Pelvic Floor Physical Therapy for the Trans Community

June is Pride Month, but caring for trans bodies isn’t something that should happen only once a year. Everyone deserves healthcare that is affirming, evidence-based, and centered on their goals. 

Your mind and body are connected. Because pelvic floor physical therapy is so closely tied to sexual health, we often collaborate directly with your mental health therapist or sex therapist to support your complete healing journey. Because of the unique physical and social experiences many transgender and gender nonconforming people navigate, pelvic PT can be especially valuable. 

Unfortunately, many trans people avoid healthcare because medical settings can increase exposure to dysphoria and misunderstandings in the best of times. At Ground Floor Physical Therapy, our approach is gender neutral and collaborative. We recognize that you are the expert on your own body, and our role is to help you move through the world with greater comfort, confidence, and ease. 

While pelvic PT is a great first line treatment for many conditions including constipation, leaking, and prolapse; we are going to focus in on the sexual functions of the pelvic floor: 

Pain with Sex

Any unwelcome pain during sexual activity warrants medical care! This is true whether you are the receptive partner or the inserting partner. Pelvic PT is absolutely part of the team that can help with this.

If the pelvic floor muscles are overactive or unable to relax, receptive sex can become painful regardless of your anatomy or entry of choice. Treatment may include improving pelvic floor muscle coordination, reducing muscle tension, addressing nervous system sensitivity, and gradually increasing tolerance to meet your goals for sexual activity. Some people taking testosterone may experience genital changes such as dryness and tissue sensitivity adding to discomfort with penetration. When appropriate, we can refer to a trans-competent OBGYN for additional evaluation and treatment. 

The pelvic floor muscles can also refer pain if they are overactive - like a charley horse. This can cause sharp pains or dull aches that radiate into the erectile tissue, low abdominals, and other pelvic structures. This can be increased by arousal, erection, or orgasm whether or not your sexual activity involves insertion. 

Pregnancy and Postpartum Care

Growing your family and bringing a new life into the world can be a magical experience. It can also be complex and compound dysphoria if you are trans or nonbinary. You still deserve all the PT care to address the aches and pains of pregnancy changes as well as pelvic PT postpartum to address any weakness or scar tissue after the birth. Finding providers who understand and respect your identity can make a tremendous difference.

And if you are not planning on having children … Say it with me: Testosterone is not birth control. Even if your cycle has stopped, when sperm meets egg, life finds a way. 

Gender-Affirming Surgeries

Gender-affirming surgeries are a significant milestone for many people, and rehabilitation can play an important role in recovery. Scar mobilization is important aesthetically as well as for range of motion. That may mean top surgery scars, bottom surgery scars, or graft site scars depending on what you opt for. Binding and tucking can also impact posture and range of motion which a pelvic PT can help you regain. 

Recovery post-vaginoplasty involves an extensive dilation schedule and a pelvic PT can be helpful in making that process more efficient and pain free. This can make it much less physically and emotionally demanding. 

Some people post-hysterectomy can develop pelvic discomfort and difficulty with going to the bathroom after surgery as the bladder and bowels shift a bit. This can mean leaking but it can also mean difficulty fully emptying when you go to the bathroom. Pelvic PT can help with both of these situations. 

You Deserve Affirming Care

This is far from a complete list of the ways pelvic floor physical therapy can support transgender and gender nonconforming people. Pelvic PT can be beneficial whether you are navigating social transition, medical transition, recovering from surgery, navigating pregnancy, addressing sexual concerns, or simply trying to feel more comfortable in your body. No matter where you are on your journey you deserve affirming supportive pelvic PT that can work in tandem with the rest of your healthcare team.

If you’re curious whether pelvic floor PT might be a good fit for you, Ground Floor PT offers free consultations as well as comprehensive evaluations to help you move on to your next step.