Transgender & Gender Expansive Pelvic Health and Orthopaedic Services at Fusion Wellness PT

Happy Pride Month! Fusion Wellness & Physical Therapy is proud to be a supportive and inclusive orthopaedic and pelvic health center. Earlier this month, I attended the first ever PT-specific course for LGBTQ care in the US, with an emphasis on transgender care. The course covered many topics, notably pre-operative, intra-operative and postoperative recovery guidelines. While this is the second course I have taken on transgender care (with a third coming up in a few months), it was the first that was held primarily for the benefit of training physical therapists.

This course was led by Holly Herman, and supported by other PTs, nurses and MDs that I had the opportunity to meet and have some long conversations with even after the course wrapped up each day.

Transgender Physical Therapy Services

Transgender patients that are prepping for, or have undergone gender confirmation surgery (also termed gender affirmation surgery or gender reassignment surgery), will require the services of compassionate and skilled pelvic health and orthopaedic physical therapists. There are many ways a physical therapist can and should be involved in their integrative treatment plan:

Preoperative Pelvic Health and Orthopaedic Assessment:

• Alignment, postural assessment and corrective exercises –
  • Binding can lead to postural dysfunctions that in turn lead to neck and back pain.
  • Tucking is associated with changes in bladder function due to long periods of delay/retention and puts you at increased risk of developing overactive pelvic floor muscles.
• Fascial mobility assessment – to help with skin graft harvesting
• Hip mobility assessment – decreased range of motion can lead to difficulty in positioning during the surgery, or increased pain postoperatively if hips placed into already restricted position due to extensive time spent in position during surgery (6-8 hours); Communication with the surgeon on these limitations for possible position alterations to decrease time spent in restricted or painful range of motion
• Functional core assessment: weakness, overactivity or incoordination of abdominal and pelvic floor muscles contributes to bladder, bowel and sexual dysfunction. Some of this dysfunction may be present preoperatively and should be assessed and treated to improve post-operative outcomes.
• Patient-specific education: This is an essential component of any physical therapy treatment plan

Postoperative Pelvic Health and Orthopaedic Assessment:

• Continue to address postural and orthopaedic dysfunction found preoperatively, and reevaluate for changes in status, including strength, muscle flexibility and joint range of motion
• Evaluation and treatment for bladder, bowel and sexual health when appropriate (urinary urgency, painful intercourse, perineal itching, burning sensation, incontinence or leakage or any other discomfort in abdominal, genital or perineal area that may be present).
• Scar tissue management and myofascial therapies for FtM chest masculinization surgery, FtM and MtF bottom surgery, MtF Feminizing Mammoplasty
• MtF--dilator training and support; sexual health and improve function
• FtM-sexual health and improve function

The transgender population needs the support of our community, and from a young age. Gender identity, gender expression and sexual orientation as portrayed by society may conflict with how adolescents are perceiving themselves. This can have devastating consequences, including suicide. The transgender population has an alarmingly high suicide rate – 41% at some point in their lives, compared with 4.6% of the general population (from American Foundation for Suicide Prevention and the Williams Institute from results analyzed from the National Transgender Discrimination Survey). Providers need to educate themselves and be sensitive to these challenges that are faced.

We are an LGBTQIA - ally facility and welcome all.

At Fusion Wellness & Physical Therapy, while focusing on pelvic health, offers chronic pain therapies for the entire body. Our main goal is to create a healing and supportive environment that is welcoming to all. We look forward to seeing you soon.