Pride Month and Pelvic Floor Physical Therapy!
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. 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.
Check out our Binding Series on Instagram!
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
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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.
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FAQ
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.