August 26, 2019
For many in the LGBTQ+ community, access to compassionate health care can be challenging. Especially for those within the transgender/gender diverse population, discrimination is continuing to be recognized. A 2014 report by Lambda Legal notes that 70 percent of transgender patients have experienced serious discrimination when seeking medical treatment, leaving many to avoid seeking treatment altogether. In fact, nearly one-quarter of transgender respondents to a 2017 survey said they avoid doctors or health care out of concern that they will experience discrimination, and 31% said they had no regular doctor or form of health care. Even emergency care can be an issue. A 2018 study found that a majority of transgender adults visiting the ER reported that staff lacked experience with and knowledge of health issues specific to the transgender community, particularly those related to hormone therapy or gender-affirming surgery.
Culturally competent health care providers recognize these challenges and aim to deliver health care services with the specific needs of the patient in mind. In recent years, the American Physical Therapy Association [APTA] noted the importance of cultural competence in working with transgender/gender diverse patients. As physical therapists, it is our goal to assist individuals in improving function and quality of life through movement. As culturally competent physical therapists, it is our goal to ensure that every patient is provided with the highest quality of care, dignity and respect.
While your exact needs should be determined by a medical professional, there are a number of common complications that accompany gender affirmation practices and surgeries that can be relieved through physical therapy. Seeking assistance from a pelvic health physical therapist can improve this experience. Here is why: While surgery in general takes a toll on your body, affirmation surgeries require extreme changes to the structure. The anatomy of your body will be completely different and you need an educated partner on your team who will assist you in navigating the process of this transition. Outside of this, surgery in general brings on scar tissue and myofascial restrictions, which can hinder your ability to move properly and often leads to pain and other complications.
Physical therapists can help prevent or address many impairments resulting from gender affirmation practices and surgeries that may arise. With the drastic change in anatomy that results from “bottom” surgery can come complications, particularly with the pelvic floor. The pelvic floor is a group of muscles located within the pelvis that act as a support system to the organs in your abdomen and works to voluntarily control bowel and bladder function. According to a recent study, 47% of those who undergo affirmation surgeries report difficulty urinating while 23% report a decrease in sexual function. A pelvic health physical therapist can help you avoid or address these complications through retraining pelvic floor muscles and improving control over bowel and bladder habits. Other procedures such as mastectomy or breast augmentation also create change to the tissue and requires the help of a physical therapist to ensure your body is able to function properly with that change.
Physical therapists are known as the experts in movement, but movement alone does not rehabilitate the whole person. Our friends in the therapy world are also great resources on assisting those in the transgender/gender diverse population in helping with affirmation changes. Some examples of other resources include:
As professionals that stand for treating the whole person, we advocate the best for our patients. There are many aspects of your care that should be addressed in a unique and personalized manner, and including the right providers on your team is important. The list of healthcare providers above is an example of the types of medical professionals you might need but is not an exhaustive list of the types of support available. We understand that searching for a healthcare provider that is aware of your specific needs can be challenging. Below are resources to assist you in finding other providers to make that process a little easier:
Louisville Trans Men
Adult group for those who identify as Trans-masculine. https://louisvilletransman.wixsite.com/support
Metro Louisville P-FLAG:
“Parents and Friends of Lesbian and Gays”. Support group that provides education to those in the LGBT population and their families/friends.
TSTAR (Trans and Sexuality Teaching, Advocacy and Research)
Group that provides community building and education to those within the LGBT/gender non-conforming population.
Adult support group for those who identify as Trans-feminine. www.transwomennational.org
National Center for Transgender Equality
Advocates/informs patients regarding insurance https://transequality.org/know-your-rights/health-care
Fenway institute National LGBT Health Education Center:
Provides healthcare providers with education in treating the LGBT population http://fenwayhealth.org/the-fenway-institute/education/the-national-lgbt-health-education-center/
Gay and Lesbian Medical Association (GLMA)
Promotes equality in healthcare for LGBT individuals and healthcare providers. www.glma.org
World Professional Association for Transgender Health
Promotes EBM, education, and research in transgender health http://www.wpath.org/
Ciesla C, Fitzgerald K, Herman H, et al. Physical Therapy Care of Patients who are Trans/ Gender Diverse.
Haas AP, Rodgers PH, Herman JL. Suicide Attempts among Transgender and Gender Non-Conforming Adults. American Foundation for Suicide Prevention. https://williamsinstitute.law.ucla.edu/wp-content/uploads/AFSP-Williams-Suicide-Report-Final.pdf
Combaz N, Kuhn A. Long-Term Urogynecological Complications after Sex Reassignment Surgery in Transsexual Patients: a Retrospective Study of 44 Patients and Diagnostic Algorithm Proposal, Am J Urol Res. 2017;2(2): 038-043.
Kuhn A, Santi A, Birkhäuser M. Vaginal prolapse, pelvic floor function, and related symptoms 16 years after sex reassignment surgery in transsexuals. Fertility and Sterility. 2011;95(7):2379-2382. doi:10.1016/j.fertnstert.2011.03.029.
Tyler Kornblum is a third year DPT student at Bellarmine University who recently completed one of her final clinical internships with Dunn Physical Therapy. She is pursuing a career in pelvic health physical therapy as she ends her final year of physical therapy school.