Pelvic Floor Physical Therapy for the Transgender and Gender Diverse Population

Photo by Steve Johnson on Pexels.com

By Molly Caughlan, PT, DPT (pronouns: she/her/hers)

Healthcare equality for the LGBTQ+ community is one area we as a society are significantly behind on and continues to require research, education, and training. For many, access to compassionate healthcare can be challenging, especially to those within the transgender/gender diverse population. According to a survey done by Lambda Legal, 52% of transgender respondents reported that they believed they would be completely denied medical services because of their gender status. They also found that 56% of lesbian, gay, or bisexual persons surveyed have experienced some type of discrimination in healthcare leaving many to avoid seeking treatment altogether.

As healthcare providers, we, at Beyond Basics Physical Therapy, understand the importance of cultural competence and strive to live up to the standards that the LGBTQ+ community deserves. Our goal is to ensure that every patient is provided with the highest quality of care, dignity, and respect. We strive to create a safe environment for patients and aim to deliver health care services with the specific needs of the patient in mind.

What Does a Physical Therapist Do?

At our core, physical therapists are MOVEMENT SPECIALISTS. We use a wide range of evaluative tools to assess how the systems of the body work together. We provide treatment to prevent, minimize, or eliminate impairments in order to optimize physical function. This includes restoration after injury, pain relief, maintenance of current function, and promotion of health.

Components of a Physical Therapy Evaluation

•        Self-report questionnaires

•        Posture and alignment in various positions

•        Breathing patterns

•        Range of motion and strength in relevant parts of the body

•        Functional movements – walking, getting in and out of chairs, in and out of bed and with any type of exercise 

•        Palpation of muscles in back, abdomen, pelvis, and lower extremity

(palpation is a fancy word for feeling parts of the body to assess for restrictions and tightness)

•        Goal setting – determine personal goals for coming to physical therapy

(How can we use the information from the evaluation to best help you meet your goals?)

What is Pelvic Floor Physical Therapy?

Pelvic Floor Physical Therapists receive special training to assess the pelvic floor muscles and abdominal organ mobility in conjunction with the other components of a standard physical therapy evaluation. This enables them to treat a variety of diagnoses including bowel, bladder, sexual problems, as well as prolapse, abdominal pain, back pain/pelvic pain, genital pain and more. We are experts in the areas associated with the pelvis, including vulvar and vaginal, penile and scrotal, and colorectal regions.

Pelvic Floor Muscle Anatomy

The pelvic floor is a sling of muscles that connect from the pubic bone to the tailbone and lives in the pelvis. They are responsible for providing the following 5 major functions:

  1. Stability: they work with the hip and core muscles to control movement in the pelvis
  2. Support: the “hammock” like muscle group holds and supports the abdominal organs (i.e. reproductive organs, bladder, bowel)
  3. Sphincteric: this function gives control to “open” (i.e. urinate or have a bowel movement) and stay “closed” (i.e. avoiding pee/poo accidents)
  4. Sexual: the muscles stretch to allow for receptive vaginal or anal intercourse; they also are what contract with orgasm
  5. Sump Pump: the muscle contract to move blood from the pelvis on its way to the heart

How can Pelvic Floor Physical Therapy help me?

If you have a pelvis, you may encounter issues with bowel, bladder, or sexual function. Although we specialize in pelvic floor treatment, it’s important to note that we treat the person as a whole and strive to understand the complexity of the many systems of the body work together.

There are also a number of common complications that accompany gender affirmation practices and surgeries that can be relieved through physical therapy. Since bottom surgeries drastically change the anatomy, there is an impact on the ability of the pelvic floor muscles to work properly. There are also many other post-operative considerations such as dilation (for neo-vaginoplasties), wound care/scar tissue management, and relearning toileting behavior with new anatomy. All of these considerations can be addressed and aided through pelvic floor physical therapy. Other procedures such as mastectomy or breast augmentation also create changes to the muscles of the chest as well as lymph vessels  and require the help of a physical therapist to ensure your body is able to function properly with that change. Practices such as binding or tucking come with their own set of complications, which can be minimized with a skilled physical therapist.  We understand how important these activities are and don’t want to make you stop, rather we want to help encourage good habits and help minimize any negative side-effects you may experience as a result.

Still unsure if we can help your specific needs after reading this article? At Beyond Basics, we offer free 15-minute phone consultations to ask us more specific questions. Give us a call to see how best we can help you today!


[1] https://www.lambdalegal.org/sites/default/files/publications/downloads/whcic-report_when-health-care-isnt-caring_1.pd

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Google photo

You are commenting using your Google account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s

This site uses Akismet to reduce spam. Learn how your comment data is processed.