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Diversity Equity and Inclusion
Health Care

Supporting Gender-Affirming Care: A Holistic PT and OT Approach

June 9, 2023
Supporting Gender-Affirming Care: A Holistic PT and OT Approach

June is Pride Month, which is a time to celebrate the LGBTQIA+ community and highlight ongoing improvements in health equity.  

GHC-SCW is committed to serving every member of the Cooperative and providing a safe and welcoming environment for all. Equitable access to health care is core to our mission and vision. Gender-affirming surgeries and procedures require post-care management to enhance patient outcomes. This includes consultation and rehabilitation interventions from professionals in our Occupational (OT) and Physical Therapy (PT) departments.  

Musculoskeletal providers at GHC support gender-affirming care. Wendy Parsons, PT and Heather Crandell, OTR, CHT, CLT have answered a few questions below on gender-affirming clinical practices for post-operative patients. 

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What is a Pelvic Floor Physical Therapist? 

Wendy: Pelvic Floor Physical Therapy is a specialty practice within physical therapy.  A Pelvic Floor Physical Therapist has taken additional education to assist and treat issues related to the musculoskeletal system of the pelvic region, especially the pelvic floor muscles. Some of the things a Pelvic Floor PT can help people with include leakage of urine/bowels (incontinence), pelvic pain, difficulty with bowel movements, postpartum recovery, and gender-affirming bottom surgeries.  

What can a Pelvic Health PT do for an individual who is planning or had gender-affirming bottom surgery? 

Wendy: Having a pelvic floor PT session prior to gender-affirming bottom surgery can help identify pelvic floor muscle dysfunction and/or weakness and work to improve these. Muscle dysfunction includes muscle activation when they should be relaxing, poor muscle recruitment, and poor coordination of these muscles. Improving pelvic floor weakness can help decrease bladder leakage. Research has indicated that individuals who have addressed pelvic floor dysfunction prior to gender-affirming bottom surgeries maintain these improvements after. For individuals that have, or are planning to have, a vaginoplasty, pelvic floor PT can help them with pelvic floor muscle relaxation and the ability to do vaginal dilation during recovery.  

What is the role of Occupational Therapy for those who have undergone a top-surgery, such as chest flattening surgery or breast augmentation? 

Heather: Occupational therapists help maximize outcomes to return to desired functional activities after surgery and in some cases involving multiple surgeries. These surgeries may come with side effects which can have long term impacts on a patient’s quality of life from sensitization, range of motion, weakness and fatigue, scar tissue adhesions, and pain.  A variety of complications could be mitigated with early rehabilitation post-operatively. An Occupational Therapist will work on a varied of areas of practice based on clients’ needs including but not limited to: musculoskeletal, sexual health, psychosocial, body image, fatigue, and pain.   

Why is scar management so important after gender-affirming surgeries? 

Heather: A scar is an area of fibrous tissue that replaces normal skin following an injury or trauma, such as a cut or burn. Scarring is a natural part of the healing process after surgery but can sometimes require management to ensure that it does not cause additional problems. Scar management helps to normalize tissue pliability, mobility, and sensation.  

The location and amount of scar tissue will dictate the impact it has on functional activities. Below are some of the common difficulties scar tissue can cause: 

  • Reduced strength, which can impact the ability to lift overhead, return to a sport, and carry items. 
  • Increased edema or swelling due to surgical changes and rerouting of soft tissues can cause limited ROM and increased discomfort. 
  • Pain, which can affect a person both when awake and when trying to sleep. 
  • Reduced range of movement, which can cause problems with carrying out activities of daily living such as washing, dressing, walking, using the stairs, or driving. 

 What are other ways PT/OT can support gender affirming care? 

Wendy:  It has been noted in research that the transgender population has a higher rate of adverse childhood experiences (ACEs). Research also has shown that individuals with more adverse childhood experiences have a higher rate of reported pain issues. This can include neck pain, shoulder pain, or pelvic pain and muscle dysfunctions. Having gender-affirming surgery does not improve these issues specifically. 

An example of this could be an individual that had pelvic floor issues before having bottom gender affirming surgery will continue to have these issues after surgery. Another example is individuals that have increased pelvic muscle tension or difficulty relaxing pelvic floor muscles before having a vaginoplasty may have more difficulty using dilators after surgery. These things can be treated and improved with pelvic floor PT. 

In both PT and OT care, the focus is on improving patients’ outcomes and quality of life. This means it is important to treat the whole individual and develop a plan WITH the patient that is specific to THEIR needs. We believe that caring for the whole person requires a trauma-informed lens to ensure that each patient feels safe and supported during their care, especially given the sensitivity of the nature of this work. 

If you feel you would benefit from PT or OT care, please talk with your primary care provider or specialist about a referral for therapy services.