Pelvic Floor Physiotherapy for Gender Diverse Patients

by Natasha Amsden  MScPT
Pelvic Physiotherapist
updated Feb 3, 2026

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Pelvic floor dysfunction can affect people of all gender identities and expressions. While pelvic health concerns are often discussed in gendered ways, the reality is that everyone has a pelvic floor and everyone deserves access to safe, respectful, and affirming care.

Unfortunately gender diverse individuals are less likely to seek medical care than cisgender patients. A U.S.-based study found that nearly 25% of trans-identifying individuals avoided healthcare due to fear of mistreatment or discrimination. This highlights the importance of creating safe, inclusive healthcare environments where gender diverse patients feel seen, respected, and supported.

 

Understanding Gender Diversity

Transgender is an umbrella term that refers to people whose gender identity does not align with the sex assigned to them at birth. This includes non-binary individuals.

• Gender identity refers to a person’s internal understanding of their gender.
• Gender expression is how someone presents their gender outwardly, through clothing, behaviour, or appearance.

Both identity and expression exist on a spectrum, and pelvic floor physiotherapy practices should honour and adapt to each individual’s lived experience.

 

Why Pelvic Floor Physiotherapy?

Pelvic floor physiotherapy plays a key role in providing affirming care for gender diverse patients. It can help address pelvic floor issues related to:

• Tucking practices
• Chest binding practices
• Gender-affirming surgeries, including:
  • Vaginoplasty
  • Phalloplasty
• Chest reconstruction surgery (including mastectomies and implants)
• Hormone therapy, which can impact tissue health, muscle function, and pelvic symptoms

Pelvic floor physiotherapy offers a non-judgmental space to explore these concerns while prioritizing comfort, ongoing consent, and autonomy.

 

How Can Pelvic Floor Physiotherapy Help?

Pelvic floor physiotherapy can support gender diverse patients in many ways, including:

Bowel and Bladder Care
Addressing symptoms such as urinary urgency, frequency, incontinence, constipation, or pelvic pain during elimination.

Pain Management
Helping manage pelvic pain, hip or low back pain, scar sensitivity, and chronic tension through manual therapy, movement, and nervous system regulation.

Pre-Operative Care
Preparing the body for gender-affirming surgery by improving pelvic floor awareness, strength, mobility, providing education on what to expect after surgery, and boost overall confidence.

Post-Operative Care
Supporting recovery through scar management, pain reduction, joint mobility work, pelvic floor strengthening, hip/core strengthening, dilator training (when appropriate), and safe return to daily activities.

Sexual Function
Improving comfort, confidence, and function related to sexual activity, including addressing pain, tension, or changes in sensation.

Hormone-Related Changes
Managing symptoms such as tissue changes, dryness, and muscle tone alterations related to hormone therapy.

 

What to Expect During a Pelvic Floor Physiotherapy Session

A Gender-Affirming Environment

Your therapist will use preferred names and pronouns, inclusive language, and prioritize your comfort and consent at every step.

Comprehensive Assessment

Sessions typically include a thorough discussion of your health history, goals, and concerns, followed by an in-depth assessment of the pelvic floor muscles, hips, spine, and core (only with your consent).

Personalized Care

Based on your needs, your therapist will create an individualized treatment plan. This may include:

• Manual therapy
• Targeted exercises
• Nervous system down-training
• Neuromuscular retraining
• Strategies for day-to-day activities, including gender affirming activities such as tucking or binding

Education and Empowerment

You’ll gain a better understanding of your body, the effects of surgery or hormones, and practical tools for self-management and long-term pelvic health.

 

Inclusive Care Matters

Pelvic floor physiotherapy should be accessible, affirming, and tailored to the individual. For gender diverse patients, finding a provider who listens, respects identity, and provides evidence-based care can make a meaningful difference in both physical and emotional well-being.

Everyone deserves pelvic health care that feels safe, supportive, and empowering.