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Physical Therapy and Gender Affirming Treatments

By Dr. Brooke Meinema, PT, DPT, FAFS, PCES

Physical therapy can help those undergoing gender-transition practices, including chest binding and genital tucking, as well as both pre- and postoperatively for those undergoing gender-affirming surgery. Through soft tissue work, postural assessment, desensitization for hypersensitive tissue, bowel and bladder training, and functional activity, a pelvic health physical therapist can help individuals address their concerns while improving tolerance to daily functional activities and hobbies. This can be especially helpful for those undergoing gender-affirming surgery.

Physical Therapy Following Top Surgery

Whether undergoing masculinizing or feminizing top surgery, working with a physical therapist can help ensure proper healing and functional activity tolerance. Your therapist can show you how to perform scar tissue massage to reduce pain and ensure good outcomes for the appearance and mobility of your scars. They will also work with you to maintain a full range of motion and strength in your upper body to help you return to your previous level of activity without limitations.

Physical Therapy Following Bottom Surgery

Gender-affirming bottom surgery can vary depending on what procedure is being performed, but most of the time, pelvic physical therapy can be extremely helpful for this process. One study specifically looking at transgender women undergoing gender-affirming vaginoplasty reported the incidence of pelvic floor dysfunction and bowel dysfunction before surgery as 42% and 37%, respectively. They also found that people who had pelvic physical therapy before and after surgery had significantly lower rates of pelvic floor dysfunction following surgery compared to those who only had physical therapy following the procedure. Regardless of having surgery before or after, physical therapy was shown to improve outcomes for those undergoing the procedure.

Bottom surgeries can create scar tissue, changes in urination (difficulty initiating the flow of urine, spraying, burning, etc.), bowel changes, pain with sitting, and may require a donor site for skin grafting, creating more potential for scar tissue, all of which can be problematic if left untreated. A physical therapist can work with you to create an ample healing environment and help reduce any pain or limitation that may come before or after your procedure.

Regardless of the procedure or treatments an individual may be undergoing, everyone deserves to have medical providers they can trust and be open with without fear of judgment. For anyone who has questions about whether physical therapy would be helpful for them, our pelvic health team offers free phone consultations as well as in-person assessments to help people make informed decisions and plans for their future.

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