Transgender and Gender Non-Conforming Pelvic Health Physical Therapy in San Francisco, CA

The trunk and lower extremities can be negatively affected when transgender or gender non-conforming individuals use tucking, binding, and packing techniques, as well as during gender-affirming procedures. These effects often result in pelvic pain and dysfunction. By working with our knowledgeable physical therapists, you can reduce or eliminate pelvic, back, and chest pain related to pelvic floor dysfunction. Pelvic floor physical therapy can also minimize symptoms of urinary, bowel, and/or sexual dysfunction that may arise from some techniques and procedures.


  • Pain from surgical scars
  • Pain with vaginal penetration
  • Inability to achieve vaginal penetration
  • Difficulty or inability to achieve orgasm
  • Urinary dysfunction including urgency, frequency, hesitancy, incontinence, and spraying
  • Pelvic pain
  • Chest and back pain
  • Shoulder pain

Causes of Symptoms

  • Surgical scars
  • Stenosis of neovagina
  • Loss of neovagina depth
  • Pudendal neuralgia
  • Persistent granulation tissue
  • Pelvic floor dysfunction
  • Compression
  • Lower extremity muscles dysfunction
  • Poor posture

Diagnostic Challenges

Unfortunately, most medical providers, including pelvic floor physical therapists, are unfamiliar with packing, tucking, and binding techniques, as well as gender-affirming surgical procedures. These surgical procedures are not widely available in the United States nor is education for health care providers on how to care for these patients. At PHRC we have been fortunate to work in geographic locations where these procedures are available, and we have had the opportunity to work with the surgeons providing these services. We have also sought out specific training on how to best care for this patient population as physical therapists. As a result, we have had the opportunity to successfully treat many patients utilizing these techniques and undergoing these surgical procedures.

How We Can Help You

Pelvic floor physical therapy can assist the transgender and gender non-conforming population for both surgical procedures and non-surgical techniques they may utilize or undergo. The non-surgical, or in some cases, pre-surgical techniques that trans men may utilize is binding and the techniques trans women may utilize are tucking and packing. Physical therapy can ensure safety when binding to avoid chest, shoulder, and back pain, numbness, and scarring and preserve good posture. Physical therapy can educate trans women who utilize packing or tucking to avoid gait abnormalities and muscle dysfunction in the lower extremities. For those who undergo gender affirmation procedures, pelvic floor physical therapists can reduce pain from surgical scars, enable or improve neovaginal penetration during intercourse, improve the ability to orgasm, normalize urinary function, and eliminate pelvic pain. Typically, patients are safe to begin physical therapy eight weeks after their surgical procedure, but this is very dependent on the type of procedure performed.

Therefore, we communicate with your surgeon to determine when it is safe to begin rehabilitation. During the evaluation, the physical therapist reviews your history and symptoms with you. If you have undergone a surgical procedure we review your operative report. Importantly, we understand what you have been through. During the physical examination, the physical therapist examines muscles, tissues, joints, nerves, and movement patterns. Once your physical therapist completes the examination they review your findings with you. The physical therapist creates an assessment that explains how you developed pain and/or dysfunction and sets short and long-term goals for your treatment plan. Typically, the frequency of physical therapy treatment is one to two times per week for roughly 12 weeks. Your physical therapist will assign an at-home exercise regimen that supports your weekly sessions while coordinating with any other members of your medical staff to ensure a successful and expeditious recovery. We are here to work with you on your behalf, so you no longer have to navigate this process on your own! We will help you reach your goals and help you live the life you want to live.

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