Gender Affirming Surgery (GAS)
Physical therapy is recommended before surgery (if possible) and after all top and bottom surgeries. Many surgical procedures require physical therapy to help patients regain full function and maximize recovery and are considered health care standards of care.
You should expect to receive support after gender-affirming surgical procedures in the form of postoperative rehabilitation. Your surgeon will provide you with instructions for healing at home. Most patients gain immense benefits from a pelvic physical therapist following a rehabilitation protocol.
Many surgeons recommend pelvic therapy as a part of their pre-and post-surgical protocols. Recovery is optimal along with quality-of-life improvements with the addition of pelvic therapy for GAS patients (Jiang, et al., 2019; Manrique, et al., 2019).
Unfortunately, in the USA and abroad, few physical therapists are experts in treating issues specific to GAS patients. The importance of a pelvic therapist with expertise in treating patients who have had GAS should not be underestimated.
GAS Top surgeries
The augmentation or removal of breasts can cause adhesions and scars. Sometimes there can be a reduction of chest mobility. Posture and breathing mechanics can be affected along with the upper body’s range of motion.
The reduction of discomfort through physical therapy will help to achieve a return to mobility after chest surgery. Range of motion is increased and the improvement of scar tissue appearance is also achieved through physical therapy.
GAS: Pelvic Considerations with Bottom Surgeries
The pelvic floor muscles, pelvic fascial and neural structures, and the urethra are involved. Numerous incisions can lead to scars and several areas of healing of the tissues. This can lead to bowel, urinary, or sexual dysfunction and pelvic pain.
Examples include urinary challenges such as:
- difficulty initiating stream
- incomplete bladder emptying
- urgency/frequency
- spraying
- pain with urination or pain with intercourse
- scar tissue formation may lead to pain while sitting, or irritation caused by underwear or clothing
A donor site is required for phalloplasty. Tissue is taken from a donor site that can result in scar tissue formation that can lead to postural changes, pain, and restriction of movement.
Myofascial release techniques help the flap and skin grafts areas of the body so that tissue length is adequate. Postsurgically, this technique improves scar mobility and minimizes pain.
Physical Therapy and Bottom Surgery
Your physical therapist plays an important role both before and after your GAS.
A pelvic physical therapist can address and treat pelvic pain, bowel problems, or urinary problems before your surgery.
PHYSICAL THERAPY EVALUATION: WHAT TO EXPECT
Your physical therapist will answer all your questions regarding physical therapy and how therapy will help you to recover after your GAS. You can also expect to discuss any problems or issues at this time.
Examining Your Pelvic Floor Muscles
During your evaluation, your pelvic therapist will examine your pelvic floor muscles. These muscles support the organs inside your pelvis—including your bowels, uterus, and bladder.
The function of pelvic floor muscles include:
- urination and bowel movements
- to pass gas
- to become aroused, have sex, and ejaculation
Your physical therapy evaluation may also include the following:
- an assessment of your posture
- testing of the strength of your muscles
- assessment of your internal pelvic floor muscles
- gait and movement
- restrictions from scar tissue
WHAT SHOULD I EXPECT DURING PHYSICAL THERAPY?
Before your gender-affirming bottom surgery, your physical therapist will find out if you have any pelvic pain or urinary or bowel problems. Your physical therapist can also assess vaginal dilation if you had a vaginoplasty.
A couple of months after surgery, you may need other therapies to help reduce tension in your pelvic floor muscles.
These treatments are designed to treat:
- Incontinence (so fewer accidents)
- Less pain when you urinate
- Less pain while walking, standing, sitting and during sex
What Does a Pelvic Physical Therapist Do?
Physical therapists are highly educated, licensed healthcare professionals who help patients to improve their mobility and restore function. Physical therapists also educate patients on how to prevent or manage certain conditions so patients can stay healthy in the long term.
Click this link for more information: At Synergy Physical Therapy and Wellness, we welcome GAS patients as the ‘go-to’ place in our community for pelvic rehabilitation, health, and physical therapy care for the LGBTQIA+ community. All 3 of our clinics are designated by LGBTQ+Allies of Lake County as a Safe Space for the Transgender Community.
