Pride Month and Pelvic Floor Physical Therapy Part 2!

In LGBQT Healthcare Rights by Danae Narvaza

Pride Month and Pelvic Floor Physical Therapy Part 2!

By Danae Narvaza PT, DPT, PHRC Encinitas

Cis-gendered people who have sought help for pelvic floor dysfunction will tell you accessibility and awareness makes finding the right help harder than it should be. June marks Pride Month and to celebrate we want to shed light on another underserved population seeking help: the transgender and non-binary population. If you have not seen my blog post Pride Month and Pelvic Floor physical Therapy Part 1: What is Binding? Please check it out! We want to help to be a part of the solution of this pelvic healthcare disparity. In this post we will be breaking down different practices that are used within gender affirming care and how this impacts safety and health, and what we can do about it from a PT, referring healthcare provider, peer, and/or patient perspective. In this specific blog, we will be discussing the practice of tucking and how physical therapy can be implemented into patient care

What is Tucking and Why Is It Used?


  • Genital tucking is the practice of reducing the appearance of one’s genitals or gonads.


  • This is often done by pushing one’s gonads into the inguinal canal and/or pulling up the shaft of the penis and moving it in between the legs.


  • Transfeminine, gender diverse, intersex, and non-binary people may practice tucking to affirm their gender identity, alleviate dysphoria, feel a better sense of safety, reduce discrimination, and/or feel more comfortable in certain clothing. Gender affirming practices (with tucking being one example) was reported to be a crucial contributor to mental health and safety – with positive outcomes including improvements in mood and reduced suicidality, anxiety, and depression. This gives individuals the sense of safety to leave their homes to do basic activities of daily living and participate in social, work, and familial activities without being subject to violence or discrimination for their physical appearance.

Safety Considerations of Tucking?


With the above positive outcomes in consideration, it is important then to provide informed consent of the negative and harmful impacts of tucking. In a research article from The Annals of Family Medicine in March/April 2024 (Kidd et. al 2024), a survey was conducted where patients reported the following symptoms that they attributed to tucking:

  • Pain in gonads
  • Genital pain
  • Itching and/or rash
  • Urinary tract infections
  • Twisting of gonads
  • Skin infection, and
  • Infertility

65% of the respondents had at least one side effect from tucking with only 10% of the respondents seeking medical care for their side effects. This gap demonstrates an apparent disconnect and need for improving access, competency, and awareness of gender affirming care.


  • It should not be painful
  • You should take regular breaks
  • It should not be done while sleeping or playing sport
  • It should be done with an appropriately fitted gaff
  • It should be done with medical grade tape and not duct/packing tape
  • It should be gradually introduced (starting off slow and carefully), and
  • You should be gentle with adjustment of gonads and penis
  • An alternative tucking method that some may use is wearing multiple layers of fitted underwear. If this method is being used, make sure the underwear is not too restricting and tight, as this can cause pelvic pain and/or injury.

Why Should Healthcare Providers Know and Care About Tucking?

As a healthcare provider, parent, friend, and human being coexisting with the gender diverse community, it is vital to recognize how gender affirming techniques are most dangerous when driven underground due to judgment of peers, family members, colleagues and healthcare providers. A survey was conducted where it was revealed that: “While 70% of respondents felt they would be comfortable or very comfortable discussing tucking with their healthcare provider, only 23% reported having discussed tucking. A majority of participants felt that it would be helpful for clinicians to openly discuss the potential risks and benefits of tucking. Suggestions for clinicians included: asking permission, using inclusive and empathic language, explaining the reasoning behind broaching the topic, and being knowledgeable about methods and potential risks of tucking.” (Kidd et. al 2024).

