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For Gender-Affirming Bottom Surgery

If you’ve just had gender-affirming bottom surgery—seeing a pelvic physical therapist can play an important role both before and after your surgery.

Before your surgery, pelvic physical therapists can help treat any pelvic pain, urinary problems, or bowel problems. Your physical therapist can also teach you about the body parts inside your pelvic region (anatomy) and how they work (physiology).

What Does a Pelvic Physical Therapist Do? 

Physical therapists are highly educated, licensed health care professionals who help patients to improve their mobility and restore function. Physical therapists also educate patients on how to prevent or manage certain conditions so patients can stay healthy in the long-term.

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Physical Therapy Evaluation: What to Expect

At your first evaluation, your therapist will spend time discussing any issues or problems that you would like to go over. Your therapist will also answer any questions about how physical therapy will help you recover after gender-affirming bottom surgery.

Examining Your Pelvic Floor Muscles

During your evaluation, your therapist will look at your pelvic floor muscles. These are the muscles that support the organs inside your pelvis—including your bladder, bowels, and uterus.

Your pelvic floor muscles help you control when you:

  • go to the bathroom (urinate and have bowel movements),
  • pass gas, and
  • become aroused, orgasm, and ejaculate.

Examining these muscles in your pelvic region will help your therapist understand your motor control, strength, and endurance. This exam will also help your therapist see whether your pelvic muscles work together correctly so you can go to the bathroom and have sex.

Your physical therapy evaluation may also include:

  • postural assessment (looking at your posture);
  • muscle testing;
  • internal muscle and fascial palpation of the pelvic floor muscles (seeing if the muscles inside your pelvic floor move correctly);
  • EMG testing; and
  • Checking for scar and soft tissue restrictions, gait, and movement patterns.

Do I Need to Have an Internal Pelvic Floor Muscle Exam?

Many people choosing to have gender-affirming bottom surgery will need to get an internal exam from a physical therapist of their pelvic floor muscles. This exam can help your therapist find any soft tissue, muscle, strength, or coordination problems you have that may be causing your symptoms and functional impairments.

To see your pelvic floor muscles, your physical therapist will most likely do an internal exam. During an internal exam, your physical therapist will insert her finger into either your rectum or vagina so she can feel your pelvic muscles.

Having an internal exam of your pelvic floor muscles is important to develop an accurate treatment plan. But if you don’t want to have an internal exam, there are ways to look at your muscles externally using electromyography testing.

Electromyography testing isn’t as accurate at testing your muscle strength, tone, or coordination. But electromyography testing is definitely an option for anyone who decides not to have an internal examination. Patients reserve the right to make this decision.  

What Should I Expect During Physical Therapy?

Before your gender-affirming bottom surgery, your physical therapist will find out if you have any pelvic pain, urinary problems, or bowel problems. We can also assess vaginal dilation if you had a vaginoplasty.

A couple months after your surgery, you may need biofeedback training and/or other therapies to help reduce tension in the muscles of your pelvic floor.

These treatments are designed to address your specific goals, such as:

  • having fewer bathroom accidents (incontinence);
  • having less pain when you urinate or go to the bathroom; and
  • having less pain while sitting, walking, standing, and during sex.

Hear From Our Patient

"I definitely feel complete. I feel whole. But that doesn’t describe it… that doesn’t even begin to describe it,” beams Josie Jesse as she sits, finally comfortable, in her new body that reflects who she has always been.

Read Josie Jesse's Story

Josie Jesse, Transgender patient