(004) Disparities in Access to Pelvic Floor Physical Therapy: Provider Distribution and Affordability in New York City

Abstract Introduction Pelvic pain and pelvic floor dysfunction are prevalent conditions that significantly impact sexual function, urinary and bowel function, and overall quality of life. Pelvic floor physical therapy (PFPT) is a cornerstone of management – a first line, guideline-recommended treatment that can reduce pain, restore pelvic muscle function, and improve sexual wellbeing with demonstrated efficacy across a wide range of pelvic pain disorders. Despite its therapeutic importance, access to PFPT remains highly inequitable, limited by geographic concentration of providers, variable insurance participation, and financial barriers. Objective We aim to characterize PFPT provider distribution and practice characteristics across New York City (NYC) and to examine supply-side factors – geographic distribution, insurance coverage, and timely access – that may limit accessibility in relation to neighborhood-level socioeconomic resources. Methods PFPT providers and practices were identified and systematically verified through publicly available online sources. Provider variables included certification status and degree level. Practice variables included insurance acceptance, self-pay rates, practice structure (solo, private group, or hospital-affiliated), and new patient availability. Data were analyzed by borough and correlated with neighborhood socioeconomic indicators using the Area Deprivation Index (ADI). Fischer-exact and Kruskal-Walis tests were applied for group comparisons. Results A total of 207 PFPTs were identified across NYC. Manhattan accounted for 68. 1% of PFPT providers (15. 7/100000 female residents), followed by Brooklyn (23. 7%, 3. 4/100000), Queens (5. 3%, 0. 9/100000), Staten Island (1. 9%, 0. 8/100000), and the Bronx (1. 0%, 0. 26/100000). Overall, 189 (91. 3%) held advanced degrees and 26 (12. 6%) were certified in pelvic floor rehabilitation, with 80. 8% of certified PFPTs concentrated in Manhattan. Insurance acceptance was limited; while rates of Medicare and private insurance were similar across boroughs (p = 0. 5), only 27 practices (21. 4%) accepted Medicaid, with most (59. 3%) located in Manhattan. Median self-pay for an initial visit were 250 (IQR 200-320). Sliding-scale payment options were reported by 34. 8% of PFPTs overall, with marked disparities by borough (44. 0% in Manhattan vs. £ 18. 4% elsewhere). PFPT density was inversely correlated with ADI rank (Spearman r = −0. 99, p = 0. 006), indicating fewer providers in socioeconomically disadvantaged areas. Conclusions Access to PFPT in NYC is limited by both geographic and economic inequities. Providers are heavily concentrated in wealthier neighborhoods, while limited Medicaid participation and high self-pay costs restrict affordability in underserved areas. These disparities likely contribute to underutilization of PFPT among vulnerable populations, including patients with pelvic pain and pelvic floor dysfunction. Targeted policy, insurance, and training initiatives are needed to improve equitable access to this essential component of pelvic floor and sexual health care. Disclosure No.