named. "Get some support with the psychological side" has the same problem — without a register attached, it sounds like a brush-off.

The one thing that goes wrong: buying treatment before you have a diagnosis

A diagnosis and a treatment are two different jobs, usually done by two different people — and doing them in the wrong order is the commonest reason women lose years.

Three patterns I see most weeks.

Kegels bought for a pelvic floor that was already too tight. Pain, trouble with tampons, a strengthening programme downloaded, four diligent months, and she is worse. That pelvic floor needed releasing, not strengthening — and a pelvic health physiotherapist who examines the muscle rather than guessing would have said so on day one.

A private cortisol panel bought for periods that had stopped. She had been running more and eating less, some of it unintentional. Her periods stopped because her body was short of energy, not because her adrenal glands had failed. The tests that show that are ordinary ones, ordered by a doctor.

Couples therapy started for pain that turned out to be a skin condition. Months of careful work on a relationship that wasn't the problem. The vulval examination took four minutes; the treatment was a prescribed ointment.

None of those women was foolish. Each did what the internet suggests you do with a symptom nobody has named. The fix isn't to distrust physiotherapy, therapy or nutrition — all three earn their place. It's the order.

Which of these job titles are protected by law — and which aren't

In the UK, "Physiotherapist", "Clinical psychologist" and "Dietitian" are protected titles that only registered professionals may use. "Psychotherapist", "psychosexual therapist" and "nutritionist" are not.

A protected title is a legal restriction on a word. Under the Health Professions Order 2001, using one when you are not registered is an offence where it is done with intent to deceive — so the register, not the wording on a website, is what settles it. The Health and Care Professions Council protects:

• "Physiotherapist" and "Physical therapist"
• "Dietitian" and "Dietician"
• Nine psychologist titles: Practitioner psychologist, Registered psychologist, Clinical psychologist, Counselling psychologist, Educational psychologist, Forensic psychologist, Health psychologist, Occupational psychologist and Sport and exercise psychologist

Any of them takes about thirty seconds to check on HCPC's "Check the Register".

Notice what's missing. "Psychologist" on its own is not protected. The guarantee lives in the adjective: a clinical psychologist must be HCPC-registered, while someone advertising as a "psychologist" may or may not be. A reason to look, not to assume the worst.

Doctors sit under a different regulator: all UK doctors are registered with the General Medical Council, and specialist training in gynaecology or psychiatry shows on the GMC Specialist Register.

Then the professions the law doesn't restrict at all. Anyone may use these words:

• psychotherapist, counsellor
• sex therapist, psychosexual therapist
• nutritionist, nutritional therapist
• health coach

Excellent, long-trained practitioners use them too, which is exactly why the words tell you nothing. So the safety question changes shape. Not "is this person qualified?", which no website can answer, but "which register are you on, and can I check it?"

Where the law doesn't regulate, a voluntary register often does. The Professional Standards Authority accredits registers held by organisations in those unregulated occupations, against standards it sets and reviews. One distinction to carry: the PSA accredits the register, not the individual. A therapist is on a PSA-Accredited Register — never "PSA-accredited".

Three questions before you pay anyone

• Is this job title protected by law? If it is, one register check settles the matter.
• If not, which register are you on — and can I verify it in thirty seconds? A named register with a public search. Not "fully qualified", not a row of letters after a name.
• Who confirmed my diagnosis before this treatment started? If the answer is "nobody yet", that's the appointment to book instead.

An unprotected title is not a red flag. An unverifiable practitioner is.

The gynaecologist: what I do, and what I don't

A medical gynaecologist diagnoses and manages gynaecological conditions medically — examination, imaging, blood tests, hormonal and non-hormonal treatment — and refers onward for surgery, physiotherapy and psychological therapy.

Medical gynaecology is a recognised specialty in France and a less familiar idea here, so I explain it often; the longer version is what a medical gynaecologist actually does. My work sits at the diagnostic and medical end: full history, examination, the scan or the bloods, the condition named where it can be named, said honestly when it can't yet, and medical treatment where medicine is the right tool.

Here is what I don't do, stated plainly, because vagueness about scope is how women end up in the wrong room.

I do not operate. If your endometriosis needs surgical excision, that belongs with a surgeon in a proper multidisciplinary setting — for complex disease, one of the BSGE Accredited Endometriosis Centres, which are reviewed annually and audit their outcomes. I investigate, manage medically, and refer.

I do not deliver physiotherapy, psychological therapy, psychosexual therapy or trauma therapy. Separate trainings, separate professions. I refer, and I tell you which register to check.

What I will do is name the profession you need, name the register, and write to whoever you choose. If you don't yet know what you're dealing with, that's the appointment to book first — a diagnostic assessment, then a referral to whoever does the rest. My assessment for pelvic pain and endometriosis is where most women start.

The pelvic health physiotherapist

A pelvic health physiotherapist assesses and treats the pelvic floor muscles — for pain, tightness, weakness, prolapse, bladder and bowel symptoms, and pain with sex. "Physiotherapist" is protected by law and every UK practitioner must be HCPC-registered.

