Gender affirming care for pelvic health physiotherapists



In the last few years there has been a groundswell of recognition for the desperate need for culturally aware and affirming care of the LGBTQIA+ community. However, with so many different folks falling under the same umbrella, it can be difficult and at times overwhelming to dive in and understand it all. After taking course #1 which gives history, background, and provides introductory terminology to communicate with and about this population, you now have the skills to examine more detailed clinical aspects.

There are myriad identities in the LGTBQIA+ population, but this course is specifically for those wishing to have more confidence and understanding with providing care as it relates to medical and surgical transition. Not all trans people choose to undergo this process, but for those who do there are many routes to take. As the research continues to expand and provide us with more insight from which to provide treatment recommendations, clinical care is rapidly changing.

How can you wield your skillset to help a patient preparing for masculinizing top surgery? How would a pelvic floor internal assessment be similar or different for someone with a neovagina compared to a patient with a natal vagina? What are the considerations for tissue healing after phalloplasty? These questions and more will be answered in this course and all done in a safe environment where you are not only free, but encouraged to ask questions you may be afraid to ask in other situations. Come learn about providing affirming care from therapists who are part of the LGTBQIA+ community themselves and have the unique combination of lived experience and clinical expertise to help you!

Course outline: 

Module 1: Understanding the basics

  • Terminology
  • Gender identity and hormone therapy in youth

Module 2: Hormonal Transitions

  • Estrogen-based hormone therapy
  • Testosterone-based hormone therapy
  • Non-hormonal/surgical alternatives

Module 3: Surgical Transitions

Module 3.1:

  • Terminology
  • Role of the Physical Therapist in Pre and Post Operative Care
  • Breast Augmentation Surgery

Module 3.2: Interview with a Trans Patient

Module 3.3:

  • Masculinizing surgeries and breast suppression
  • Feminizing surgeries
  • Facial feminization surgery
  • Facial masculinization surgery

Module 3.4: Interview with a Speech-Language therapist Specializing in Voice Transition

Module 3.5:

  • Penile inversion vaginoplasty
  • Colovaginoplasty
  • Peritoneal traction vaginoplasty
  • Phalloplasty
  • Scrotoplasty
  • Penile implants
  • Metaiodoplasty surgery
  • Hysterectomy surgery
  • Non-binary surgical transition

Module 3.6: Interview with a gender affirming surgeon

Module 4: Transpregnancy

  • Hormonal and fertility considerations
  • Trans pregnancy and the postpartum period

Module 5: Clinical Considerations and Additional Resources

  • Comprehensive Lifestyle and Sexual Questionnaire
  • Subjective assessment of pre-operative symptoms
  • Objective assessment of pelvic-perineal function
  • Patient education on the postoperative period
  • Pre-operative exercises
  • Pre- and post-operative care of phallopasty
  • Immediate post-operative advice and exercises
  • Post-operative care of vaginoplasty
  • Re-training for post-phalloplasty and vaginoplasty activities
  • Different types of cancers in trans women and men
  • Pelvic pain in trans men
  • Bone health in trans men


  1. Understand the variety of medical transition options and paths for transgender patients
  2. Communicate effectively and confidently with patients and other medical providers regarding transition-related treatments
  3. Utilize your knowledge regarding clinical implications of both masculinizing and feminizing hormonal transition to provide better care for your patients
  4. Answer questions regarding common misconceptions of puberty blockers
  5. Reframe your understanding of pregnancy and fertility in the trans community
  6. Familiarize yourself with the array of surgeries available for transition including: penile inversion vaginoplasty, peritoneal pull through vaginoplasty, colovaginoplasty, phalloplasty, metoidioplasty, scrotoplasty, and more
  7. Recognize that non-binary transition may also be a desire for patients
  8. Provide pre-operative care to trans patients to help optimize their success with surgery
  9. Provide post-operative care for trans patients to help facilitate healing, reduce pain, and enhance use of their new anatomy!

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