This study aimed to review and compare the outcomes of patients undergoing gender-affirming surgery that attended pelvic floor physiotherapy versus those who did not. The hypothesis was that those that did attend physiotherapy appointments after their gender-affirming surgery would have better adherence to dilator protocols and fewer instances of pelvic pain than those that did not attend physiotherapy.

The population consisted primarily of those undergoing a Mcindoe vaginoplasty performed by a urologist in one hospital through 2022. This surgeon regularly refers patients to physiotherapy approximately six weeks after the surgery to help improve dilation and canal depth outcomes. The physiotherapist performed the evaluation and would see each patient approximately once per month for twelve months after the initial surgery. During this presentation, the author will describe the physiotherapy protocol developed between the physiotherapist and the urologist to attempt to ensure more successful dilation procedures and reduce the need for revision. These charts were compared to patients who underwent the same surgical procedure but, for various reasons, were not able to attend physiotherapy appointments. Outcomes researched included: the need for revision surgery, loss of depth (more than 2 cm), or total canal closure. The physiotherapist also included bladder outcomes in determining if those completing physio-directed strengthening activities were less likely to experience urinary leakage after this surgery.
Over forty charts were reviewed initially to ensure patients were not lost to follow-up with either the physiotherapist or the physician in the year following surgery. There were fewer charts of patients who did not complete physiotherapy appointments than those who attended at least one physiotherapy visit, as the physician required most patients to attend physiotherapy education and evaluation sessions. Overall, the preliminary results indicate that those that did attend pelvic physio appointments had better adherence to dilation schedules and required fewer revisions. Those requiring revision were identified early and could resume dilation without pelvic pain very quickly after revision. Those that attended physiotherapy appointments were far less likely to abandon dilation for reasons of pelvic pain. No patients that attended physiotherapy appointments reported urinary leakage after three months post-surgery.

Preliminary results of this retrospective review indicate that those undergoing gender-affirming vaginoplasty should attend several sessions with a pelvic floor physiotherapist. Patients better understood new anatomy, were more adherent to their dilation plan, and required less medical intervention to maintain depth and width after their surgeries. This review will present the physiotherapy protocol and treatment ideas used for pelvic pain complications post-surgically. By referring patients to pelvic floor physiotherapy, surgeons may have improved surgical outcomes and a better therapeutic alliance with their postoperative patients.

Those that attend physiotherapy post-gender-affirming surgery have fewer instances of pelvic pain and better adherence to dilator protocols in the year following surgery.

This presentation will also include next steps for measuring pelvic pain and satisfaction with dilation when seeing physiotherapy after surgery.