Transgender Care and the Role of Physical Therapy

Transgender individuals, or individuals who identify with a gender that differs from their sex assigned at birth, may elect to have procedures, surgeries and other medical interventions performed in order to transition to a gender that better matches their identity.

These procedures may include hormone therapy and gender affirming surgeries that aim to alter the individual’s physical appearance to match their gender identity (Dubin et al., 2018).

Gender affirming surgeries include facial reconstruction surgeries, surgeries aimed at chest reconstruction - also known as “top” surgeries, and surgeries aimed at genital reconstruction - also known as “bottom” surgeries.

Transgenger Surgery Options

Male-to-female bottom surgeries, or transfeminine surgeries, involve reconstructing male genitalia to match a female genital appearance.

Orchiectomies, vulvoplasties and vaginoplasties are transfeminine surgeries that are performed in order to remove the testicles, construct a vulva and construct a vagina, respectively (Transfeminine, n.d.).

Female-to-male bottom surgeries, or transmasculine surgeries, involve reconstructing female genitalia to match a male genital appearance.

The most common procedures are called phalloplasties and metoidioplasties (Metoidioplasty, n.d.; Phalloplasty, n.d.).

How Your Pelvic Floor Physical Therapist Can Help with Gender Affirming Care

When it comes to bottom surgeries, pelvic floor physical therapists play a unique and essential role in your care before, during and after surgery.

Pelvic PTs are specialized in treating pelvic floor dysfunction as well as improving function, providing pain relief, treating bowel and bladder disorders, addressing sexual function, and so much more.

As with any surgical procedure, there are risks of complications that can affect quality of life. Luckily, pelvic therapists are specifically trained to help prevent these complications and treat them if they arise.

What Should You Expect from a Pelvic Physical Therapy Treatment?

During the time before your surgery, your surgeon might recommend that you schedule an appointment with a pelvic PT. Why should you see a pelvic PT before surgery?

Many reasons!

Pelvic PTs can perform a baseline functional assessment of your pelvic floor prior to surgery so that recovery and function can be monitored against baseline after surgery.

Additionally, the therapist may assess areas other than your pelvic floor itself such as your general posture and alignment. You can expect questionnaires to fill out to help in creating a comparison of your functioning pre- and post-surgery.

If they notice any muscle weakness or tightness, they can work with you to improve your pelvic functioning before surgery.

All of this work beforehand will help the postoperative period run much more smoothly and help reduce complications that may arise after the surgery.

Finally, your therapist may be in contact with your surgeon to suggest specific body positions in order to reduce risks for complications related to positioning during the surgery.

What Should You Expect After the Gender Affirmation Surgery?

Current research has shown that pelvic floor physical therapy is beneficial for those undergoing vaginoplasty both before and after the procedure (Jiang et al., 2019).

It is especially important to work with a pelvic therapist in the weeks and months following a vaginoplasty due to the nature of the surgery and risks of complications that can occur afterwards.

Individuals who elect to have a vaginoplasty can expect to stay in the hospital for 5-7 days on bedrest to ensure adequate healing immediately following the surgery (Meltzer, 2016).

Once cleared to go home, the surgeon will provide a list of important instructions to keep in mind, including visiting your pelvic PT.

A pelvic therapist will instruct you in the use of vaginal dilators which will be used up to three times daily in the first few months. Vaginal dilators are medical devices used to maintain the depth and girth of the vaginal canal (Meltzer, 2016).

This is just one crucial component of care after the surgery, but you can be sure your therapist will be there to help guide you and support you every step of the way. 

References

Jiang, D. D., Gallagher, S., Burchill, L., Berli, J., & Dugi, D. (2019). Implementation of a pelvic

floor physical therapy program for transgender women undergoing gender-affirming

vaginoplasty. Obstetrics & Gynecology, 133(5), 1003-1011.

Meltzer, T. (2016, June 17). Vaginoplasty procedures, complications and aftercare. Retrieved

from https://transcare.ucsf.edu/guidelines/vaginoplasty

Transfeminine Bottom Surgery. (n.d.). University of Utah Health. Retrieved from

https://healthcare.utah.edu/transgender-health/gender-affirmation-surgery/vaginoplasty.php

Phalloplasty. (n.d.). University of Utah Health. Retrieved from

https://healthcare.utah.edu/transgender-health/gender-affirmation-surgery/phalloplasty.php

Metoidioplasty. (n.d.). University of Utah Health. Retrieved from

https://healthcare.utah.edu/transgender-health/gender-affirmation-surgery/metoidioplasty.php

Dubin, S., Nolan, I., Streed Jr, C., Greene, R., Radix, A., & Morrison, S. (2018). Transgender

health care: improving medical students’ and residents’ training and awareness. Advances

in Medical Education and Practice, 9, 377–391.

 

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By Dr. Amanda Olson,DPT, PRPC