Genital reconstruction surgery (GRS) is a surgical procedure that is performed to alter the genitals of a person’s body. It is a highly specialized surgery that requires the help and attention of multiple experienced health professionals, including a physical therapist.

Pelvic floor physical therapy is an incredibly important element to include for a comprehensive care plan—before and after genital reconstruction surgery. Before discussing how physical therapy plays a role in this type of surgery, let’s discuss more about what GRS is and why someone may need it.

This surgery can be performed for a variety of reasons, but it is commonly known to be sought out by those who want their physical characteristics (functional or appearance) to match their gender identity. Therefore, this operation is often referred to as “gender-affirming surgery” or “gender confirmation surgery.”

*Hive Therapy and Wellness understands that gender is a spectrum, and welcomes all gender identities. We understand that those who identify with gender nonconforming or genderqueer identities may also choose to undergo GRS. The language used on this page is only used for ease of understanding.

For transgender individuals, gender-affirming surgery can include the following:

For transgender women (people assigned male at birth):

• Vaginoplasty: Creation or reconstruction of a vagina.
• Labiaplasty: Creation or reconstruction of labia.
• Clitoroplasty: Creation of a clitoris.
• Orchiectomy: Removal of the testicles.
• Penectomy: Removal of the penis.

For transgender men (people assigned female at birth):

• Metoidioplasty: Creation of a penis using the clitoris.
• Phalloplasty: Construction or reconstruction of a penis using a piece of bodily tissue.
• Vaginectomy: Removal of part or all of the vagina.
• Hysterectomy: Removal of the uterus.
• Hysterectomy with Bilateral Salpingo Oophorectomy: Removal of the uterus, ovaries, and fallopian tubes.

There are a few different ways to go about genital reconstruction, all of which depend on the preferences and medical considerations of the patient. While gender affirmation is a common reason for genital reconstruction, it is not the only reason. Other uses for genital reconstruction include:

• Intersex Conditions: Some individuals are born with ambiguous genitalia. Some of these individuals may choose to undergo genital reconstruction that conforms to one type of genitalia. In some cases, this may be done in infancy.
• Reconstructive Surgery: For those who have experienced trauma, injury, cancer, or congenital anomalies, reconstructive surgery may be necessary to repair or reconstruct the genital area.
• Cosmetic Reasons: Some individuals may seek out genital reconstruction for aesthetic or functional reasons.

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As described above, there are a variety of reasons why an individual may seek out genital reconstruction surgery. Gender affirmation, functional purposes, or aesthetic purposes are all perfectly valid reasons for seeking out genital reconstruction surgery. If it is something you have deemed necessary for your health or happiness, remember to keep advocating for yourself.

It is important to note that not all people who receive genital reconstruction surgery are transgender, nor do all transgender folks go through genital reconstruction surgery. Transitioning is something that varies from person to person. It is a very personal decision that can vary based on a person’s own experiences, preferences, and values.

Those who do choose to undergo gender affirming surgery may do so for the following reasons:

Alleviating Gender Dysphoria: Gender dysphoria is a feeling of disconnection between an individual’s gender identity and the sex they are assigned at birth. It can be a very intense dissatisfaction that can lead to a decrease in mental health. GRS can be a solution for many with gender dysphoria who want to align their physical appearance with their gender identity.

Matching The Sense of Self: Similarly to the experience described above, GRS allows some individuals to feel more comfortable with their own body by aligning their identity with their physical appearance. This can significantly improve one’s mental health, allowing them to be their true self.

As mentioned previously, genital reconstruction surgery is not limited to those who are transitioning. Other individuals may choose to undergo this surgery for medical or personal reasons:

• Aesthetic Reasons: Body image can vary from person to person. For some, they may want to alter the appearance of their genitals for comfort or cosmetic reasons. This can include both reshaping or resizing of genitals.
• Congenital Anomalies: For some, genital reconstruction may be necessary to allow for normal function of the genitalia. This is often the case for those born with congenital abnormalities.
• Trauma: In some cases the genitals may have been affected by injury, which may require reconstruction to restore function or appearance.
• Cancer: Some surgical treatments in cancer can require removal of affected organs, which can include reproductive organs or genitals. GRS may be necessary to restore the form and function of an individual’s genitals in these cases.
• Medical Conditions: Some types of infections or diseases can lead to tissue damage of the genitals, which would require GRS to restore function.

Regardless of your reasoning for GRS, pelvic floor physical therapy will be essential to your healing journey. Let’s talk about why!

Firstly, this surgery will involve and affect your pelvic floor. The pelvic floor, no matter what genitals you have, plays an important role in your body. It supports your pelvic organs, back and hips, allows for sexual appreciation, and is what controls your ability to urinate or have a bowel movement.

These functions are obviously incredibly important to your health, so before and after your genital reconstruction surgery your physical therapist will need to screen your pelvic floor. The pelvic floor plays a role in preparation of your surgery as well as during recovery, so let’s take a look at how physical therapy is used for each:

Preoperative Physical Therapy for GRS

Preoperative physical therapy can help improve physical and mental readiness, lower the risk of complications, and enhance recovery. Your physical therapist will first screen for any possible complications or dysfunctions, and create a plan of care to get your pelvic floor in optimal health before your surgery. Additionally, they will help to educate you on this essential part of your body and work to ensure you have optimal control of it.