This is the profession reached last and needed early. Two things get in the way. The belief that physiotherapy means sports injuries — and something subtler: women tell me they've "had physio" and it did nothing, and when I ask, it was general musculoskeletal physiotherapy. POGP itself notes that pelvic health work is not widely taught in undergraduate physiotherapy programmes.

Finding one. POGP is the Pelvic, Obstetric and Gynaecological Physiotherapy network, and its find-a-physiotherapist search filters by specialty — continence, pelvic pain, obstetrics — and by postcode, town or region. POGP states that all its members are physiotherapists and are registered with the HCPC if working in the UK. Confirm anyone yourself through HCPC's "Check the Register": name, registration number, thirty seconds.

What an assessment involves. Often an internal vaginal examination, because that is how the muscle is assessed rather than inferred. It should be explained first, always with your consent, and you can decline it — a good practitioner has other ways in and won't make you feel difficult for asking.

On the NHS. Pelvic health physiotherapy runs at many English trusts, some accepting self-referral, though provision varies by area — not a national entitlement, so ask your GP or look up your local service. For pelvic floor weakness and prolapse it is often the first-line route. Response varies between women, and the evidence base is less settled than the internet suggests.

For French patients. In France, post-partum rééducation périnéale with a kinésithérapeute or sage-femme is a normal prescribed course. There is no routine national programme like it here; the equivalent professional is an HCPC-registered pelvic health physiotherapist, and you will usually have to find her yourself.

Psychologist, psychotherapist, counsellor — and why a referral here is not "it's in your head"

Being referred for psychological therapy does not mean your symptoms are imagined. It means part of the treatment for the condition you have is delivered by someone other than a doctor.

I hear the objection most weeks: "So you think it's psychological." I understand it. Most women asking have been dismissed at least once, and in that context a referral sounds like a door closing.

So, the evidence rather than my reassurance. RCOG's guideline on premenstrual syndrome says women with severe PMS should ideally be managed by a multidisciplinary team, and names who that team might include: a gynaecologist, a psychiatrist or psychologist, a dietitian and a counsellor. A national body of gynaecologists wrote that down. Team care is the recommended standard for severe premenstrual mood symptoms (PMDD), not a consolation prize for when the doctor gives up. The same logic runs through persistent pain, and through mood and mental health in perimenopause.

The three roles. Clinical and counselling psychologists train to doctoral level, must be HCPC-registered, and assess as well as treat; other practitioner-psychologist routes, such as occupational or sport and exercise psychology, can qualify at Master's level with supervised practice. A psychotherapist works in depth over time, usually within one modality. A counsellor works on a defined difficulty, often over fewer sessions. The last two titles are unprotected, and their registers are the voluntary ones: BACP, UKCP and NCPS each hold a PSA-Accredited Register with a public search.

Trauma-informed therapy, described accurately. Where a history of trauma is part of the picture, NICE recommends specific treatments for post-traumatic stress in adults: trauma-focused CBT, typically eight to twelve sessions with more where clinically indicated, and EMDR for adults meeting the stated criteria. Structured, time-limited work. I will not tell you the pelvis stores trauma, because that isn't something we can show. Trauma changes how the nervous system responds to pain and to examination — treatable, and never a substitute for investigating your symptoms properly.

When it's a psychiatrist rather than a psychologist

A psychiatrist is a medical doctor on the GMC Specialist Register — specialist registration granted on the recommendation of the Royal College of Psychiatrists — who diagnoses and treats mental illness and can prescribe. A psychologist does not prescribe. That's the practical dividing line.

Psychiatry is the right route where mood symptoms are severe, where there's an existing psychiatric diagnosis to work around, or where medication is likely to be part of the answer. For severe premenstrual mood symptoms, those decisions may sit with a psychiatrist rather than with me; they are individualised and belong with the clinician prescribing.

If your mood ever takes you towards thoughts of harming yourself, don't wait for any of these appointments. Call 111, contact your GP urgently, or call the Samaritans free on 116 123, at any hour.

The psychosexual therapist — and the register question nobody answers

"Psychosexual therapist" is not a protected title in the UK, so the only meaningful check is which register the therapist is on and whether that register is externally accredited.

Psychosexual therapy is the right treatment for a great deal of what I see: pain with sex once a physical cause has been treated or excluded, difficulties with desire and arousal, the fear that builds after months of pain. It pairs with the medical work on low libido and painful sex, and it isn't something I deliver.

Which makes the register question the whole thing — and it's where almost every directory stops.

COSRT — the College of Sexual and Relationship Therapists — is the UK's specialist membership body for this work. It holds its own public registers and requires its members to adhere to a code of ethics, with performance regularly monitored. What it does not appear to hold, as at July 2026, is external accreditation from the Professional Standards Authority: it does not appear among the PSA's Accredited Registers, and makes no such claim itself. None of that speaks to the competence of any individual COSRT member. So do this: ask your therapist which register they are on, and check it yourself before the first session. If external accreditation matters to you, that route runs through NCPS, BACP or UKCP.

