How Pelvic Floor Therapy Plays a Role in Gender-Affirming Care

Hi friends! When we think about pelvic floor physical therapy, we often picture support during pregnancy, postpartum recovery, or bladder control issues.  We often picture pelvic floor clients as being pregnant, postpartum, or older females. But did you know pelvic floor therapy can also play an important role in gender-affirming care?

Whether you're preparing for gender-affirming surgery, recovering afterward, or simply looking to feel more connected to your body, pelvic floor physical therapy can support you throughout your journey.

What Is the Pelvic Floor?

The pelvic floor is a group of muscles at the bottom of your pelvis that support your bladder, bowels, and—depending on your anatomy—your reproductive organs. These muscles also help with urination, bowel movements, sexual function, and core stability.

Everyone has a pelvic floor, and just like any other muscle group, it can become tight, weak, overactive, or painful.

Several factors, including hormonal therapy, in transgender individuals can affect pelvic floor muscle function because of changes in muscle mass, connective and adipose tissue, and the pelvic organ support system (Dominoni, 2025).  Up to 42% of individuals have symptoms of pelvic floor muscle dysfunction before ever having surgery (Dominoni, 2025).

How Pelvic Floor Therapy Supports Gender-Affirming Care

1. Pre-Surgical Preparation

If you're planning gender-affirming surgery surgery (like vaginoplasty, phalloplasty, hysterectomy, etc.), pelvic floor therapy can help prepare your muscles for a smoother recovery. A therapist can help teach you how to :

• Relax pelvic floor muscles that are too tense

• Strengthen pelvic floor muscles that are weak

• Coordinate the muscles to do the right thing at the right time

• Address any underlying symptoms like urinary urgency, pain with sex, or constipation

This can not only help pre-operatively but can help to improve pelvic floor muscle function post-operatively.  One study found that 69% of individuals undergoing vaginoplasty who had pelvic floor therapy prior to surgery had pelvic floor symptoms resolve by their first post-operative appointment (Jiang, 2019).

2. Post-Surgical Recovery

In the first 15 days following genital gender affirming surgery, the pelvic floor muscle strength and electrical activity has been shown to be lower because of pudendal nerve damage, hematomas, and/or small fluid collections (Bertolotto, 2017).

After gender-affirming surgery, you may experience pain, tightness, scarring, or difficulty with bowel movements, urination, or sexual activity. A pelvic floor physical therapist can:

• Guide you through scar massage and gentle mobility work

• Help with dilator use after vaginoplasty

• Support bowel and bladder function

• Help restore strength, comfort, and confidence

Recovery is personal, and therapy is always tailored to your body and your goals.  A pelvic floor therapist should perform a complete evaluation to help determine the best treatment options for you.

3. Non-Surgical Support

You don’t need to have surgery to benefit from pelvic floor therapy. Trans and nonbinary individuals may seek therapy for:

• Pain with sitting, penetration, or sexual activity

• Urinary urgency or leakage

• Constipation or bowel changes

• Tension related to gender dysphoria or past trauma

  
  

Your therapist should meet you where you are and work with you in a respectful, affirming way.

What to Expect in a Pelvic Floor PT Session

Accessing supportive care can be a barrier, especially depending on your location.  Remember that your comfort is the top priority. The first visit usually involves a conversation about your goals, symptoms, and medical history. If you're comfortable and it’s appropriate, the therapist may check how your pelvic floor muscles are working—either externally or with your consent internally.

You are always in control. You can stop or decline any part of the exam at any time, and your therapist will always explain everything beforehand.

Treatment then addresses any areas that were found in the initial exam.  This might include breath work, stretches, strengthening exercises, changes to daily habits, and more.

Inclusive, Affirming Care Matters

Everyone deserves care that respects their identity, body, and goals. Pelvic floor physical therapy can be a powerful tool in helping you feel more at home in your body—whatever that looks like for you.

To learn more about your pelvic floor muscles, check out these great resources:

• Find a Therapist near you at www.mypfm.com/find-a-pt

• Check out our YouTube channel

• Learn more about your pelvic floor on our Instagram

• Visit our Amazon store for our favorite pelvic health products

• Sign up for our email newsletter

For providers, check out myPFM Academy to learn more so you can better help your clients. With two membership options, you have access to courses, a growing library of patient handouts, hundreds of custom sharable images and infographics, and multilingual resources.

Written by Emily Reul, PT, DPT

References

1. Bertolotto M et al.  MR imaging in patients with male-to-female gender affirming surgery: post-operative anatomy and complications. Br J Radiol. 2017;90(1072):20170062.

2. Dominoni M et al.  Pelvic floor and sexual dysfunctions after genital-affirming surgery: a systematic review and meta-analysis. J Sex Med.  2025;22:184-195.

3. Jiang DD et al.. Implementation of a pelvic floor physical therapy program for transgender women undergoing gender-affirming vaginoplasty. Obstet Gynecol. 2019;133(5):1003-1011.