Presentation Authors: Da David Jiang*, Sandra Gallagher, Laura Burchill, Jens Berli, Daniel Dugi, Portland, OR
Introduction: For transgender women undergoing gender-affirming vaginoplasty, the creation of the vaginal canal causes disruption of the pelvic floor; furthermore, patients must perform neovaginal dilation after surgery. This study sought to determine the utility of pelvic floor physical therapy (PFPT) with pelvic floor dysfunction, dilation and surgical recovery.
Methods: Retrospective, single institution study on vaginoplasty patients between 5/1/2016 and 2/28/2018; all were referred for PFPT. We reviewed medical records for baseline demographics, medical comorbidities, prior surgeries, insurance data, attendance at PTPF, and issues identified by physical therapists, and dilation success at 3 and 12 months.
Results: Out of 77 patients, 94% attended PFPT at least once. Preoperative PFPT 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 71% and 73%, respectively. There were significantly lower rates of pelvic floor dysfunction postoperatively for those patients who attended PFPT preoperatively vs only postoperatively (p=0.006). Patients reporting a history of abuse had a significantly higher rate of preoperative pelvic floor muscle dysfunction, 91% vs 31% (p < 0.001). Successful dilation at 3 months in all patients was 89%.
Conclusions: Pelvic floor physical therapists identify and help patients resolve pelvic floor-related problems before and after surgery. We find strong support for PFPT for patients undergoing gender-affirming vaginoplasty. Further study is needed to determine if this improves outcomes with dilation or neovaginal stenosis.