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The Gender Diverse Patient and Physical Therapy’s Role

The number of individuals who identify as transgender is growing each year. The Williams Institute estimated in 2016 that 0.6% of the U.S. population or roughly 1.4 million people identified as transgender (Flores, 2016). This was a 50% increase from a 2011 survey which estimated only 0.3% or 700,000 people identified as transgender (Gates, 2011). Though these numbers are growing each year, due to increased visibility and social acceptance, it is presumed that these numbers are underreported due to inadequate survey methods, stigma/fear associated with “coming out” and deficient definitions of the multitude of options for gender identity (Flores, 2016).

With the rise of individuals who identify as transgender, gender non-binary and intersex, healthcare professionals have equally seen an influx of patients who require care throughout their discovery and transition. Though medical intervention for these individuals is not new, the first documented surgery was in 1922 to Dora Richter, it has often been segmented and lacking in evidence-based treatment strategies (“Dora Richter,”2019). In 1979 The World Professional Association for Transgender Health (WPATH) was founded and published their first version of the Standards of Care (SOC) for the Health of Transsexual, Transgender, and Gender Nonconforming People (“WPATH,” 2019). Currently, WPATH is on their seventh version of the SOC which is opening doors for the treatment of this population.

Though organizations such as WPATH have attempted to standardized care, the patient experience and reception of quality care are significantly lacking. In 2015 the National Center for Transgender Equality performed a groundbreaking survey of 27,215 respondents with the aim to “understand the lives and experiences of transgender people in the United States and the disparities that many transgender people face” (“About,”n.d., para. 1). This survey revealed that 33% of individuals who saw a health care provider had at least one negative experience related to being transgender (National Center for Transgender Equality, 2015). Negative experiences included; being refused treatment, verbal harassment, physically or sexually assault, and teaching the provider about transgender people in order to get appropriate care (National Center for Transgender Equality, 2015). Alternatively, 23% of respondents did not see a doctor when they needed to because of fear of being mistreated as a transgender person (National Center for Transgender Equality, 2015). Though these statistics are staggering and affronting there is hope for a better future.

Research for the care of these patients, specifically related to pelvic floor physical therapy, is on the rise. In the Annals of Plastic Surgery, an article was published with the purpose to capture incidence and severity of pelvic floor dysfunction pre-surgery, monitor any progression of symptoms with standardized outcome measures and highlight the role of physical therapy in the treatment of patients undergoing vaginoplasty (Manrique, et al., 2019). While in the Journal of Obstetrics & Gynecology a retrospective case series similarly focused on physical therapy pre and post-operatively highlighting dilator selection and success, pelvic floor dysfunction including bowel and bladder as well as reported abuse history (Jiang, Gallagher, Burchill, Berli, & Dugi, 2019). Through articles such as these clinicians can expect an uptick in calls questioning if they treat these patients. This begs the question of, "How can you best prepare?"

The answer is simple, attend continuing education. It is where you can not only learn evidence-based evaluation and treatment but also connect with other providers and mentors that care for these patients. In 2020 Herman & Wallace will be offering a continuing education course that serves this exact purpose. Keep your eyes on next years offerings, as spaces will surely fill quickly.


About. (n.d.). Retrieved May 15, 2019, from http://www.ustranssurvey.org/about
Dora Richter. (2019, May 09). Retrieved May 15, 2019, from https://en.wikipedia.org/wiki/Dora_Richter
Jiang, D. D., Gallagher, S., Burchill, L., Berli, J., & Dugi, D. (2019). Implementation of a Pelvic Floor Physical Therapy Program for Transgender Women Undergoing Gender-Affirming Vaginoplasty. Obstetrics & Gynecology,133(5), 1003-1011. doi:10.1097/aog.0000000000003236
Manrique, O. J., Adabi, K., Huang, T. C., Jorge-Martinez, J., Meihofer, L. E., Brassard, P., & Galan, R. (2019). Assessment of Pelvic Floor Anatomy for Male-to-Female Vaginoplasty and the Role of Physical Therapy on Functional and Patient-Reported Outcomes. Annals of Plastic Surgery,82(6), 661-666. doi:10.1097/sap.0000000000001680
National Center for Transgender Equality. (2015). Annual report of the U.S. Transgender Survey. Retrieved May 15, 2019, from https://transequality.org/sites/default/files/docs/usts/USTS-Executive-Summary-Dec17.pdf
Wpath. (n.d.). Standards of Care version 7. Retrieved May 15, 2019, from https://www.wpath.org/publications/soc

Carolyn McManus Presenting at NEXT 2019 in Chicago...
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Upcoming Continuing Education Courses

Boundaries, Self-Care, and Meditation - Remote Course

Sep 12, 2020 - Oct 11, 2020
Location: Replacement Remote Course

Pelvic Floor Level 2A - Atlanta, GA (Postponed)

