Gender Affirmation Surgery: What is a vaginoplasty?
The visibility of the transgender community is increasing and so are options for gender affirming surgeries. These procedures alter the individual’s existing sexual characteristics to reflect their identified gender. An option for male to female gender affirming surgery is vaginoplasty, which means constructing a neovaginal canal - a new vagina! This requires altering external and internal pelvic structures. As you might imagine, disrupting the muscular support of the pelvic floor and changing urogenital structures may affect their function. Pelvic floor physical therapy, before and/or after your operation, may speed up your recovery and improve your satisfaction with the results of your surgery.
Physical Therapy and Prepping for Your Operation
If you are currently experiencing any pelvic floor dysfunction, from tight muscles to urinary incontinence, any operation that manipulates pelvic structures can amplify these symptoms. Some doctors may prescribe prehab - aka preoperative physical therapy - to help you get into the best shape you can before your surgical appointment.
Prehab can include patient education, manual therapy, and exercises to improve muscle strength, flexibility and speed of response. What this entails can vary based on patient need. If you are experiencing pelvic muscle pain or tension, your therapy may involve relaxation techniques and massage to the affected area. If you are experiencing urinary issues, you may work on strengthening the muscles in the pelvic floor.
Physical Therapy and Recovery
Recovery from surgery also looks different for every person. Some patients require little or no physical therapy to achieve successful outcomes. Others may find PT beneficial.
One important consideration after vaginoplasty is the use of a dilator to ensure the proper opening of the neovaginal orifice. Post-surgical patients may work with a pelvic floor physical therapist to best progress dilators until they have achieved their desired results. Another issue to address is proper tissue healing after reconstruction. Once a muscle is operated on, it’s important to regain strength and flexibility to preserve its function. Just as you would strengthen the muscles around your knee after an ACL repair, you can use exercise and stretching to regain strength and pliability in the muscles of your pelvic floor. A physical therapist can help guide these exercises and progress them appropriately. Scar tissue build-up can also affect function. Scar tissue is stiff, inflexible and makes movement difficult. Manual therapy with an experienced physical therapist can lesson scars, make them more pliable and therefore help you recover more movement faster.
Physical therapy involvement in prehab and rehab for gender affirming surgeries is evolving. As surgeries become more prevalent, some hospitals are developing partnerships with pelvic floor PTs to help patients achieve successful outcomes for their procedures. Research concerning the effect of pelvic floor PT on outcomes for vaginoplasty has thus far been positive. As more studies get funded, it will be exciting to see how else PT can aid the success of these surgeries.
- Event: Physical Therapy in Gender-Affirming Care: Transgender Health in Oakland, CA (Oct 19-20, 2019)âSection on Women’s Health. https://www.womenshealthapta.org/phptrans/. Accessed October 11, 2019.
- Flores AR, Herman JL, Gates GJ, Brown TNT. HOW MANY ADULTS IDENTIFY AS TRANSGENDER IN THE UNITED STATES? :13.
- Flores et al. - HOW MANY ADULTS IDENTIFY AS TRANSGENDER IN THE UNI.pdf. http://williamsinstitute.law.ucla.edu/wp-content/uploads/How-Many-Adults-Identify-as-Transgender-in-the-United-States.pdf. Accessed October 11, 2019.
- How Pelvic Floor Physical Therapy Can Serve the Transgender Population: Part 1. Pelvic Health and Rehabilitation Center. August 2018. http://pelvicpainrehab.com/transgender-health/5642/how-pelvic-floor-physical-therapy-can-serve-the-transgender-population-part-1/. Accessed October 11, 2019.
- Manrique OJ, Adabi K, Huang TC-T, et al. Assessment of Pelvic Floor Anatomy for Male-to-Female Vaginoplasty and the Role of Physical Therapy on Functional and Patient-Reported Outcomes. Annals of Plastic Surgery. 2019;82(6):661. doi:10.1097/SAP.0000000000001680.