Learn About Gender Health Physical Therapy and Gender Affirming Services at Fusion Wellness PT

What is Gender Health?

Gender health is a broad collection of multidisciplinary gender affirming treatments, interventions, and care that specifically relate to a person's gender, that may require specific expertise to manage.  Anyone can benefit from gender affirming care no matter if they are cisgender, transgender, and nonbinary (NB) people. This article is focused on how Gender Health relates to trans and nonbinary people. 

For anyone undergoing surgery, it is often beneficial to consult with a physical therapist several months prior to your surgery. Physical therapists can help improve strength and conditioning needed for recovering from surgery, no matter where in the body the surgery is performed. This can help you prepare by being in better health prior to surgery, for better outcomes after.

Patients that are prepping for, or have undergone gender affirming surgery (also termed gender confirmation surgery), will require the services of compassionate and skilled pelvic health and orthopedic physical therapists. There are several gender affirming surgery programs, such as OSHU and NYU Langone, that are incorporating pelvic floor physical therapy into their care plans. 

Physical therapists can also support transgender people that do not plan to have surgery, often referred to as Non-op. Trans bodies go through many desired changes as they transition; sometimes this can result in changes that are less desired such as changes in urinary function, sexual function, strength, or pain, and many of these changes can be successfully managed in pelvic floor physical therapy. Our physical therapists provide both pelvic health and orthopedic services, integrating a holistic approach to better treat our patients.

There are many ways a physical therapist can and should be involved in their integrative treatment plan to support their specific needs:

Nonoperative Pelvic Health and Orthopedic 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.
• Managing pain and dysfunction associated with hormonal changes to pelvic organs. Changes in hormonal balances can be associated with urinary and sexual dysfunction in people of any gender, cis or trans. Physical therapy can help reduce pain and improve function of pelvic organs that may be caused by hormone changes
• Orthopedic Pain management - not all aches and pains trans people experience are related to their transitions. Physical therapists can help manage pain with musculoskeletal causes no matter who you are.  It’s important for this safe and affirming care is accessible to everyone.
• Pregnancy, birth prep, and postpartum rehab - Trans men and transmasculine people become pregnant too and need just as much support through this life changing process as cisgender women.  Pelvic floor physical therapists can help manage pain, safe physical activity, preparation for delivery, and postpartum care and recovery. 

Preoperative Pelvic Health and Orthopedic Assessment:

• Fascial mobility assessment – to help with skin graft harvesting
• Shoulder mobility assessment prior to top surgeries (transmasculine or transfeminine)
• 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:

• Postsurgical edema and pain management
• Continue to address postural and orthopedic 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
• Dilator training and support if applicable
• Improve sexual and pelvic health

Access to safe and affirming care can be difficult for trans people to find. According to the 2022 US transgender survey, 48% of transgender people report at least one negative experience in healthcare in the last year. Everyone deserves to be treated with respect and to be seen as who they are. Providers need to educate themselves and be sensitive to these challenges that are faced. We go the extra mile at Fusion Wellness to not just be allies, but also hiring members of the LGBTQIA+ community to better meet the needs of the patients we serve.

We are a safe space and welcome all individuals to our practice.

At Fusion Wellness & Physical Therapy, while our primary focus is on pelvic health, our physical therapists all have advanced training to support our patients throughout their lifespan with their pelvic health, post-operative and orthopedic needs. This includes advanced certifications in lymphatic drainage and complete manual decongestive therapy, pilates, yoga, strength & conditioning and orthopedic board certification. We also offer chronic pain therapies for the entire body. We look forward to hearing from you, and you can use this form if you would like to schedule an appointment with one of our licensed physical therapists.