Sep 25, 2020 - Sep 27, 2020
Location: Emory Healthcare

Nutrition Perspectives for the Pelvic Rehab Therapist - Winfield, IL (Postponed)

Sep 25, 2020 - Sep 27, 2020
Location: Northwestern Medicine

Low Pressure Fitness for Pelvic Floor Care - Houston, TX (Postponed)

Sep 25, 2020 - Sep 27, 2020
Location: Texas Children’s Hospital

Sacral Nerve Manual Assessment and Treatment - Vancouver, WA (Postponed)

Sep 25, 2020 - Sep 27, 2020
Location: PeaceHealth Southwest Medical Center

Pelvic Floor Level 1 - Mequon, WI Satellite Location

Sep 26, 2020 - Sep 27, 2020
Location: Health In Balance Physical Therapy

Pelvic Floor Level 1 - Atlanta, GA (Postponed)

Sep 26, 2020 - Sep 27, 2020
Location: Emory Healthcare

Coccydynia and Painful Sitting - Philadelphia, PA (Postponed)

Sep 26, 2020 - Sep 27, 2020
Location: Core 3 Physical Therapy

Nutrition Perspectives for the Pelvic Rehab Therapist - Remote Course (SOLD OUT)

Sep 26, 2020 - Sep 27, 2020
Location: Replacement Remote Course

Pelvic Floor Level 1 - Milwaukee, WI (Postponed)

Sep 26, 2020 - Sep 27, 2020
Location: Aurora Medical Center

Pelvic Floor Level 1 - Columbia, SC (Postponed)

Sep 26, 2020 - Sep 27, 2020
Location: Columbia Rehabilitation Clinic

Pelvic Floor Level 1 - Self-Hosted

Sep 26, 2020 - Sep 27, 2020
Location: Self-Hosted Course

Pelvic Floor Level 1 - Decatur, GA Satellite Location (SOLD OUT)

Sep 26, 2020 - Sep 27, 2020
Location: Emory Healthcare

Pelvic Floor Level 1 - Columbia, SC Satellite Location (SOLD OUT)

Sep 26, 2020 - Sep 27, 2020
Location: Columbia Rehabilitation Clinic

Pelvic Floor Level 1 - Minnetonka, MN Satellite Location (SOLD OUT)

Sep 26, 2020 - Sep 27, 2020
Location: Viverant

Pelvic Floor Level 1 - Marietta, GA Satellite Location

Sep 26, 2020 - Sep 27, 2020
Location: Southern Pelvic Health

Pelvic Floor Level 1 - Satellite Lab Course

Sep 26, 2020 - Sep 27, 2020
Location: Replacement Remote Course

Pelvic Floor Level 1 - Orland Park, IL Satellite Location

Sep 26, 2020 - Sep 27, 2020
Location: Palos Community Hospital

Pelvic Floor Level 1 - Columbus, OH Satellite Location

Sep 26, 2020 - Sep 27, 2020
Location: Fitness Matters

Pelvic Floor Level 1 - Colorado Springs, CO Satellite Location (SOLD OUT)

Sep 26, 2020 - Sep 27, 2020
Location: Strive Physical Therapy

Pelvic Floor Level 1 - Torrance, CA Satellite Location

Sep 26, 2020 - Sep 27, 2020
Location: Women's Advantage Inc

Pelvic Floor Level 1 - Kenosha, WI Satellite Location (Sold Out)

Sep 26, 2020 - Sep 27, 2020
Location: Aurora Health Care

Pelvic Floor Level 1 - Lansing, MI Satellite Location

Sep 26, 2020 - Sep 27, 2020
Location: Physical Therapy Services of Lansing

Mobilization of Visceral Fascia: The Urinary System - Phoenix, AZ (Postponed)

Oct 2, 2020 - Oct 4, 2020
Location: Banner Physical Therapy and Rehabilitation

Mobilization of Visceral Fascia: The Urinary System - Medford, OR Satellite Location

Oct 2, 2020 - Oct 4, 2020
Location: Asante Rogue Valley Medical Center

Mobilization of Visceral Fascia: The Urinary System - Self-Hosted

Oct 2, 2020 - Oct 4, 2020
Location: Self-Hosted Course

Mobilization of Visceral Fascia: The Urinary System - San Diego, CA Satellite Location

Oct 2, 2020 - Oct 4, 2020
Location: FunctionSmart Physical Therapy

Mobilization of Visceral Fascia: The Urinary System - Colorado Springs, CO Satellite Location

Oct 2, 2020 - Oct 4, 2020
Location: Manual Edge Physiotherapy

Mobilization of Visceral Fascia: The Urinary System - Fairlawn, NJ Satellite Location

Oct 2, 2020 - Oct 4, 2020
Location: Bella Physical Therapy