Relevance to Pelvic Floor Physical Therapy

With considerations of potential tension and compression forces put on the pelvic myofascial tissues with tucking, this may put users at risk for pelvic and/or genital pain related to nerve and/or muscle contributions. Seeing a pelvic floor physical therapist could be helpful to balance the use of tucking by managing residual pain secondary to tucking. A pelvic floor physical therapist is advisable to better assess the current state of your tissues involved with tucking such as: the tone pelvic floor muscles, gluteal muscles, adductors, core, and more!

Reasons you should be advised to see a pelvic floor PT include the following:

  • Pelvic Pain
  • Abdominal Pain
  • Genital Pain
  • Painful Sex
  • Sexual Dysfunction
  • Urinary Urgency and/or Increased Frequency of Urination
  • Urinary Incontinence
  • Constipation
  • Gluteal, Pelvic Floor, and/or Lower Extremity Weakness/Pain

Would you like more information? Check out our Tucking Series on Instagram!

Tucking Part 1

Tucking Part 2

Tucking Part 3

Tucking Part 4

Frequently Asked Questions

Q: Why is pelvic health important for the LGBTQ+ community?

A: Pelvic health is vital for everyone, but the LGBTQ+ community may face unique challenges and stigmas that can impact their overall well-being. Understanding and addressing these specific needs ensures better healthcare outcomes and fosters a more inclusive healthcare environment.

Q: Are there specific pelvic health issues that affect the LGBTQ+ community?

A: Yes, certain pelvic health issues may be more prevalent or present differently within the LGBTQ+ community. For example, transgender individuals may experience unique pelvic health concerns related to hormone therapy or surgical procedures. It’s essential to address these issues with specialized knowledge and care.

Q: How can healthcare providers create a welcoming environment for LGBTQ+ patients?

A: They can create a welcoming environment by using inclusive language, displaying LGBTQ+ affirming symbols, offering training on LGBTQ+ health issues, and ensuring privacy and respect during consultations. Building trust through culturally competent care is crucial.

Q: Where can LGBTQ+ individuals find resources about pelvic health?

A: There are various resources available, including LGBTQ+ health organizations, online forums, and specialized healthcare providers who focus on LGBTQ+ pelvic health. Reputable websites like the American Psychological Association and the World Professional Association for Transgender Health also offer valuable information.

Q: Is there any other information you can give us in regards to pride month physical therapy?

A: We have a section on our site about Transgender PFPT services.


Physical Therapy Rehab After Gender Affirming Surgeries

Gender-Affirming Surgery + Pelvic Floor PT: IG Live w/ Dr. Jun

Our Services



Check out our recently published e-book titled “Vulvodynia, Vestibulodynia, and Vaginismus,” designed to empower and inform individuals on their journey towards healing and understanding.

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What are pelvic floor muscles?

The pelvic floor muscles are a group of muscles that run from the coccyx to the pubic bone. They are part of the core, helping to support our entire body as well as providing support for the bowel, bladder and uterus. These muscles help us maintain bowel and bladder control and are involved in sexual pleasure and orgasm. The technical name of the pelvic floor muscles is the Levator Ani muscle group. The pudendal nerve, the levator ani nerve, and branches from the S2 – S4 nerve roots innervate the pelvic floor muscles. They are under voluntary and autonomic control, which is a unique feature only they possess compared to other muscle groups.

What is pelvic floor physical therapy?

Pelvic floor physical therapy is a specialized area of physical therapy. Currently, physical therapists need advanced post-graduate education to be able to help people with pelvic floor dysfunction because pelvic floor disorders are not yet being taught in standard physical therapy curricula. The Pelvic Health and Rehabilitation Center provides extensive training for our staff because we recognize the limitations of physical therapy education in this unique area.

What happens at pelvic floor therapy?

