Trans or Non-Binary & Seeking Pelvic Floor PT? Here's What to Consider

“The good news is that you’re emptying your bladder fully,” the urogynecologist told me during a bladder exam. “The bad news is that you’re experiencing an unusual amount of pelvic pain.”

Ever since I could remember, every pelvic exam has been accompanied by tense, sometimes stabbing pains. Just the sight of a metal speculum could make my pelvic floor tense up. In high school, I noticed something was different when I struggled with tampons or to urinate comfortably in public restrooms, unlike my cis female peers.

In 2020, this tightness disrupted my ability to urinate at all. I sat on the toilet bowl in my own home and little to no pee would come out. Additionally, as a trans and nonbinary person on testosterone, I also knew others on testosterone hormone therapy report similar pelvic pain.

“Have you heard of pelvic floor therapy?” The urogynecologist asked. When she explained this kind of physical therapy could help strengthen a weak pelvic floor, I realized this could be the key to addressing years of discomfort.

Pelvic floor therapy can be transformative for trans, nonbinary, and gender nonconforming people, offering relief and improving quality of life for those navigating pelvic pain. However, the industry’s overwhelming focus on cisgender women often leaves others feeling overlooked or excluded. If you’re experiencing pelvic pain and don’t fit the typical patient demographic, here’s what to expect and why pursuing care is worthwhile.

Why pelvic floor therapy benefits all bodies of all genders

Pelvic floor therapy has traditionally been framed as a postpartum recovery tool, targeting cisgender women who have given birth. This bias is evident in marketing materials with gendered language, making it difficult for trans and nonbinary people to see themselves reflected as potential patients. However, everyone has a pelvic floor and these muscles are essential to every person’s bodily functions like urination, bowel movements, and sexual health. A body of any gender can benefit from pelvic floor therapy.

Pelvic floor therapy can particularly help transgender, nonbinary, and gender nonconforming (GNC) people manage pelvic pain. For those who’ve sought gender-affirming care through bottom surgery — such as vaginoplasty or hysterectomy — pelvic floor therapy is often a vital part of recovery. It can also be invaluable for those experiencing vaginal atrophy or discomfort associated with bottom-growth due to testosterone hormone therapy. Although pelvic floor PT can support gender affirming care, it’s also important to note that someone who hasn’t medically transitioned can benefit from it, too.

Additionally, cisgender men can benefit greatly from pelvic floor therapy, such as those with idiopathic chronic pelvic pain syndrome, or bladder leakage after prostate surgery.

Challenges for transgender and nonbinary patients

Seeking healthcare as a transgender, nonbinary, or GNC person can be challenging, especially when faced with transphobia and a lack of gender-competent providers. Limited research on pelvic floor therapy for non-cisgender people further perpetuates feelings of exclusion.

It took me years to seriously consider pelvic floor therapy. The idea of finding a provider who understood my needs felt overwhelming. It wasn’t until a transgender-identified primary care provider personally vouched for a cis woman pelvic floor therapist that I felt comfortable pursuing this type of care.

Financial cost can also be a barrier to care. Many insurance plans inadequately cover pelvic floor therapy, leaving patients to pay expensive out-of-pocket fees. Providers like Origin offer more accessible self-pay options, but even those can still strain finances. After being laid off and losing my insurance, I struggled to afford in-person pelvic floor therapy. Origin’s flexibility then became essential — ensuring I could see a trans-competent pelvic floor therapist virtually without paying hundreds of dollars per session, even if my insurance changed again.

Systemic biases and financial obstacles can understandably feel disheartening, but your need for care is valid. You deserve a provider who understands gender-affirming and overall LGBTQ+ competent care in pelvic floor therapy.

It’s been over two years since I started pelvic floor therapy. As a nonbinary trans person, I’m grateful to have found gender-affirming providers who not only understand my identity, but provide treatment in an informed, competent way. Though I am still healing through symptoms such as painful sex and frequent urination, I’ve received invaluable education as a patient from my providers on how to manage and care for pelvic pain, such as using yoga and pelvic wands to loosen the pelvic floor to promote painless sex and less frequent urination.

Everyone has a pelvic floor

Pelvic floor therapy benefits anyone with pelvic pain, regardless of gender. These muscles are integral to many essential functions, and prioritizing pelvic health is a powerful act of self-care and self-advocacy.

While challenges remain in accessing inclusive care, progress is being made. More providers are working to make pelvic floor therapy accessible to patients of all genders. Change may feel slow, but each step forward is a signal of hope for a future where pelvic health centers every patient.

You are worthy of care, and your health matters.