Gender Affirming Surgery
If you are considering Gender Affirming Surgery (GAS), pelvic therapy is recommended both prior to (if possible) and following all top and bottom surgeries. Physical therapy is mandatory after many other surgical procedures in order to help patients maximize their recovery and reach full function. The same postoperative rehabilitative support should be expected and available after gender affirming surgical procedures! Your surgeon will likely give you instructions for what to do at home to assist with your healing, but most patients benefit from the guidance and supervision from a pelvic therapist to successfully follow a rehabilitation protocol.
Many surgeons performing GAS recommend pelvic therapy as part of standard pre- and post-surgical care, and recent research suggests that it is helpful in optimizing recovery and improving quality of life (Jiang, et al., 2019; Manrique, et al., 2019). However, both in the US and internationally, there is a scarcity of pelvic therapists who have expertise in treating issues specific to gender affirming surgeries. It is important that your pelvic therapist has expertise in working with individuals who have undergone a GAS and that you feel both welcomed and supported.
At Grace Physical Therapy & Pelvic Health, we delight in being the ‘go-to’ place in our community for pelvic health and physical therapy care for LGBTQIA+ individuals. We are also available to assist those living in other areas. While it is best to work with a local pelvic therapist if possible, many of our interventions include patient education and home exercises that we can offer even from a distance via our Telehealth program to serve those desiring pelvic therapy before and/or after surgery.
Please refer to our Post-Surgical Rehabilitation page for general information on our treatment approach for pelvic and abdominal surgeries. Here we will discuss specific GAS considerations.
Pelvic Considerations with Bottom Surgeries:
Bottom surgeries involve numerous incisions that can lead to scars and multiple areas of healing tissue. The pelvic floor musculature, urethra, and pelvic neural and fascial structures are often involved during surgery, which can result in urinary, bowel, and/or sexual dysfunction and pelvic pain. Examples include urinary challenges such as difficulty initiating stream, incomplete bladder emptying, urgency/frequency, spraying, and pain with urination, or pain with intercourse, sitting, or irritation by clothing/underwear due to scar tissue formation.
Phalloplasty involves additional challenges due to the requirement of a donor site. The areas where tissue is taken often have significant scar tissue formation that, if left untreated, could lead to pain, restrictions, and/or postural changes. Manual soft tissue and myofascial release techniques are beneficial on the areas of the body that will be used for the flap and skin grafts to allow for adequate tissue length. After surgery, these techniques can assist in improving scar mobility to minimize discomfort and optimize range of motion.
Breast augmentation or removal can cause scars and adhesions that reduce mobility in the chest, ribs, and spine. This can affect breathing mechanics, posture, and upper body range of motion. Physical therapy will help normalize scar mobility post operatively to address these concerns by reducing discomfort, increasing range of motion, and improving the appearance of scar tissue and/or breasts.