Dearest Gentle Readers,

It has come to this author’s most refined attention that a most curious scandal has fluttered through the drawing rooms - or rather, the online salons - of the pelvic health world. The whispers suggest that the reputable purveyor Intimate Rose has, perhaps, been reappropriating patients from their dear therapist partners by embarking upon a bold new venture: the offering of telehealth services.

One can scarcely imagine a more titillating topic among those who prize propriety and pelvic alignment in equal measure. And thus, in the spirit of intellectual inquiry, I present to you an ethical analysis of this latest society stir: Intimate Rose versus Pelvic Floor Therapists.

The tale begins, as many modern dramas do, on that most notorious of forums, Facebook. A well-respected instructor from the esteemed Herman & Wallace Institute, shared an innocent observation in a popular support group. Having ordered a pelvic wand for a patient, they received an automated invitation for that very patient to engage in virtual pelvic floor services.

Some found the offer thoughtful, even gallant - particularly in cases where patient-provider gender mismatch posed a barrier. Yet others clutched their pearls, aghast at what they perceived as a potential overreach. Within moments, the comments swelled to a chorus exceeding fifty voices - some indignant, some indifferent, and a few serenely supportive.

It was, as they say, a scandal with excellent posture.

According to Dr. Nancy Kirsch’s tome, Ethics in Physical Therapy (2024), the first step in any ethical inquiry is to identify the realm, whether individual, institutional, or societal.

In this case, dear readers, we find traces of all three. The individual therapist wrestles with feelings of betrayal or relief. Society at large may applaud increased access to care. Yet the heart of the controversy lies within the organizational realm, a perceived discord between Intimate Rose’s business decisions and the expectations of the Pelvic Health Community.

And oh, how quickly those expectations can sour when business and benevolence entwine too tightly.

Our therapists, like the heroes and heroines of any great moral tale, passed through all five ethical stages:

• Moral Sensitivity - the uneasy flutter of “something feels off.”
• Moral Judgment - the pondering of right versus wrong.
• Moral Motivation - the desire to do something about it.
• Moral Courage - the bravery to actually say something.
• Moral Potency - the strength to act and endure the fallout.

And indeed, act they did some commented publicly, others whispered privately, and a few renounced Intimate Rose altogether. There were letters, posts, and even podcasts. One might call it a veritable Regency Riot - via Wi-Fi.

Is this a case of right versus wrong, or merely a duel between two virtues?

While some would label it misconduct, others, including your humble author, see instead a true ethical dilemma: a choice between two acceptable, yet conflicting courses of action.

After all, dear reader, there is honor in both sides:

• Intimate Rose seeks to extend access to care.
• Therapists seek to protect their patient relationships.

A moral quandary worthy of the finest London drawing rooms.

Lady Whistledown, ever thorough, has examined the ten criteria of ethical clarity. A sampling follows:

1. Context & Character – For a decade, Intimate Rose has graced our community with generosity: free starter kits, global donations, educational outreach, and over $2 million in support of pelvic health causes. Their affiliate program offers modest rewards for both patients and therapists, while free YouTube resources, blogs, and training sessions abound. Truly, their consistent kindness and commitment to patient care hardly bespeak the manners of a villainous schemer.
2. The Players – On one side, Intimate Rose; on the other, pelvic health providers (some insurance-based, some cash-based). Those in private practice perhaps felt their clients might be wooed away. Yet, survey results revealed none of Intimate Rose’s telehealth patients were taken from other therapists.
3. Consequences – Might the company lose favor among providers? Might patients feel conflicted? Certainly. But evidence shows telehealth outcomes rival in-person care (Razak Ozdincler et al., 2025; Lin et al., 2025).
4. Laws & Obligations – As long as state telehealth regulations are observed, no impropriety exists. Transparency, after all, was maintained through pre-launch communications.
5. Professional Guidance – The APTA and AOTA themselves embrace telehealth as a means to widen access.
6. Legal Test – The only real trespass may be slander; those hasty tongues wagging falsehoods (NYC Bar Association, 2025).
7. The Stench Test – Does it smell off? To some, yes. Betrayal has a distinct bouquet. Yet virtue ethics (beneficence, non-maleficence, justice, autonomy, veracity, fidelity) all appear intact (Kirsch, 2024).
8. Front-Page Test – “Company Expands Access to Pelvic Care” inspires far less uproar than “Company Steals Patients.” Scandal, it seems, is in the phrasing.
9. Mom Test – One’s mother might simply say, “If you’re as good as you claim, my dear, your patients shall stay.”
10. Professional Test – Many seasoned mentors would call this not theft, but savvy business strategy. After all, other beloved practitioners in our field have followed the same “educate, nurture, offer” model to great acclaim.

Cultivating an audience before offering products is, in truth, a well-established business practice. So why the uproar among pelvic health providers? Perhaps it is the struggle to embrace an abundance mindset over one of scarcity. Similar scenarios elsewhere drew little ire, yet here, it seems, the matter strikes far too close to home.

This author, ever impartial, concludes that we face not malice, but misunderstanding. A dilemma indeed - where both sides act in good faith yet find themselves at odds.

Three approaches offer resolution:

• Rules-Based: No rule was broken; thus, no penalty applies.
• Ends-Based: The greater good, increasing patient access, outweighs commercial discomfort. Pelvic health providers no longer using Intimate Rose due to a misunderstanding is harmful to the company. However, Intimate Rose offering telehealth services to patients who do not have access to a local in person therapist, are home bound, or prefer telehealth due to fear or history of trauma is definitely a larger provider of “good.”
• Care-Based: Healing the relationship through communication and transparency serves all parties best.

No one, dear reader, is automatically swept into telehealth services. A customer who purchases a tool may merely receive a polite missive or text noting the existence of such offerings, or an invitation to learn more. These post-purchase courtesies may, upon request, be removed for those using a provider’s code. Patients may yet glimpse the occasional update or newsletter, but any suspicion of client re-appropriation may now be, quite elegantly, laid to rest.

Harmony, it seems, can be restored with a touch of dialogue and decorum.

Let this serve, dear readers, as a reminder that in matters of both ethics and enterprise, the path to virtue lies not in outrage, but in understanding.

When next you feel that unmistakable whiff of impropriety, pause before unsheathing your quill (or opening your comment thread). Reflect, inquire, and consult your moral compass - for therein lies the difference between righteous indignation and mere gossip.

After all, preserving one’s reputation and one’s reason is the finest posture of all.

P.S. Should this tantalizing ethical quandary have piqued your curiosity, one may further indulge one’s moral refinement by attending Ethical Concerns for Pelvic Health Professionals scheduled for November 23, 2025 where we will learn how to journey through the landscape of moral quandaries together.

References:

• Kirsch, N. R. (2024). Professional issues and ethics in physical therapy: A case-based approach (2nd ed.). McGraw Hill. 
• Lin, K. Y., Chen, C. Y., Wu, P. C., Huang, M. H., Ou, Y. C., Kao, Y. L., & Lin, K. H. (2025). The feasibility and effects of a telehealth-delivered physical therapy program for postmenopausal women with urinary incontinence: A pilot mixed-methods study. Maturitas, 197, 108376. https://doi.org/10.1016/j.maturitas.2025.108376