Pelvic floor physical therapy for AMAB persons undergoing gender-affirming vaginoplasty

Gender-affirming vaginoplasty is a major reconstructive surgery that can impact the pelvic floor. The pelvic floor is a complex anatomic region. It has functional importance in urination, defecation, and sexual activity; thus, it is advisable that the surgical team screen patients preoperatively for bladder, bowel, and pelvic floor dysfunction including, a history of chronic pain. Each of these conditions can affect a patient's recovery after vaginoplasty and their success with dilation. Gender-affirming vaginoplasty requires dissection of the space between the rectum inferiorly and the urethra, prostate, and bladder superiorly. This dissection passes through the pelvic floor, resulting in anatomic change in the pelvic floor specifically the puborectalis muscle. During the process of wound healing and wound contraction, dilation is essential. Relaxation of the pelvic floor muscles before and during dilation can help dilation be less painful. Pelvic physical therapists are skilled at training relaxation of the pelvic floor muscles and other aspects of pain reduction and surgical recovery. They are an integral part of care for people having gender-affirming vaginoplasty.