Understanding Transgender Surgeries, Recovery and the Role of Pelvic Floor Physical Therapy

Transgender surgeries, also known as gender-affirming surgeries, are critical procedures that help individuals align their physical bodies with their gender identities. These surgeries can be life-changing - promoting psychological well-being, improving body image and providing relief from gender dysphoria. However, like any significant medical procedure, recovery is a vital phase, requiring time, attention and often specialized care. Pelvic floor physical therapy plays a crucial role in helping individuals recover and regain functionality, especially after bottom surgeries (such as vaginoplasty and phalloplasty).

Let’s explore transgender surgeries, the recovery process and how pelvic floor physical therapy can aid in healing and improve long-term outcomes.

 Types of Transgender Surgeries

Transgender surgeries vary depending on whether an individual is undergoing male-to-female (MTF) or female-to-male (FTM) transition. Some of the most common surgeries include:

Male-to-Female Surgeries:

●      Vaginoplasty: This involves constructing a vagina, typically from penile and scrotal tissue, to create a functional and aesthetically aligned vaginal canal.

●      Facial Feminization Surgery (FFS): Procedures that alter the bone structure of the face to create more feminine features.

●      Breast Augmentation: Often performed to enhance the chest for a more feminine appearance.

Female-to-Male Surgeries:

●      Phalloplasty: This creates a functional penis, often using tissue from the forearm, thigh, or other parts of the body. It can also involve urethral lengthening and other procedures to allow for urination through the phallus.

●      Metoidioplasty: A surgery that creates a penis from the hormonally enlarged clitoris.

●      Chest Masculinization (Top Surgery): This involves removing breast tissue to create a flat, male-contoured chest.

Each surgery comes with unique risks, recovery times and challenges. Aftercare and follow-up, including pelvic floor therapy, play a significant role in ensuring optimal healing and function.

The Recovery Process: Key Phases and Challenges

The recovery period varies depending on the type of procedure, overall health and individual factors. However, common challenges include pain, swelling, tissue healing, scarring and in some cases urinary issues or concerns related to bowel function. Recovery typically follows these phases:

Acute Recovery (First Weeks Post-Surgery):

●      Rest and Wound Care: The first stage focuses on managing pain and swelling, preventing infections and ensuring the surgical site heals properly.

●      Limited Mobility: Depending on the surgery, individuals may need to limit movement to prevent strain on healing tissues.

●      Dilations and Urinary Care (MTF): Vaginoplasty patients often need to begin vaginal dilations to keep the neovagina open and functional. There may also be challenges with urination as tissues heal and swelling subsides.

Intermediate Recovery (1-3 Months):

●      Resuming Daily Activities: Gradually, individuals can start resuming light activities and work. Swelling and discomfort will reduce, but there may still be restrictions on strenuous exercise, sexual activity or lifting of heavy objects.

●      Pelvic Floor Focus: In this stage, addressing pelvic floor dysfunction or discomfort becomes crucial, particularly in patients who have undergone bottom surgery. Pelvic floor physical therapy can begin during this time to prevent complications and improve long-term outcomes.

Long-Term Recovery (6 Months and Beyond):

●      Return to Full Functionality: Over time, patients can expect to return to most activities, including exercise and sexual activity. However, some may experience lingering issues, such as scar tissue or discomfort, which can be mitigated through ongoing pelvic floor therapy.

●      Follow-Up Surgeries: In some cases, revisions may be necessary to refine surgical outcomes or address complications.

The Role of Pelvic Floor Physical Therapy

Pelvic floor physical therapy is an essential but often overlooked aspect of recovery, especially for transgender individuals undergoing bottom surgery. Pelvic floor muscles play a crucial role in urinary, bowel, and sexual function, all of which can be affected by surgery. Pelvic floor physical therapists are specially trained to assess and treat dysfunctions related to these areas.

Pelvic Floor Challenges in Transgender Recovery:

●      Muscle Tension and Pain: After surgery, pelvic floor muscles can become tense or painful. This is particularly common after vaginoplasty or phalloplasty, where the pelvic muscles may have been stretched, manipulated or affected by scarring.

