Transgender, Intersex, Non-binary and Gender Expansive Physical Therapy: Part 2
Is Trans PT only for after gender affirming surgeries?
Short answer is: No. Physical therapy is for so much more that just rehab after surgeries. Transgender, Intersex, Non-binary and Gender Expansive folx also experience issues that can affect anyone, including urinary or fecal leakage, pelvic pain conditions, Persistent Genital Arousal Disorder, Peyronies, SIJ dysfunction, pelvic organ prolapse, constipation and pregnancy related issues. That is just a sample of conditions that can be treated with pelvic floor physical therapy. PT can also address orthopedic issues related to binding, tucking and hormone therapy, such as genital pain related to bottom growth. Gender Expansive folx can also have shoulder pain, low back pain, neck pain, knee pain, etc and deserve a competent and affirming physical therapist.
It is true that physical therapy is really helpful in preparing for and recovering from gender affirming surgeries. Most folx benefit from a pre-operative appointment with a physical therapist to make sure that any issues get addressed beforehand. PT can help you improve tissue mobility, strength, and coordination prior to surgery and that will set you up for a good surgical outcome. PT will help with wound healing, scar tissue, pain, flexibility, coordination and strength after surgeries such as chest augmentation, chest reconstruction, chest masculinization, hysterectomy, metoidioplasty, phalloplasty, vulvoplasty and vaginoplasty.
Who can provide it?
Physical therapists can specialize in areas that they feel especially connected to, including Trans PT and Pelvic Floor PT.
A LGBTQ+ competent and affirming physical therapist will have extra training be trauma-informed, gender affirming, and body and sex positive and incorporate this into their practice. It is hard to verify these things in a physical therapist but asking some questions will help you figure out if the PT is a good fit for you. Ask whether or not they have treated Trans folx previously, if they have any signs in the clinic that signal it’s a safe space for everyone, and if they will use your name and pronouns if it differs from your medical chart. This will ensure that the PT you are seeing has done the minimum to ensure their treatment space is safe.
PTs who treat pelvic floor issues need special training to evaluate pelvic floor muscles and the surrounding areas. A word of caution, any physical therapist can call themselves a pelvic floor physical therapist because there is no required certification. In order to make sure the physical therapist has the appropriate training, ask if they can perform internal assessments (even if you don’t plan on having one). Only pelvic floor physical therapists who can perform internal assessments have adequate training to truly be labeled a pelvic floor physical therapist.
What you should expect from a gender affirming physical therapist
A physical therapist who treats Transgender, Intersex, Non-binary and Gender Expansive individuals should use the name and pronouns that affirm you. They should offer a private room if a body part needs to be exposed or ask personal health questions, and only ask health questions directly related to the reason you are seeking physical therapy. They should have general knowledge about surgeries, hormones and other gender affirming procedures. They should be able to talk about procedures, body parts and different types of relationships without judgement. The PT should ask for consent prior to physical touch and continue to ask for consent throughout the visit. Finally, the physical therapist should be flexible during the appoint to allow for modification of examination and use words for body parts that make you feel comfortable.
