Pelvic Health Physical Therapy For Gender-Affirming Physical Wellness

Pelvic Health Physical Therapy and Gender-Affirming Care

“Pelvic Health Physical Therapy” and “Gender-Affirming” have not always been terms that were found in the same sentence. For the longest time, The special-interest group even went by another name, “Women’s Health” and it was not until 2019 that it was changed to “Pelvic Health”. It is a sad reality that even within this group of professionals, who understand how isolating it is to deal with pelvic health dysfunction, the name-change still only passed by a narrow ⅔ majority. This demonstrates that we still have a long way to go as a profession toward being inclusive to all bodies, but pelvic health physical therapy and gender-affirming care is a pathway forward.

The good news is that with this name change, more and more individuals are understanding that pelvic health is a part of wellbeing for all bodies! It has also encouraged practitioners to broaden their understanding of how they approach pelvic health concerns. We are so committed to inclusivity in our practice that we also changed our name from EudeMOMia to Garner Pelvic Health. While we were always happy to treat all bodies, we understand that words matter and we want all to feel welcome here. 

Why Pelvic Health Physical Therapy and Gender-Affirming Care for our Transgendered Friends?

Pelvic Health Physical Therapy and Gender-Affirming Care

While it is true that many of the same conditions are experienced across the gender spectrum, there are also some concerns that are unique to those who are transitioning. Some will choose to undergo surgical procedures, and some will not, but both options may pose some physical and or emotional/mental challenges. The good news is that pelvic health physical therapy and gender-affirming care can safely coincide in a way that covers all your physical wellness concerns! 

As experts on the pelvis, we have found that a three-diaphragms approach is the best way to approach optimal pelvic health. This means that we understand the interplay between how your posture, breath, voice, and pelvic floor work together. We know that when any one of the diaphragms is affected, it can have an effect on all three. This is extremely important to understand when we are working with folks who may have been binding, tucking, packing, or modifying their vocal tone. It is also crucial when working with those who have undergone gender-affirming surgical procedures, regardless of which “top” or “bottom” surgery was performed.

A good pelvic health physical therapist also understands that your pelvis is the thing that connects the upper and lower halves of your body. For this reason, we learn that for it to function optimally, we often have to look above or below to find the cause of dysfunction. We, therefore, become de-facto experts in the entire body and how the fascial chains connect you from head to toe. All of this is to say that yeah, we know about more than “just the pelvis”.

Pre and Post-Surgery care:

It is finally standard that people are referred to pelvic health physical therapy following a vaginoplasty surgery because there is research that shows how important the impact is. Unfortunately, the research has not yet caught up with the impact that physical therapy can have on optimizing function for various other gender-affirming “bottom” or “top” surgeries. This does not, however, make it any less true. It simply means that no one has funded the research yet. For this reason, most will not get a referral automatically and may have to self-advocate for one or seek one out themselves in direct-access states. 

Making sure that you receive both pre-habilitation (before surgery) and rehabilitation (after surgery) for your gender affirming procedures is the best way to make sure that you have the best possible surgical outcomes and function. Optimizing your core and pelvic health leading into surgery will allow for the fastest recovery and return to function, especially for individuals who have pelvic floor or breathing dysfunction going into the surgery. Post-surgical re-hab is important to manage scar tissue formation/healing, and to help the muscles and other tissues that were interrupted get back on-line and work together optimally to prevent dysfunction. 

Pelvic Health Physical Therapy and Gender-Affirming Care on the Effects of non-surgical practices:


Pelvic Health Physical Therapy and Gender-Affirming Care

Some folks choose to bind to give the appearance of a flatter chest and more masculine appearance. While the mental health outcomes of binding are very beneficial for these individuals, about 97% of individuals studied reported at least one of 28 different negative health outcomes as a result. These outcomes included some kind of musculoskeletal pain in 74% of folks, as well as shortness of breath, lightheadedness, poor posture, rib and spine changes, overheating, fatigue, and soft tissue irritation.


Packing is another common practice that folks may choose to use to give a more masculine appearance, allow for penetrative intercourse, or allow for urination while standing. Unfortunately, using a stand-to-pee style prosthetic can lead to difficulty emptying, straining, and development of pelvic floor dysfunction over time in some cases. Changes in gait can also increase adductor tension from trying to keep the prosthetic situated while moving. The results of excessive adductor tension are often pelvic floor dysfunction or even pelvic pain.


Other folks may use a practice known as tucking to appear more feminine. This technique, like the others mentioned, can go a long way to help improve gender dysphoria and improve mental health. It does have the potential, however, to cause: some skin irritation, testicular pain, and urinary infections. Tucking may also change your gait pattern, similar to packing, and could lead to soft-tissue changes around the genitals.

The Good News – Real Solutions with Pelvic Health Physical Therapy and Gender-Affirming Care!

Working with a provider skilled in pelvic health physical therapy and gender-affirming care allows for appropriate education on how to bind, tuck, and pack in the safest way possible. It also allows for treatment of postural changes and release of restricted tissues that can lead to negative health outcomes. Finally, it will help you by developing a home program that you can use to combat the tissue changes that may occur to help you STAY out of pain and dysfunction long-term.

If you are looking for an LGBTQ+ affirming provider near you, check out the OutList Developed by OutCare Health.

If you are interested in accessing physical therapy in NC for any physical concern, please schedule a Free 10-min. Phone Consult today!