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Implementation of a Pelvic Floor Physical Therapy Program for Transgender Women Undergoing Gender-Affirming Vaginoplasty

Jiang, Da David, MD; Gallagher, Sandra, PT; Burchill, Laura, PT; Berli, Jens, MD; Dugi, Daniel III, MD, FACS

doi: 10.1097/AOG.0000000000003236
Contents: LGBTQIA Health: Original Research

OBJECTIVE: To describe the incidence of pelvic floor dysfunction in transgender women undergoing gender-affirming vaginoplasty and outcomes in a program providing pelvic floor physical therapy (PT).

METHODS: We conducted a retrospective, single-institution study on vaginoplasty patients between May 1, 2016, and February 28, 2018; all were referred for pelvic floor PT. We reviewed medical records for baseline demographics, medical comorbidities, prior surgeries, insurance data, attendance at pelvic floor PT, and dilation success at 3 and 12 months.

RESULTS: Seventy-two of 77 patients (94%) attended pelvic floor PT at least once. Preoperative pelvic floor PT identified a high incidence of potential problems: 42% had pelvic floor dysfunction, 37% had bowel dysfunction. Of those patients found to have dysfunction preoperatively, the rate of resolution by the first postoperative visit of pelvic floor and bowel dysfunction were 69% and 73%, respectively. There were significantly lower rates of pelvic floor dysfunction postoperatively for those patients who attended pelvic floor PT both preoperatively and postoperatively compared with only postoperatively (28% vs 86%, P=.006). Patients reporting a history of abuse had a significantly higher rate of preoperative pelvic floor muscle dysfunction (91% vs 31%, P<.001). Successful dilation at 3 months in all patients was 89%.

CONCLUSION: Pelvic floor physical therapists identify and help patients resolve pelvic floor-related problems before and after surgery. We find strong support for pelvic floor PT for patients undergoing gender-affirming vaginoplasty.

The high incidence of pelvic floor dysfunction in patients undergoing gender-affirming vaginoplasty is improved with pelvic floor physical therapy.

Department of Urology and the Division of Plastic Surgery, Transgender Health Program, and the Department of Physical Therapy and Rehabilitation, Oregon Health & Science University, Portland, Oregon.

Corresponding author: Daniel Dugi, MD, FACS, 3303 SW Bond Avenue, CH-10-U, Portland, OR 97239; email:

Financial Disclosure Sandra Gallagher is employed at OHSU and teaches courses for the American Physical Therapy Association, Section on Women's Health. Jens Berli received a research grant unrelated to this study from Allergan Inc., and consulted two times for Guidepoint Consulting on skin replacement products unrelated to this study. The other authors did not report any potential conflicts of interest.

Presented at the 25th World Professional Association for Transgender Health (WPATH) Symposium, November 3–6, 2018, in Buenos Aires, Argentina.

Each author has confirmed compliance with the journal's requirements for authorship.

Peer reviews and author correspondence are available at

© 2019 by the American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.