The case of Lawrence G. Nassar, the former doctor for the American gymnastics team who was sentenced last week for systemic sexual abuse of his young patients, raises many uncomfortable questions. One of the more troubling is the way the team doctor duped patients, parents and other physicians into believing that his “treatments” were medically appropriate, even after complaints were lodged.

It wasn’t entirely implausible. A form of physical therapy called pelvic floor physical therapy uses internal vaginal soft tissue manipulation, or massage, to relieve pelvic pain by accessing muscles that cannot be reached any other way. The therapy has been tested and found effective in several small studies and clinical trials published in peer-reviewed medical journals.

But medical professionals use pelvic floor physical therapy primarily for conditions like persistent pelvic pain, bowel and bladder problems like incontinence, and painful intercourse. It is not the first line of treatment for the kinds of problems that typically afflict gymnasts, like lower back and hip pain, which are less likely to require internal vaginal manipulations, experts say.

Furthermore, physicians generally do not perform the therapy themselves, even if they are, like Dr. Nassar, osteopathic physicians who are trained in hands-on techniques that use stretches and pressure to relieve muscle pain. Doctors who recommend pelvic floor physical therapy usually refer patients to physical therapists who specialize and are certified in it. And most of those therapists are women.