Gender Affirming Care and the Pelvic Floor  - Legacy Physical Therapy
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Gender Affirming Care and the Pelvic Floor 

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Every day we continue to grow in our understanding of gender expression and sexuality. For LGBTQIA+ folx, gender expression often helps with affirming gender identity and helps address gender dysphoria. Pelvic floor therapy can be a great asset to individuals who are practicing gender affirming care without surgical intervention (or awaiting surgery). While these practices can be very important for mental health and positive outlook on life, there can be side-effects or complications from these practices. Below are descriptions of these practices, main concerns, tips to decrease these issues, and how pelvic floor therapy can help.

BINDING

Binding is a flattening of the breast tissue to give the appearance of a flatter chest. This can be performed with multiple different types of materials including tight-fitting sports bras, specialty tape, binders, or shirts. It is recommended to avoid ACE bandages, plastic wrap and duct tape. Due to the prolonged compression that binding provides, a wearing schedule is highly recommended. 

The main health concerns with binding include abdominal pain, abdominal muscle wasting, constipation/GI distress, breathing dysfunction, and back pain. In order to decrease these complications, it is recommended to limit binding time to 8-12 hours per day (removing binder while sleeping) as well as to take a break from binding (ideally one day per week). When applying the binder, make sure your skin is fully dry. You also want to make sure that you are wearing the correct size (do not “size down”) and you should be able to breathe easily and fully while wearing the binder. If you choose to wear a binder while exercising, try to use less-restrictive compression to allow for better breathing and to avoid skin breakdown.

So how can we help? Pelvic physical therapy can help address posture, breathing, as well as by working on the muscles and tissue of the chest in order to decrease pain and discomfort, and to ensure safe binding technique. 

PACKING

Packing is a creation of a bulge in the genital area. This can be performed with a prosthesis, a dildo, or socks.

The main health concerns with packing include skin breakdown, infection, changes in walking pattern, pelvic pain, and urinary dysfunction. In order to decrease these complications, it is recommended to ensure proper hygiene and cleaning of the skin and packing material. If possible, try to use breathable fabrics. It is also recommended to allow the skin to recover by adjusting the wearing time and removing the prosthesis/packers when you are sleeping and when at home. 

We can help here too! Pelvic physical therapy can help by addressing urinary concerns, decreasing muscle tension of the hips and pelvis, as well as by assessing and modifying gait pattern to decrease the potential for additional muscle compensation.

TUCKING

Tucking includes moving of the penis and scrotum to give the appearance of a flatter pubic area. The testicles can be moved to the base of the shaft of the penis or the inguinal canal, and the penis can be moved between the legs. This can be performed with tape or a tight fitting garment (such as underwear or a gaff). If you choose to use tape, it is recommended to use athletic tape to decrease skin breakdown. It is also recommended to try to use breathable fabrics.

The main health concerns with tucking include dehydration (as many individuals who practice tucking restrict fluid intake – the process of tucking can be time-consuming and they want to decrease the trips to the bathroom), bladder dysfunction, skin breakdown, constipation and bowel dysfunction, infection and irritation of the urethral meatus (due to the urethra sitting close to the anus), changes in walking patterns, and muscle tension in the legs. In order to decrease these complications, it is recommended to not tuck while sleeping and to have breaks from tucking for short periods throughout the day. If possible, it is also recommended to wear looser-fitting clothing so you do not have to tuck as tightly. In addition, it is essential to drink plenty of water. 

Again, pelvic physical therapy can help you by addressing tight muscle tension of the pelvis and legs as well as addressing proper gait patterns. Pelvic physical therapy can also address any urinary concerns or constipation.  

We are very aware that individuals of the LGBTQIA+ community have hesitancies and concerns when choosing a medical provider, especially when trusting a health professional with your pelvic health. In order to help ease these concerns, we offer a free virtual or in-person consultation with one of our licensed physical therapists. If you are interested in scheduling an appointment with one of our pelvic floor therapists, please fill out the link below!

We look forward to seeing you and being a part of your team!