●      Urinary and Bowel Dysfunction: Some individuals may experience difficulty with urination or bowel movements, either due to muscle tightness, nerve involvement or post-surgical swelling.

●      Sexual Function and Comfort: Pelvic floor therapy can improve sexual comfort by addressing scar tissue, muscle tension or alignment issues, particularly for those who may experience discomfort during penetration or other forms of sexual activity post-surgery.

How Pelvic Floor Therapy Can Help:

Pelvic floor therapy aims to promote healing, restore function and improve quality of life by addressing these key areas:

1. Scar Tissue Mobilization: Therapists use gentle manual techniques to soften scar tissue and improve mobility, reducing discomfort.

2. Pelvic Floor Muscle Retraining: Using biofeedback, manual therapy and exercises, pelvic therapists help patients retrain their pelvic floor muscles to function optimally for urination, bowel movements and sexual function.

3. Pain Management: Techniques like trigger point release, myofascial release and relaxation exercises can relieve pain and tension in the pelvic muscles.

4. Education and Dilation Guidance: For MTF patients, physical therapists can provide education and support for vaginal dilation to ensure the neovagina stays open, functional, and pain-free.

Solstice Physiotherapy Recommendations when using Dilators:

-       We commonly work with Soul Source dilators, which are prescribed by your physician: Soul Source Dilators

-       At Solstice Physiotherapy, we use Slippery Stuff lubricant, a water-based lubricant that can be used during PT sessions and at home when dilating.  Slippery Stuff Lubricant    

Suggested Positions When Dilating:

●      Lie down on your back or side (1, 2).

●      You can use a pillow to support your head (3) or leg (4).

Relax your abdominal (belly) and pelvic muscles. These positions won’t put stress on surgical sites at the labia and vaginal opening.

1.

Description: Laying flat on your back with knees bent

2.

Description: with upper back and head propped up with pillows, knees bent

*With head supported and resting comfortably on pillow

3.

Description: Laying on your side, with bottom knee bent and top knee bent

4.

Description: Laying on your side with top knee bent and resting on pillow, bottom knee is also bent; reaching from behind to insert the dilator

*This position is not commonly used but helpful if reaching over

your abdominal (belly) is difficult.
Positions to avoid:

●      The butterfly pose (5) puts stress on surgical areas at the labia and

            vaginal opening. It also makes the vaginal opening harder to reach.

●      The seated position (6) makes placing the dilator difficult. It also puts

            stress on the vaginal opening as it needs to heal from surgery.

5.

Description: Laying flat with knees butterflied out to the sides

6.

Description: sitting upright

Optimizing Recovery Through Multidisciplinary Care

While surgeons perform the life-changing procedures, post-operative care is a team effort. Surgeons, primary care providers, mental health professionals and pelvic floor physical therapists all work together to ensure that transgender individuals not only heal well physically but also thrive emotionally and psychologically.

The healing process is multifaceted, and patients should feel empowered to seek the full range of medical and therapeutic care they need. For those undergoing bottom surgeries, pelvic floor physical therapy can provide significant relief and prevent long-term complications, allowing individuals to enjoy the full benefits of their surgery.

In Summary…

Transgender surgeries are a significant step in gender affirmation, but the recovery process demands attention, care and patience. Pelvic floor physical therapy is a key component of this journey, especially for those undergoing bottom surgeries like vaginoplasty or phalloplasty. By addressing pain, improving muscle function and promoting healing, pelvic therapy ensures a smoother recovery and better long-term outcomes.

If you or someone you know is preparing for or recovering from gender-affirming surgery, don’t hesitate to explore the benefits of pelvic floor physical therapy as part of a comprehensive post-surgery care plan. With the right support, recovery can be empowering, helping you live more comfortably in your body.

Call us at 929-269-2505 or email us at info@solsticept.com to schedule a free 15-minute consultation to discuss your concerns and learn about how we may be able to help with your transgender journey.