Greater Boston Urology Blog

Transgender Health Care: How Pelvic Floor PT Can Help

Dr. Cathryn Morris is one of our wonderful pelvic floor physical therapists who works out of our Plymouth Care Center.

Dr. Morris is a firm believer in bringing awareness to gender diversity in health so as to create a more welcoming environment for all patients. Specifically, she's done several presentations on the role of pelvic floor physical therapy in transgender health care. In the Q&A below, we asked Dr. Morris to share some insights from these presentations.

Let's define pelvic floor physical therapy. What is it? And what does a pelvic floor physical therapist like yourself do?

DR. MORRIS: Pelvic floor physical therapists are experts in the areas associated with the pelvis, including vulvar and vaginal, penile and scrotal, and colorectal regions.

Pelvic floor physical therapists receive additional training outside of the general physical therapy education to be able to assess the muscles, nerves, and ligaments of the pelvic floor, as well as the surrounding structures of the hips, spine, and abdominal region. This allows us to treat a variety of diagnoses affecting bowel, bladder, and sexual function.

It's important to note that everyone has a pelvis, which means everyone has a pelvic floor regardless of genitals or gender. Because everyone has a pelvic floor, anyone can be susceptible to dysfunction or injury of the pelvic floor just like any other body part. One of my favourite sayings is "Pelvic floor physical therapy is for everybody—and every body."

Discuss the role of pelvic floor physical therapy in the LGBTQ+ community.

DR. MORRIS: Pelvic floor health has long been assumed to be relevant only to cisgender women. Cisgender means the gender a person identifies with aligns with the sex they were assigned at birth. So, in this case, a cis woman is a person who was assigned female at birth and identifies with this gender.

But remember what I mentioned above: Everyone has a pelvic floor. So pelvic floor health matters to everyone.

Thankfully, over the years, the conversation has evolved to address concerns across the gender spectrum, and more research has been done on how pelvic floor physical therapy is beneficial to everyone.

In the queer and transgender community, it is common that members may adopt practices such as binding or tucking to better align with their gender identity. These practices influence how an individual moves and breathes, and, if not monitored appropriately, this can adversely affect how their pelvic floor is functioning.

For example, a 2016 study found that greater than 97% of participants reported at least one negative outcome attributed to chest binding. Many outcomes would fall under the pelvic health physical therapist's scope of care, including but not limited to the following:

  • Abdominal pain (14.5%)
  • Muscle wasting (5.4%)
  • GI symptoms (17.7%)
  • Respiratory symptoms (50.7%)[1] [2] 

Some may choose to undergo hormone therapy and/or gender confirmation surgery. A physical therapist is helpful both pre-operatively and post-operatively. Pre-operative therapy can address impairments that would limit the outcome of the surgery, delay healing, or impede the functional, pain-free return to daily activities.

Post-operatively, physical therapy can be utilized to optimize surgical outcomes and address scar tissue, muscle dysfunction, strength, and mobility.[3] [4]

Historically, the LGBTQ+ community has been neglected in healthcare. Many members in this community can recall at least one negative experience with a provider, making them hesitant to seek care in the future. The goal is to provide quality care to every person who walks through the door, regardless of their gender identity or expression.

Discuss your approach with transgender and gender nonconforming patients. How do you create a more welcoming, inclusive, and safe environment in your practice?

DR. MORRIS: Language matters. If there is any precaution for treatment of a transgender or gender nonconforming patient, it is to be aware of language, both verbal and non-verbal. This can be on an individual level by using the preferred name and pronouns, the preferred terminology for anatomy, and apologizing if an error was made.

On an institutional level, having inclusive intake forms and gender-neutral restrooms seems small but can ease a lot of worry for the patient. Pelvic floor physical therapy can be anxiety-provoking for any patient, especially those who may have a complicated relationship with their anatomy. As a provider, you need to be ready to communicate and willing to learn from your patients in order to maximize their experience.

When it comes to transgender health care . if there's one main point that you want ALL readers of this article to understand, what would that be?

DR. MORRIS: LGBTQ+ discrimination in healthcare is not only a public health problem, but also a human rights problem. Discussing concerns around bowel, bladder, and sexual function is inherently difficult, and it should be the provider's job to educate themselves on ways to be more inclusive and welcoming in order to ease the burden of the patient.

Thanks so much for your insights, Dr. Morris!

Click here to schedule an appointment with Dr. Morris or one of our other pelvic floor physical therapists. Your quality of life matters. Let us help!

[1] Gallagher L. How to Bind. Published online 2016. Accessed March 30, 2020.

[2] Peitzmeier S, Gardner I, Weinand J, Corbet A, Acevedo K. Health impact of chest binding among transgender adults: a community-engaged, cross-sectional study. Cult Health Sex. 2017;19(1):64-75. doi:10.1080/13691058.2016.1191675

[3] Scahrdein JN, Zhao LC, Nikolavsky D. Management of vaginoplasty and phalloplasty complications. Urol Clin North Am. 2019;46(4):605-618. doi:10.1016/j.ucl.2019.07.012

[4] Kuhn A, Santi A, Birkhäuser M. Vaginal prolapse, pelvic floor function, and related symptoms 16 years after sex reassignment surgery in transsexuals. Fertil Steril. 2011;95(7):2379-2382. doi:10.1016/j.fertnstert.2011.03.029

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