Pelvic Floor Physical Therapy and the LGBTQIA+ Community

Dr. Hannah Lattanzio, PT, DPT

Happy pride month! This month’s blog post is dedicated to not only how pelvic floor physical therapy can play a role in LGBTQ+ healthcare but also calling out the disparities in healthcare for the LGBTQ+ community overall. 

Introduction

Historically the LGBTQ+ community has faced many challenges in healthcare compared to their  heterosexual and cisgender counterparts. Many theories and studies have suggested various contributing causes including:

• Low healthcare utilization

• Lack of access

• Actual and perceived discrimination/prejudice 

• Past negative experiences 

• Negative social environment/societal stigma

• Lack of knowledgeable and competent healthcare professionals 

These factors lead to reduced health-seeking behaviors and thus reduce access to healthcare and screening/prevention services. 

Healthcare disparities for the LGBTQ+ community include but are not limited to: 

• Lesbian and bisexual women are likely to report poor health, presence of chronic conditions, and heavy drinking and smoking compared to their heterosexual peers

• Gay and bisexual men are at higher risk for sexually transmitted infections 

• Lesbian women are less likely to get preventative healthcare screening for cervical cancer

• Lifetime suicide rate for the transgender and gender nonconforming people is 40% 

• Older members of the LGBTQ+ community have faced additional limitations to care because of lack of social support and competent providers 

• LGBTQ+ people have the highest rates of alcohol, tobacco, and drug use. 

Inclusive Care 

To combat these startling statistics, clinicians and medical providers can continue to grow their cultural competence. Suggestions include:

• Be familiar with common terms and recognize that preferred terminology can vary by person and/or time. 

• Not to make assumptions regarding a person’s gender identity or sexual orientation based on gender expression/appearance 

• Have an understanding about what gender affirming care may look like for transgender folks as well as various medical interventions they may seek.

• Ask their patients about their sexual orientation and gender identity if not asked on intake forms as this improves the providers ability to screen for and prevent conditions more common in the LGBTQ+ community. 

• Provide care that is free of personal bias and assumptions. 

How a clinician and/or practice can improve their communication and inclusivity for members of the LGBTQ+ community:

• Use gender-neutral language while first taking a social/sexual history 

• Post non-discriminatory policies and highlight symbols of welcome (flags, pins, etc.)

• Encourage basic LGBTQ+ training for all staff (especially since many medical providers do not receive adequate education in school!) 

• Organizations that offer competency training include: GLMA, National LGBT Cancer Network, and National LGBT Health Education Center

Pelvic Floor Physical Therapy and The Transgender Community

Some transgender people may opt for gender-affirming surgeries such as:

• Chest reconstruction/breast augmentation

• Hysterectomy 

• Vaginoplasty/phalloplasty 

As with any surgery, each of these procedures will affect the surrounding tissue and musculature, changing the function and structure of the anatomical structures involved. Physical therapy is not only expected but required for most post-operative care with gender affirming surgeries being no different, and thus require the same rehabilitative process. Physical therapists are trained in post-operative care including scar tissue management, wound healing, gentle strengthening and range of motion exercises, neural interventions and posture re-education. 

Physical therapists can also help coach patients through binding, packing and tucking safely. Additionally, therapists are optimal medical professionals to assist an individual in preparing their body for surgery as “pre-hab” for an increase in successful outcomes and expectations. 

How Pelvic Floor Therapists Can Serve The LGBTQ+ Community 

As mentioned in our prior blog post everyone has a pelvis, and thus everyone has a pelvic floor! Regardless of anatomy or gender. A pelvic floor physical therapist can help with urinary, bowel, and/or sexual dysfunction. 

Everyone deserves caring, informed and attentive healthcare and at The Pelvic Institute we support our patients no matter their sexual orientation and/or identity. 

If you have further questions please visit our website to book a discovery call with us today!