Physiotherapy Tips for a Healthy Pelvic Floor in Gender Diverse Communities

by Catherine MacGillivray (she/her)

What is the pelvic floor?

The pelvic floor is a group of muscles that sit at the base of your pelvis. They extend between your pubic bone, tail bone and both “sit bones”. Your pelvic floor muscles are involved in bowel, bladder and sexual function. They also act as the base of our core muscle group when supporting your body in physical activity.

Pelvic floor concerns in gender diverse populations

We know that the pelvic floor tends to tighten or tense up as a response to stress and anxiety. A tight pelvic floor that is not able to go through rest periods of lengthening and relaxing can lead to dysfunction. Pelvic floor dysfunction can include change in bowel or bladder function such as leaking, constipation or feelings of urgency. It can also lead to pain during or after sex or general pelvic girdle pain.

Literature has shown that folks who have gender dysphoria are more likely to also have stress and anxiety. This may be due to a lack of safe spaces available to them, feelings of distress that come along with dysphoria or other influences.

Medical research is still heavily impacted by the gender bias towards cisgender men, so we are lacking studies on pelvic floor function of diverse populations. It is highly likely, however, that the connection between pelvic floor dysfunction and people who have gender dysphoria exists. There is a recent study published in 2022 that found the rates of painful sex was far higher in transmasculine individuals compared to the general population and that taking testosterone wasn’t an influential factor.

Pelvic floor tightness and dysfunction are also commonly found after any pelvic surgery (such as gender affirming bottom surgeries). It’s recommended that people who have gender affirming surgery see a pelvic health physiotherapist through their recovery afterwards.

How do physiotherapists suggest we relax our pelvic floors?

Pelvic floor tightness can decrease with general stress reducing activities. Your pelvic floor muscles are going to react to your stress hormone levels so if you’re doing something relaxing and fun, you’re more likely to rest your pelvic floor!

Deep breathing, particularly a slow inhale, naturally presses our pelvic floor towards its lengthened position. This can help improve mobility of the muscle group and it also works to calm and regulate our nervous system. If you find yourself stressed and worried, it’ll be helpful to take a few slow deep breaths.

See a pelvic health physiotherapist! A physio can assess the unique factors influencing your pelvic floor and help develop a plan that works for you. It’s highly recommended that you seek a pelvic health physiotherapist if you’ve had gender affirming surgery, and changes to your bowel, bladder or sexual function. Physiotherapists can also help you if you’re having pain or other symptoms from tucking, binding or other gender affirming practices.

Shine Therapy Services is a telehealth physiotherapy service in Western Canada. Catherine MacGillivray can treat any adult musculoskeletal condition and also specializes in pediatric physio and pelvic health for both kids and adults. If you have a video calling device and reliable internet, you can access our service! Shine Therapy Services strives to be a safe space for gender affirming care we and hope to improve accessibility to inclusive physio in Canada.