Inclusive Wellness: Pelvic Floor Therapy and Transgender Care

As a pelvic floor therapist and a member of the LGBTQIA+ community I believe that non-binary and trans folxs deserve to feel understood and to have educated health care providers that can adequately match their individualized needs. Pelvic floor and Transgender care is important to our values here at Vibrancy Pelvic Health because we believe that respecting a person’s body interdependent of their sexual or gender identity is our responsibility as pelvic floor therapists.

In pelvic floor therapy we treat a variety of pelvic floor dysfunctions including pelvic pain, bowel and bladder incontinence, urinary urgency, sexual dysfunctions, GI distress, and post-operative care to name a few. It is a common misconception that cis-gender women are the only ones who seek out help addressing their pelvic floor dysfunctions, this is simply untrue! I am here to yell out to the masses, all bodies have a pelvic floor! And many individuals who identify outside of the gender norms would benefit from seeking out a pelvic floor therapist for their gender-affirming and overall healthcare needs.

Related Article: Understanding The Pelvic Floor

*It’s important to note that not all who identify with a trans or gender non-conforming identity will choose to have surgeries or hormone therapy. For those individuals who decide to pursue gender affirming surgeries pelvic floor therapy can be an essential part of their surgery preparedness and post-op healing.

Gender-affirming care, as defined by the World Health Organization, encompasses a range of social, psychological, behavioral, and medical interventions “designed to support and affirm an individual’s gender identity” when it conflicts with the gender they were assigned with at birth (Boyle, 2022). According to a recent study gender-affirming surgeries have almost tripled since 2019 (Wright et al., 2023). Gender-affirming surgeries include a wide variety of surgical interventions including but not limited to: Metoidioplasty, phalloplasty, chest surgery, vaginoplasty, orchiectomy, and mammoplasty.

There are various studies that have shown that gender-affirming healthcare helps decrease the odds of depression and suicidal ideation, improve general well-being (Tordoff et al., 2022), and gender- affirming surgeries improved mental health outcomes (Almazan & Keuroghlian, 2021).

This is where we come in!

The role of pelvic floor therapist is to assess the function and disorders of the bowel, bladder, pelvis, low back, hip, and breathing mechanics. For patients who have undergone a gender affirming surgery a retrospective study has shown that as high as 42% of patients had pelvic floor dysfunction and 37% had bowel dysfunctions (Jiang et al., 2019). In the same study they found that “there were significantly lower rates of pelvic floor dysfunction postoperatively for those patients who attended pelvic floor PT both preoperatively and postoperatively compared with only postoperatively” (Jiang et al., 2019).

So what are the benefits of pelvic floor therapy for transgender and gender non-conforming individuals?

Pelvic floor therapy can offer support for those who do not know what to expect. Pelvic floor therapists are special because we have both orthopedic and specialty education in pelvic floor care. As pelvic floor therapists we can help pre- and post-operatively in your journey with:

• Top surgery: We can help you understand the impact of binding and give you advice on

  improving strength, mobility, and posture pre-op. We are experts in scar management and we

  can help you post-op with education on healing times, mobilizing scar tissue and providing

  strengthening and stretching exercises to help you maintain shoulder range of motion.

• Bottom surgery: depending on the type of surgery recovery we will guide you through preparing

  for bottom surgery by strengthening the surrounding tissue to help with post-operative

  outcomes. We will also provide you with tools to help you with any pelvic floor dysfunction

  needs that may have arised post-operative. Pain management, general vulvar and penile health,

  sexual function, bowel and bladder norms, and scar tissue extensibility may be addressed during

  your post-op visits.

• Dilator training: We have extensive education on dilator training for neovaginal patients and

  find it to be essential in maintaining the vaginal canal length, width, and maintaining sexual

  pleasure.

At Vibrancy Pelvic Health we are committed to being inclusive to the LGBTQIA+ community. During your visits we will provide you with resources on how to make your pre- and post-op journey smoother and provide you with resources on other providers who may help with any hormonal, mental health, or other support you may need. Providing a safe space to learn more about pelvic health for transgender and gender non-conforming individuals is important, it is compassionate care, and it matters.

Written by: Beck Hall, PTA, PRPC

References:

Wright, J. D., Chen, L., Suzuki, Y., Matsuo, K., & Hershman, D. L. (2023, August 23). National Estimates of Gender-Affirming Surgery in the US. JAMA Network Open; American Medical Association. https://doi.org/10.1001/jamanetworkopen.2023.30348

In-Text Citation: (Wright et al., 2023) Boyle, P. (2022, October 13). What is gender-affirming care? Your questions answered. AAMC. https://www.aamc.org/news/what-gender-affirming-care-your-questions- answered#:~:text=Gender%2Daffirming%20care%2C%20as%20defined,they%20were%20assigned %20at%20birth.

Tordoff, D. M., Wanta, J. W., Collin, A., Stepney, C., Inwards-Breland, D. J., & Ahrens, K. R. (2022, February 25). Mental Health Outcomes in Transgender and Nonbinary Youths Receiving Gender- Affirming Care. JAMA Network Open; American Medical Association.

https://doi.org/10.1001/jamanetworkopen.2022.0978 Full Citation: Almazan, A. N., & Keuroghlian, A. S. (2021, July 1). Association Between Gender- Affirming Surgeries and Mental Health Outcomes. JAMA Surgery; American Medical Association. https://doi.org/10.1001/jamasurg.2021.0952

Jiang, D. D., Gallagher, S., Burchill, L., Berli, J. U., & Dugi, D. (2019, May 1). Implementation of a Pelvic Floor Physical Therapy Program for Transgender Women Undergoing Gender-Affirming Vaginoplasty. Obstetrics & Gynecology; Lippincott Williams & Wilkins. https://doi.org/10.1097/aog.0000000000003236