Pride Month and Pelvic Floor Physical Therapy!

In LGBQT Healthcare Rights, Transgender Pelvic Health by Danae Narvaza

By Danae Narvaza PT, DPT, PHRC Encinitas

Cis-genered 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. 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 physical therapist, referring healthcare provider, peer, and/or patient perspective. In this specific blog, we will be discussing the practice of binding.

 

What is Binding and Why Is It Used?

WHAT: 

  • Binding is the act of using special undergarments to tightly wrap around the breast tissue in order to achieve a flatter chest contour. 

WHY:

  • Some may do this with or without the intention of having gender-affirming chest surgery. The purpose of binding is to help individuals feel more aligned with their gender identity or expression, and to help with gender dysphoria. 
    • Gives individuals the sense of safety to participate in basic activities of daily living (ex: the ability to leave their homes confidently to work, socialize, run errands, etc) without being subject to violence or discrimination for their physical appearance. 

BENEFITS FOR PEOPLE WHO BIND: 

  • It is a crucial contributor to mental health and safety – having positive outcomes including improvements in mood and reduced suicidality, anxiety, and depression (Hughto et. al 2020)

 

What are Safety Considerations of Binding?

RECOMMENDATIONS:

  • Do not wear a binder for over eight hours
  • Schedule binding breaks if you need to go longer than eight hours
  • Do not sleep with the binder on
  • Do not exercise with your binder on (unless advertised as exercise-safe binder) 
  • Get appropriately sized for a binder
  • Take one or more days off of binding throughout the week

 

DANGERS OF STIGMAS:

  • If an individual lives in an environment where binders are not accessible (ex: living in an unsupportive household or being in an environment with caregivers/parents/family members who disapprove of or do not understand your needs for gender affirmation), many turn to elastic binding – which is not advised. This informal way of binding is not recommended, because it is linked with negative health outcomes (seen in the following paragraph). In other cases, some may get access to a binder, but have to hide it due to the home environment, hindering them from regularly washing it and puts them at risk for skin irritation and infections. Another obstacle of consideration may be an inaccurately sized binder, which is also problematic, where too tight or too loose binders could affect someone’s trunk mobility and/or function. 

 

NEGATIVE HEALTH OUTCOMES:

  • Binding may affect your skin, muscles, and movement, while excessively tight binders can damage nerves and muscles, and restrict breathing leading to gastrointestinal and/or pelvic issues. A cross sectional study in 2020 covered negative physical health outcomes involving pain, musculoskeletal, neurological, gastrointestinal, general, respiratory, and skin/soft tissue systems in 97% of the 1800 participants with 18 of 27 symptoms observed having an average time of onset of under 1 year, assuming average intensity of binding to 10 hours per day. Meanwhile, more rare and serious symptoms took longer to emerge, such as rib fractures, muscle wasting, respiratory infection, scarring, swelling, and skin infections (Peitzmeier et. al 2021). Additionally, in rare occasions, incorrect binding can lead to rib fractures.

 

Why Should We Care About Binding?

It is crucial to recognize how gender affirming techniques are most dangerous when driven underground due to judgment of peers, family members, colleagues and healthcare providers. In a national cross sectional study in 2020, more than half of the nonbinding cohort participants reported that their parent was a barrier to them binding their chest, which was also consistent with the past of those participants who were currently binding. The study highlighted the resourcefulness of the youth who do not have access to commercial grade binders, due to the barrier of finances and/or parental support, leading to participants using miscellaneous items for binding to mitigate the distress they were experiencing (ex: tarps, pantyhose, girdles, etc.). While resourceful, the potential harm of these items supports the argument that medical providers should be asking more questions when patients present with chest dysphoria or discomfort. The authors recommended that medical providers then learn how to size and fit a patient for a binder, advocate for insurance companies to provide coverage for this medical device, and work with trans affirming binder companies to provide in-clinic binders.

 

Relevance of Binding to Physical Therapy

Binding may result in back, chest, and/or shoulder pain, numbness, or scarring. In addition, with the chest, ribs, and posture potentially impacted, this may affect myofascial tissue extensibility – which we would want to be at an adequate state prior to surgery in order to prevent post op complications. Seeing a physical therapist would be helpful to determine if you need manual work done for your myofascial mobility and/or exercises to correct muscle length, posture, and biomechanics related to presentations secondary to binding.

 

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

 

Binding 1

Binding 2

Binding 3

Binding 4

Stay tuned for more in our Tucking Series!

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: Providers 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.

 

Resources

Physical Therapy Rehab After Gender Affirming Surgeries

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

Our Services

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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.

Did you know we opened our 11th location in Columbus, OH? Now scheduling new patients- call (510) 922-9836 to book! 

Are you unable to come see us in person in the Bay Area, Southern California or New England?  We offer virtual physical therapy appointments too!

Virtual sessions are available with PHRC pelvic floor physical therapists via our video platform, Zoom, or via phone. For more information and to schedule, please visit our digital healthcare page.

Melissa Patrick is a certified yoga instructor and meditation teacher and is also available virtually to help, for more information please visit our therapeutic yoga page

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