Pelvic Floor Physical Therapy & Gender Affirming Practices
In case you haven’t noticed, June is Pride month, which is a great time to highlight LBGTQAI+-specific health issues. While healthcare for the community as a whole is notoriously lacking, healthcare for those within the transgender/ gender non-conforming community is even further behind the times. Many healthcare practitioners may not be familiar with health issues specific to trans/gender non-conforming patients and their treatment options. Until all medicine is inclusive, there are several areas of trans health that can require the unique attention and specialization that a pelvic health physical therapist can provide.
Pelvic Health Concerns
As a pelvic health physical therapist, I work with people who have some form of pelvic floor dysfunction. This often looks like low back and/or pelvic pain, bowel and bladder symptoms, and even sexual dysfunctions. While those who are pregnant or have been pregnant are the ‘typical’ patients who seek treatment from a pelvic health PT, every person has a pelvic floor and can experience these issues.
In the LBGTQAI+ community, trans/gender non-conforming individuals may experience these issues for reasons that require specific assessment techniques. Specifically, trans/gender non-conforming folx may practice gender affirmation practices. This can include (but is not limited to) binding, tucking, and packing. While these practices are often necessary for an individual to be affirmed in their identity, they can often lead to unwanted secondary symptoms. Here we will describe each practice and explain the secondary symptoms that could come along with it, and how a pelvic health PT can help address these symptoms.
Binding: Binding is often used by trans-men or GNC folx to decrease the visibility of the breast tissue and attain a flatter chest.
Potential secondary symptoms and how pelvic health PT can help: Binding techniques have significantly improved over the years to improve comfort and protect the skin. However, there is still a major influence on the rib cage mobility and ability to properly breathe when wearing a binder. The diaphragm is the main respiratory muscle that lives in the bottom of your rib cage. If the rib cage cannot expand or move properly, this muscle is not able to function as well as it should and you have to use other secondary muscles to initiate an inhale. Not only does this influence how you breathe, it can also influence the function of your core and pelvic floor muscles. Since the diaphragm runs parallel to the pelvic floor, it has influence over how the pelvic floor muscles work. If the diaphragm isn’t moving properly, the pelvic floor isn’t moving properly. This is often when we see the dysfunctions that show up as bowel/bladder symptoms, sexual dysfunctions, and pelvic pain.
Besides sticking to a wear schedule for a binder, there are many manual therapies, exercises, and breathing techniques that a pelvic PT can help with.
Tucking: Tucking is a term used to describe the act of pulling the external genitalia back between the legs/buttocks, in order to decrease the visibility.
Potential secondary symptoms and how pelvic health PT can help: This can often stretch and compress the urethra and supportive structures of the genitals and lead to common symptoms such as urinary dysfunction and pelvic/genital pain. Because of the presence of pain and inflammation from irritated structures, the pelvic floor muscles often guard and become painful themselves.
A pelvic floor PT can assist you in addressing the dysfunction within the muscles and managing the pain while finding techniques that can allow you to continue affirmative practices while decreasing the unwanted side effects.
Packing: Packing is a way to increase the appearance of having external genitalia.
Potential secondary symptoms and how pelvic health PT can help: There are many different types of packers, but it’s relevance to pelvic floor physical therapy really comes into the adjustment of wearing one. For packers in general, it takes up space within the genital region and can cause you to alter how you walk/hold your body. This can often lead to tension within the groin muscles that can be addressed with PT. There are also some packers that allow the wearer to stand up while urinating. Standing with urination is often a major change for trans men, and can cause them to strain. This chronic straining puts a lot of pressure into the pelvic floor and often causes dysfunction in the muscles.
Gender Affirming Practices & Pelvic Health Therapy
Overall, gender affirming practices provide positive outcomes in terms of self-acceptance/affirmation. If you or someone you know uses affirmative practices such as binding, tucking, packing, or if they have had top/bottom surgery, pelvic PT may be a great option for those secondary symptoms that often come along with these adjustments.
How can physical therapy help:
As a pelvic health physical therapist, my job is to optimize the function of the pelvic floor and it’s role in working with the rest of the body during everyday life, or during specific activities such as: exercising, voiding, or even having sex. Addressing this function is an important part in addressing pelvic pain, urinary/bowel continence, and sexual function. Through various manual, exercise, and behavioral techniques, these symptoms that you are experiencing can be addressed and managed through an individual approach.
About the Author:
Tyler Kornblum, PT, DPT, ATC is a pelvic health physical therapist at Absolute Kinetics Physical Therapy in Cincinnati. She aims to improve the quality of care for those experiencing pelvic health related concerns by utilizing a trauma informed treatment approach to help women, men, and non-binary individuals get the help they need.
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