Gender Affirmation Surgery and How Pelvic Floor Physical Therapy Can Aid in Optimizing Outcomes and Decreasing Complications Post Operation

By Dr. Zarina Vitebsky, DPT, MSPT, PRPC, TPS, LPF, DN on 9/20/2023

The LGBTQIA+ community deserves access to both healthcare services and providers who continue to learn, adapt, and train for the specific needs of this community. If you have experienced discrimination by a health care provider somewhere along the continuum of care, please know that Pelvic Health is actively working to decrease that prevalence. Health care equality is a priority here at Pelvic Health, especially to the transgender/gender diverse population, whom may chose to undergo surgical procedures to affirm their identity. As pelvic floor physical therapists, we strive to optimize the human experience through movement. Our goal is to evaluate and treat pelvic dysfunctions associated with surgical procedures to optimize outcomes and decrease complications. Such procedures that can be addressed through physical rehabilitation are discussed below.

Female to Male surgical options:

• Chest reconstruction

• Hysterectomy with or without oophorectomy

• Metoidioplasty (clitoral enlargement with or without urethral lengthening)

• Phalloplasty (acquiring a skin flap with nerve and blood supply as well as a skin graft to cover where the flap was taken from another area on the patient’s body, in order to have enough tissue to create the neophallus)

Treatment modalities that our therapy specialists utilize include: soft tissue mobilization, myofascial release, scar tissue mobilization to surgical site/ skin graft, motor control, coordination techniques, and relearning toileting behavior.

Male to Female surgical options:

• Breast augmentation

• Vaginoplasty (penile inversion between the rectum and urethra to create a vaginal vault)

Treatment modalities that our therapy specialists utilize include: dilation, soft tissue mobilization, myofascial release, scar tissue mobilization to surgical site/ skin graft, motor control, coordination techniques, activity modifications, pain management, relearning toileting behavior.

There are additional unique healthcare concerns regarding pelvic / orthopedic concerns for the gender diverse that Pelvic Health Center treats, such as:

• Side effects of binding, including back pain, chest pain, poor posture, shoulder pain, numbness, and scarring

• Urinary dysfunction associated with packing and/or tucking

• Pelvic pain, changes in walking pattern, and muscle tension in the legs associated with packing and/or tucking

• Tucking leading to increased risk for developing urinary tract infections due to urethral opening being placed close to anus, as well as compression of the urethra leading to urinary dysfunction

• Urinary retention or other issues related to stand-to-pee devices

If you’re experiencing pelvic floor dysfunctions associated with the options listed above, please reach out to us here at the Pelvic Health Center in Madison, NJ to set up an evaluation & assessment! Feel free to call us 908-443-9880 or email us at receptionmadison@pelvichealthnj.com.

Works Cited:

Jiang DD, Gallagher S, Burchill L, Berli J, Dugi D 3rd. Implementation of a Pelvic Floor Physical Therapy Program for Transgender Women Undergoing Gender-Affirming Vaginoplasty. Obstet Gynecol. 2019 May;133(5):1003-1011. doi: 10.1097/AOG.0000000000003236. PMID: 30969210.

Chen ML, Reyblat P, Poh MM, Chi AC. Overview of surgical techniques in gender-affirming genital surgery. Transl Androl Urol. 2019;8(3):191-208. doi:10.21037/tau.2019.06.19

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

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