Transgender Pelvic Health

Published January 1, 2026

What You Need to Know 

• Inclusive environments—such as displaying pronouns, offering all-gender restrooms, and using affirming language—help patients feel welcome and respected.
• PTs will generally see people for gender-affirming care including pelvic floor therapy, post-surgical rehabilitation (e.g., vaginoplasty, phalloplasty, chest reconstruction), and management of hormone-related musculoskeletal and metabolic changes.
• All PTs—not only pelvic health specialists—have a role in supporting lifelong movement health for people who are transgender or gender diverse.

Pelvic physical therapists and all physical therapists consider a biopsychosocial model when working with patients with varied conditions and diagnoses.  A trauma informed care approach to practice in an inclusive environment is important when working with veterans, refugees and people who sustained injuries in accidents or violent events. People need to feel safe, heard and validated.  Each of the above is essential when working with people from the transgender gender diverse community, people who are part of a currently, and historically, marginalized group. Many have a history of negative experiences with medical professionals (James, S. et al., 2024). Societally, they tend to have less family support, employer support and housing support (James, S. et al., 2024). A therapy clinic can be a place to heal and experience a welcoming and inclusive environment. Images of diverse people in your facility, forms with open-ended questions, your pronouns displayed on your badge, and all-gender bathrooms are simple ways to signal that you are a safe person. 

All physical therapist have a role in working with people from the TGD community. By default, we think of genitals when with think of gender.  Gender affirmation is more than that, and it affects more than reproductive structures. It is true the pelvic physical therapists will more frequently see people for gender affirming care, in situations like vaginal tissue changes associated with gender affirming testosterone (Coleman et al., 2022), dilation training following gender affirming vaginoplasty (Coleman et al., 2022; Jiang et al., 2019) or sensory training following phalloplasty (Peters et al., 2022). Common gender affirming surgeries include the face, chest, forearm and thigh (Coleman et al., 2022) Rehabilitation of these surgeries optimizes return to function. Medical transition with hormonal suppression and gender affirming testosterone or estrogen will have life span impacts on bone health, metabolic health, muscles and the cardiovascular system (Coleman et al., 2022; McGovern, 2023). Our role as the movement specialist is paramount to keeping these systems healthy throughout a person’s life. 

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