What is Pelvic Floor Therapy?
“What is Pelvic Floor Therapy?” I ask my friend as we sip our cocktails in a dimly lit booth of Sputniks. A way-too-ecstatic Danny Divito cardboard cutout popping up in the booth behind my friend makes me giggle as I ask the question.
“It’s far more helpful than you would think,” exclaims my friend “For everyone! The hard part is finding providers who are accepting and willing or who have the knowledge to work with trans and nonbinary patients.” They sigh. “I have a friend who is a pelvic floor therapist that is inclusive and just overall a really good person. That could be an interesting story … I’ll send you her info.”
My friend is trans, and we were discussing important issues within the trans community as well as coming up with interesting photo assignments I could give myself. The topic of accessible and non-discriminatory healthcare has been an overwhelming subject for the trans community, as they are severely limited on where they can go to seek care.
In a study done by the LGBTQ Task Force, nearly 50 percent of survey participants reported having to teach their medical providers about transgender care and roughly 28 percent report postponing medical care when sick or injured due to discrimination and disrespect.
The first time I typed the words ‘pelvic floor therapy’ into my search bar, images of pregnant women and dilators aligned on my screen. “How is this therapy for everyone?” I thought to myself. The information that was out there was confusing and not-so-inclusive. Here is a therapy that is incredibly beneficial to the trans community, yet there is little information out there for them.
I wanted to know more, so I reached out to a couple pelvic floor therapists in the area, Dr. Krystyna Holland who works with the surgical team at Denver Health as well as her own private practice and Dr. Sarah Poinski-McCoy who works closely with the surgical team at UC Health. To accurately write about what it is they do, I scheduled an appointment with Krystyna at her private practice.
To be honest, I was terrified. After becoming a survivor of sexual assault before I’d ever seen my first OBGYN, letting someone assess my pelvic floor was not something I’d ever imagine adding to my to-do list. Now 29 going on 30, my heart still races, palms still sweat, and getting there is still the hardest part.
The amount of comfort and request for consent in our session was drastically better than my first OGBYN appointment.
“As medical providers, we learn that the numbers are high enough that any time you lay your hands on any human being, you should be thinking along the lines of, ‘This person may be experienced trauma, and I could be crossing into territory that is triggering for them.’ So, we need to be looking out for how they’re responding, what they’re feeling, and be talking to them and ensuring that they still have given you consent to continue moving forward,” states Dr. Sarah Poinski-McCoy.
Those undergoing or recovering from gender-affirming surgeries are feeling all of this and more as they seek providers who have the training and experience tailored to their specific needs.
As struggles with mental health are on the rise after the tumultuous year-and-a-half we’ve all faced, it’s been far worse for many in the LGBTQ community, and finding care that is inclusive and knowledgeable about your specific needs is more important than ever.
There are many complications that accompany gender-affirmation practices, and since bottom surgeries drastically change anatomy, it is important that the pelvic floor muscles work properly. There are also many other postoperative considerations such as dilation, wound care, and scar tissue management, and relearning toileting behavior with new anatomy. With such an intimate therapy, the need for inclusive providers who are understanding and knowledgeable about what you are going through is necessary.
“There is a lot of distrust in the medical community due to past traumas and past experiences,” states Dr. Poinski-McCoy. “I’ve had some patients tell me that their previous doctors told them that something was wrong with them, and that they just needed to pray. So, after having an experience like that with someone that you’re supposed to trust, it can be disheartening, especially for those in the trans community.”
At my appointment with Dr. Holland, I learned so much about my body on top of feeling muscles I’ve never felt before. The amount of comfort and request for consent in our session was drastically better than my first OGBYN appointment. Her training in inclusivity resulted in my feeling accepted and well cared for with something very personal.
After months of further research, I became aware of how beneficial pelvic floor therapy is for quite literally everyone. Pelvic floor therapists work closely with cancer survivors, survivors of sexual assault, those experiencing painful sex, pregnant women before and after giving birth, children who experience nighttime or daytime wetting, pre- and post-op trans men and women, and so many more. However, not all pelvic floor therapists work or have furthered their education in all of these areas.
Dr. Poinsky Mc-Coy explains that, “When you go to school to become a physical therapist, you are a generalist when you leave, so there is no one area where you get extra training. Once you leave, you can further your education and do outside work on your own, which is one of the things that I and Dr. Krystyna Holland chose to do specifically with transgender patients.”
As I was looking for other inclusive, pelvic floor therapists in the Denver area, I quickly realized there weren’t many. Denver Health and UC Health are great resources for gender-affirming care. However, there are some other private practices in the Denver area such as Inclusive Care LLC, Activcore Physical Therapy, and N2 Physical Therapy, all which have providers with education and experience in working with trans and nonbinary patients.
Special thanks to Krystyna Holland for allowing me to photograph her process through an initial examination and to those who volunteered to be photographed.
*Words and photos by Kelsey Sale
