Transgender Pelvic Health:
Binding, Tucking & Surgery
Pelvic floor physical therapy for trans, nonbinary and gender-diverse people in Denver: pain from binding or tucking, pelvic pain on testosterone, and prep and recovery for vaginoplasty, phalloplasty, metoidioplasty and hysterectomy.
Every visit is one-on-one with Dr. Caroline Gamwell, PT, DPT, PRPC. Your name, your pronouns, your words for your body, and you decide what happens in every exam. Start with a free phone consult.
What I Help With
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Back, rib, chest or shoulder pain, or shortness of breath from binding
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Groin, testicular or pelvic floor pain from tucking
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New pelvic pain, cramping or painful penetration on testosterone
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Getting ready for vaginoplasty, phalloplasty, metoidioplasty or hysterectomy
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Pain, tightness or trouble with dilation after vaginoplasty
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Dribbling, spraying or trouble emptying after phalloplasty or metoidioplasty
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Constipation, or tight and painful scars after surgery
After surgery, call your surgeon or go to the ER for fever, heavy bleeding, a wound that’s opening, being unable to pee, or sudden severe pain.
Why Pelvic Floor PT Helps
By the numbers
97%
of 1,800 trans adults who bind reported at least one physical effect, most often back pain, chest pain or shortness of breath (Peitzmeier et al., Culture, Health & Sexuality 2017)
36%
of 280 people on testosterone for more than a year reported pelvic pain, and most had none before starting T (Grimstad et al., J Sex Med 2023)
42%
of people assessed before vaginoplasty in one surgical program already had pelvic floor dysfunction, and with pelvic floor PT, 69% of those cases had resolved by their first post-op PT visit (Jiang et al., Obstet Gynecol 2019)
Binding and tucking
Binding and tucking are worth doing safely, not giving up. I treat the rib, back, shoulder and breathing restriction that binding can cause, and the groin, testicular and pelvic floor tension that tucking can cause, and help you set up habits (sizing, break days, breathing) that make both easier on your body.
Pelvic pain on testosterone
Cramping, a tight or overactive pelvic floor and painful penetration are common after starting T, and very treatable. I work alongside your prescriber or gynecologist when something like endometriosis, cysts or tissue changes needs to be ruled out.
Vaginoplasty
Before surgery we find and treat pelvic floor tension, constipation and bladder issues, and practice relaxation and dilation positioning so you start recovery ahead. After surgery we work on pain, dilation depth and consistency, bowel and bladder function, and scar tissue.
Phalloplasty and metoidioplasty
After surgery many people deal with dribbling after peeing, spraying, urgency or trouble emptying while the new urethra and pelvic floor adapt. I work on pelvic floor coordination, techniques to clear the urethra, and scar and graft-site mobility, and send you back to your urologist for anything structural like a stricture or fistula.
How I treat it
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Your exam, your rules. Your name, pronouns and words for your body. Internal exams are always optional, and you can pause or stop anything.
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Pelvic floor relaxation and coordination. For pain, dilation, and emptying your bladder and bowels.
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Dilation coaching. Positioning, breathing and pacing so dilation hurts less and becomes routine.
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Scar and tissue work. Top surgery, graft donor sites, abdominal and genital scars.
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Real-time ultrasound and dry needling when they help. To see how your pelvic floor moves and to release stubborn muscle tension.
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Coordination with your care team. Surgeon, urologist, gynecologist and hormone prescriber.
Additional Resources
Frequently Asked Questions
Related Reading
