Pelvic floor dysfunction and the issues of pelvic pain and/or incontinence can have a massive impact on your health and quality of life. And yet, it is often an overlooked part of our general well-being. It can also be a source of embarrassment for many and/or an area associated with trauma, making pelvic health difficult to raise with a health professional, let alone seek assistance.
For transgender folk who may have experienced discrimination in the past from health professionals, or worry they might be exposed to it, seeking help is challenging. Unfortunately, care providers who are not well informed about trans health may also fail to understand the diverse concerns, and needs, trans people may have.
The pelvic floor health of transgender people is an area which requires more research. However, some studies do exist, and these suggest an increased occurrence of pelvic floor dysfunction in the transgender community.
Some risk factors apply to us all, including heavy lifting and constipation, and childbirth for those who have borne children. There are also some things trans folk need to know about their pelvic floor.
Any changes to the sexual or reproductive organs via surgery or hormonal treatment are likely to have some influence on the pelvic floor and pelvic health.
How reproductive organs are tucked or bound can disturb the flow of blood and lymph (a fluid that helps fight off bacteria in the body). Tucking and binding can also impact on muscle activity.
We also know that tucking and binding can be an important part of managing gender dysphoria and being able to get out there in the world with confidence. So it’s important to find a balance between feeling good in your body, and making sure you’re binding and tucking safely.
If you are trans gender and you’re considering gender affirming lower surgery, talk to your health professional about your overall health, the health of your pelvic floor and the current functioning of your bladder and bowel. Making sure your pelvic floor is in good working order, before surgery, is a great way to set yourself up for the best possible recovery.
For advice and help around accessing gender affirming medical help – The Tasmanian Sexual Health Service is the best place to start. They have clinics in Hobart, Launceston and an outreach clinic in Devonport.
The needs for trans men and women are different. Here are some of the ideas that could be useful when thinking about pelvic health and gender affirmation.
Pelvic floor health for transgender women
- Tucking reproductive organs for too long, or too vigorously, can cause pain and may have an impact on pelvic floor health.
- Lower surgery to create a vagina (vaginoplasty) does carry some risks – including risks to the pelvic floor. A good surgeon or doctor will discuss these risks with you so that you can make an informed decision. A counsellor to help you weigh up the risks versus the benefits. Working It Out has counsellors who can help you talk these matters over.
- Physical therapy with a pelvic floor specialist, before and after gender-affirming vaginoplasty, has been shown to improve the outcomes in pelvic floor function.
Pelvic floor health for transgender men
- Depending on the dosage, testosterone can affect vaginal tissue - increasing the risk of atrophy and inflammation of the vagina and/or cervix. Lowering oestrogen can affect tissues needed for skin resilience, vaginal pH, lining bladder pipe, and vaginal lubrication. Often you can use vaginal oestrogen without increasing systemic oestrogen, which can be useful when transitioning – talk to your doctor about this.
- Get tested! While not directly related to the pelvic floor, it’s all part of health down there! We know there are barriers to trans guys getting tested, but there are services out there that do better in this space. Ask around, find someone you trust, don’t give up! Untreated STIs are no fun. Also everyone with a cervix needs a cervical screen every 5 years. You can now ask to self-collect (you swab yourself, instead of having a nurse or doctor do it).
- If you’ve got a small frame, the increased muscle mass as result of testosterone therapy could lead to changes in posture which may impact on the pelvic floor muscles.
- Binding of the chest can cause pain and difficulty breathing. Diaphragmatic breathing affects the pelvic floor and has an influence on the contraction and relaxation of the muscles. Always bind safely bro! There are resources out there about safe binding techniques (see below).
What to look out for
Some signs your pelvic floor may need attention are problems urinating or an increase in frequency; leaking bladder when coughing or sneezing; pain or discomfort when having sex; and pelvic, back, hip or sacroiliac pain.
Don’t wait if you notice any changes in the functioning of your bladder, bowels or sex organs - seek advice and assistance. There are lots of things you can do to improve your pelvic floor health; reduce caffeine, drink water, eat healthily for muscular development and growth; quality sleep. For muscular recovery; regular exercise. To keep the muscles strong; diaphragmatic breathing and kegel exercises, to relax and contract the pelvic floor muscles.
Minus18, ‘How to bind your chest safely and healthily’, www.minus18.org.au