Three routes you can check for yourself:

• NCPS — the National Counselling and Psychotherapy Society holds a PSA-Accredited Register and operates a Relationship Therapist Register with a psychosexual therapist sub-register, open only to therapists already on its main accredited register. Today that is the clearest externally accredited route to a psychosexual therapist. Its directory shows nothing until you filter it, so tick the "Psychosexual Therapists" specialist filter when you search.
• BACP and UKCP — PSA-Accredited Registers for counselling and psychotherapy generally, so a therapist listed there may well do this work without the sub-specialty label.
• The Institute of Psychosexual Medicine — a training and membership body for clinicians from several professions, not doctors alone: it trains and lists doctors, nurses, midwives and physiotherapists, and allied health professionals may sit its membership exam and run specialist clinics. So check the register that applies to the individual — the GMC for a doctor, the NMC for a nurse or midwife, the HCPC for a physiotherapist.

I have named registers rather than individual practitioners on purpose. Registers you can check yourself; recommendations you have to take on trust.

What about nutritionists, health coaches and hormone testing?

"Dietitian" is a protected title regulated by the HCPC. "Nutritionist", "nutritional therapist" and "health coach" are not — anyone may use them.

A dietitian is the regulated profession that works with diet in clinical conditions, and there's a real role for one in gynaecology: periods lost to low energy availability, eating that has become restrictive, metabolic problems alongside PCOS. If you're choosing a nutritionist instead, ask which register they're on. The Association for Nutrition runs a voluntary register, the UKVRN, whose members use RNutr — voluntary, so plenty of good practitioners aren't on it, and absence isn't disqualifying.

Cortisol, briefly. A cortisol test is ordered and interpreted by a doctor — your GP, a gynaecologist, an endocrinologist — and it is genuinely useful for the conditions it was designed to detect: cortisol excess, as in Cushing's syndrome, and adrenal insufficiency. What it has not been validated for is grading everyday stress or measuring "adrenal fatigue". Two separate findings are worth keeping straight. A 2025 review in the Journal of the Endocrine Society (McDermott) concluded that the salivary cortisol profiles sold for this purpose have never been scientifically tested or validated as tools for evaluating the HPA axis. And a 2016 systematic review in BMC Endocrine Disorders (Cadegiani and Kater), which screened 3,470 studies and analysed 58, found that "adrenal fatigue" is not a recognised condition and that the studies claiming to show it used cortisol-assessment methods not endorsed by endocrinologists. I have written separately about what a cortisol test can and cannot show. Stress may well be part of your story. It is never a reason to leave symptoms uninvestigated.

Do you need a GP referral? And what the NHS will and won't cover

If you are paying for yourself, you can usually book a private gynaecology appointment directly. If you are claiming on private medical insurance, most UK insurers require a GP referral first — check with your insurer before you book.

That catches French patients out constantly: in France you book your gynécologue médicale yourself and nobody mentions a gatekeeper. Self-funding here is much the same. Insurance isn't — most policies want a GP referral for pre-authorisation, a few allow direct access, and the only way to know is to ring them before the appointment. Your GP is still the right first stop for plenty, including GP or gynaecologist for smears and contraception.

The free routes are real. In England you can refer yourself to NHS Talking Therapies for anxiety or depression without seeing a GP first — registered with a GP, aged 18 or over, 16 in some areas — and the service explicitly covers coping with a long-term health condition, chronic pain included. It is an England service; Scotland, Wales and Northern Ireland run their own equivalent talking-therapy services under different names, so look up the one for your nation. NHS pelvic health physiotherapy runs at many English trusts, some accepting self-referral, availability depending on where you live. Gynaecology, urogynaecology, psychiatry and dietetics are all reached through your GP.

These routes are free and you should use them. What a private appointment buys is the choice of who you see and when — not a different standard of medicine.

The registers, in one place

Worth saving. Six links answer almost every "is this person who they say they are" question:

• HCPC "Check the Register" — physiotherapists, practitioner psychologists, dietitians.
• GMC online register — every UK doctor, including specialist registration.
• NMC register — nurses and midwives, some of whom run psychosexual clinics.
• POGP find-a-physiotherapist — pelvic health physiotherapists by specialty and area.
• The PSA's list of Accredited Registers — which voluntary registers carry external accreditation.
• BACP, UKCP and NCPS register searches — counsellors, psychotherapists, and via NCPS's Relationship Therapist Register, psychosexual therapists (tick the "Psychosexual Therapists" filter).

One appointment, in the right order

Take one thing from this page and make it the order. Somebody has to establish what this is and what it isn't; then the right people can treat it — often several of them, which is how good women's health care has always worked. Going straight to the treatment end is how five years pass.

So pick one appointment this week, and make it a diagnostic one. New or undiagnosed symptoms mean a GP or a gynaecologist. If you already have your diagnosis, use the table above and check the register before you pay. And if you're overdue a proper look at everything, a full well-woman check is a reasonable place to begin.

Book a gynaecology assessment with Dr Victoire Kotur de Castelbajac — Kensington or Harley Street.

Please note: this page is general information about how UK care pathways work. It is not medical advice and cannot replace an assessment of you as an individual. If your symptoms are new, changing or severe, see a GP or a gynaecologist; in an emergency, call 999 or go to A&E. Any treatment or medication decision belongs with the clinician who assesses you.