Boundaries Matter

Posted: juin 18, 2025

The College received a complaint from a patient who received pelvic health physiotherapy.

The patient was a teenager when they attended a series of appointments to treat urinary incontinence.

During the appointments, the physiotherapist asked the patient questions that made them uncomfortable. These included questions about the patient’s sexual orientation, sexual experiences and ability to achieve orgasm. The patient later described the interactions as invasive and inappropriate.

Additionally, after their final scheduled appointment, the physiotherapist called the patient and crossed another boundary.

The physiotherapist said their reason for calling was simply to follow up with the patient. But during the call, the physiotherapist also asked the patient what post-secondary program they were enrolled in. The physiotherapist admitted they asked this question because they were interested in attending classes at the school themself.

After the patient gave the physiotherapist the contact information of their friend – who was also a student – the physiotherapist contacted the patient’s friend to ask questions about the classes.

The Standards

The physiotherapist in this case failed to maintain professional boundaries on multiple occasions.

Boundaries are the physical and emotional limits of the therapeutic relationship between a patient and a physiotherapist.

Physiotherapists have a responsibility to always act in a patient’s best interest and manage boundaries, as stated in the Boundaries and Sexual Abuse Standard. This includes recognizing that each patient’s boundaries are unique and can be impacted by things like their age, culture, values and experiences of trauma.

It may be appropriate for physiotherapists providing pelvic health care to ask some questions about a patient’s sexual history, for example if they experience pain during sex. But the questions asked by the physiotherapist in this case went far beyond what was necessary to assess, diagnose and treat the patient.

Asking a patient about their sexual orientation or experience with various sex acts is not within the physiotherapy scope of practice.

As for questions that were clinically indicated (asking about pain during sex), the physiotherapist failed to recognize and respect the patient’s boundaries.

It’s good practice to always get consent before discussing a patient’s sexual health. Remember to be sensitive to a patient’s age, cultural background and experiences of trauma. Before having a conversation regarding sexual history, ask if the patient is ready to have this conversation. Pay particular attention to non-verbal cues and be ready to stop questions if your patient is showing signs of being uncomfortable. Some examples of non-verbal cues include crossing arms in front of their body, avoiding eye contact or providing one-word answers.

The physiotherapist in this case also should not have called the patient to discuss schooling. By acting in their own self-interest and not the patient’s, the physiotherapist once again failed to meet the requirements of the Boundaries and Sexual Abuse Standard and put themselves in a conflict of interest.

The Outcome

The Discipline Panel decided that the concerns raised by this case were serious enough that the physiotherapist’s license should be suspended for three months until they completed an education program on boundaries and consent.

Following their return to practice, the physiotherapist was required to work with a practice enhancement coach for one year. The cost of the education course and the practice enhancement program was paid for by the physiotherapist.

Details of this case have been changed to maintain anonymity.