During an evaluation for pelvic floor dysfunction the physical therapist will take a detailed history. Following the history the physical therapist will leave the room to allow the patient to change and drape themselves. The physical therapist will return to the room and using gloved hands will perform an external and internal manual assessment of the pelvic floor and girdle muscles. The physical therapist will once again leave the room and allow the patient to dress. Following the manual examination there may also be an examination of strength, motor control, and overall biomechanics and neuromuscular control. The physical therapist will then communicate the findings to the patient and together with their patient they establish an assessment, short term and long term goals and a treatment plan. Typically people with pelvic floor dysfunction are seen one time per week for one hour for varying amounts of time based on the severity and chronicity of the disease. A home exercise program will be established and the physical therapist will help coordinate other providers on the treatment team. Typically patients are seen for 3 months to a year.

What is pudendal neuralgia and how is it treated?

Pudendal Neuralgia is a clinical diagnosis that means pain in the sensory distribution of the pudendal nerve. The pudendal nerve is a mixed nerve that exits the S2 – S4 sacral nerve roots, we have a right and left pudendal nerve and each side has three main trunks: the dorsal branch, the perineal branch, and the inferior rectal branch. The branches supply sensation to the clitoris/penis, labia/scrotum, perineum, anus, the distal ⅓ of the urethra and rectum, and the vulva and vestibule. The nerve branches also control the pelvic floor muscles. The pudendal nerve follows a tortuous path through the pelvic floor and girdle, leaving it vulnerable to compression and tension injuries at various points along its path.

Pudendal Neuralgia occurs when the nerve is unable to slide, glide and move normally and as a result, people experience pain in some or all of the above-mentioned areas. Pelvic floor physical therapy plays a crucial role in identifying the mechanical impairments that are affecting the nerve. The physical therapy treatment plan is designed to restore normal neural function. Patients with pudendal neuralgia require pelvic floor physical therapy and may also benefit from medical management that includes pharmaceuticals and procedures such as pudendal nerve blocks or botox injections.

What is interstitial cystitis and how is it treated?

Interstitial Cystitis is a clinical diagnosis characterized by irritative bladder symptoms such as urinary urgency, frequency, and hesitancy in the absence of infection. Research has shown the majority of patients who meet the clinical definition have pelvic floor dysfunction and myalgia. Therefore, the American Urologic Association recommends pelvic floor physical therapy as first-line treatment for Interstitial Cystitis. Patients will benefit from pelvic floor physical therapy and may also benefit from pharmacologic management or medical procedures such as bladder instillations.

Who is the Pelvic Health and Rehabilitation Team?

The Pelvic Health and Rehabilitation Center was founded by Elizabeth Akincilar and Stephanie Prendergast in 2006, they have been treating people with pelvic floor disorders since 2001. They were trained and mentored by a medical doctor and quickly became experts in treating pelvic floor disorders. They began creating courses and sharing their knowledge around the world. They expanded to 11 locations in the United States and developed a residency style training program for their employees with ongoing weekly mentoring. The physical therapists who work at PHRC have undergone more training than the majority of pelvic floor physical therapists and as a result offer efficient and high quality care.

How many years of experience do we have?

Stephanie and Liz have 24 years of experience and help each and every team member become an expert in the field through their training and mentoring program.

Why PHRC versus anyone else?

PHRC is unique because of the specific focus on pelvic floor disorders and the leadership at our company. We are constantly lecturing, teaching, and staying ahead of the curve with our connections to medical experts and emerging experts. As a result, we are able to efficiently and effectively help our patients restore their pelvic health.

Do we treat men for pelvic floor therapy?

The Pelvic Health and Rehabilitation Center is unique in that the Cofounders have always treated people of all genders and therefore have trained the team members and staff the same way. Many pelvic floor physical therapists focus solely on people with vulvas, this is not the case here.

Do I need pelvic floor therapy forever?

The majority of people with pelvic floor dysfunction will undergo pelvic floor physical therapy for a set amount of time based on their goals. Every 6 -8 weeks goals will be re-established based on the physical improvements and remaining physical impairments. Most patients will achieve their goals in 3 – 6 months. If there are complicating medical or untreated comorbidities some patients will be in therapy longer.