Utilizing physical therapy in preparation for genital reconstruction surgery may include the following:

• Pelvic Floor Training: In order to get your pelvic floor to normal function before surgery, your physical therapist can guide you through exercises and treatments that will allow you to gain better coordination, strength, flexibility, and awareness of your pelvic floor muscles.
• Breathing Exercises: Your physical therapist can help teach you important breathing exercises, such as diaphragmatic breathing. Diaphragmatic breathing will be a very helpful technique before and after surgery to help you become more relaxed and reduce anxiety.
• Nutritional Advice: The pelvic floor involves bowel and bladder movements—therefore, your physical therapist may suggest dietary changes (such as fiber or fluid intake) that can not only help with dysfunctions (such as constipation) but also support your body during recovery.
• Exercise Prescription: They may recommend an exercise routine not only to practice for your pelvic floor, but also to improve your general health, which will better support your recovery.
• Flexibility Training: Similarly to exercise prescription, your physical therapist will work to improve mobility, range of motion, and flexibility of your body to aid in recovery. This will help reduce stiffness and mobility struggles after surgery.
• Post-Op Prep: Your physical therapist may help you prepare for movements that will be more difficult after surgery, such as walking or getting in and out of bed. Additionally, they can suggest resources to obtain before surgery to help improve the post-operative experience, such as a mirror to assess the area, pain management strategies, and ways to better clean yourself following the procedure. 

Before your surgery, your pelvic floor physical therapist will outline what your surgery may entail and how it will affect the pelvic floor muscles. This will help you know what to expect, especially during recovery.

They’ll discuss post-op pain management strategies with you, and safe exercises you can practice after the operation. They may also recommend useful tools such as mirrors, douching devices, undergarments, or other items well-suited to GRS recovery.

Postoperative Physical Therapy for GRS

Postoperative physical therapy is absolutely essential to experiencing an effective recovery after genital reconstruction surgery. It allows the patient to regain normal function of their pelvic floor, manage pain, and overall have a better healing experience after their operation.

Postoperative physical therapy needs can vary from person to person. Typically, patients will come back in around 6-8 weeks post-operation; however some individuals may need to come in sooner (usually only necessary if issues arise). It is important to see a physical therapist who is highly trained, educated, and experienced with patients who have undergone GRS (you can get started with one of our awesome providers at Hive).

Recovery and rehabilitation after genital reconstruction can vary by the patient and type of surgery, but physical therapy will always play a crucial role. Here are some of the ways it will aid during this important period of recovery:

• Pelvic Floor Rehabilitation: As mentioned earlier, this operation will greatly affect the pelvic floor. Therefore, after surgery, it will be essential to work on regaining proper function of these muscles and helping to re-coordinate them as needed. This involves regaining pelvic floor strength and flexibility, which will help maintain proper bowel, bladder, and sexual function, as well as support for the pelvic organs, back, and hips.
• Assisting Restroom-Related Functions: Similarly to the task above, the pelvic floor therapist will help the patient regain normal bowel movements and urination, which can often pose challenges depending on the surgery.
• Regaining Sexual Appreciation: Sexual sensation, including but not limited to arousal and orgasm, can take time to reappear after genital reconstruction. Physical therapists can use sensory mapping, dilation, and other techniques to assist with regaining this important function.
• Exercise Prescription: The healing period after such a specialized surgery can often leave the patient with some form of debility. Therefore, it is essential for a physical therapist to provide guidance on strengthening, flexibility and mobility training. This can help the patient regain normal activity, and eventually complete more challenging tasks as needed.
• Scar and Wound Care: Wound care is an incredibly important aspect of genital reconstruction surgery. Your therapist will be able to provide guidance on techniques and strategies for improving scar mobility, as scars can often become adherent—which affects tissue mobility and blood flow. This lack of mobility and blood flow can restrict and even harm the nerves and muscle function. Additionally, your physical therapist can provide you with the education and resources necessary to monitor the surgical site and minimize complications during the healing process.
• Pain Management: Postoperative pain is to be expected, but your physical therapist can help teach you safe pain management methods to use throughout your recovery, such as body positioning, therapeutic modalities, massage, or exercises. Inadequate pain management can affect patient compliance with the surgeon’s required post-operative tasks. A physical therapist can recommend modifications to the program and aid in minimizing pain to help improve patient compliance and, ultimately, success in completing their home program.

These activities are essential to the recovery process and must be performed with the supervision or advice of a pelvic floor physical therapist who has specialized knowledge and training in genital reconstruction or transgender healthcare (if applicable). This professional will collaborate closely with other healthcare professionals in your care team to ensure the best possible outcome and recovery for your surgery.

In some cases, those who have had genital reconstruction may come back for additional physical therapy sessions months or years later as other needs or complications arise. This can vary from person to person, but it is important to know that the body still changes over time regardless of the changes made during surgery.

Therefore, future physical therapy sessions may be necessary to alleviate complications or to meet a patient’s new goals. For example, an individual may experience pelvic pain some time after their GRS surgery, which can be addressed with physical therapy. Or perhaps someone is experiencing dyspareunia years after receiving a vaginoplasty, which could be addressed with pelvic floor therapy training.

It’s not possible to predict future complications, but it can be helpful to acknowledge that they may arise as your body changes with age or your personal goals change throughout life.

At Hive Therapy and Wellness, we proudly provide pelvic floor treatment to help GRS patients pre and post operation, for all individuals including our friends in the transgender or LGBTQI community. As part of our individualized and comprehensive standard of care, we may use the following treatments to help GRS patients through their journey:

• Neuromuscular re-ed
• Manual therapy
• Exercise prescription
• Cupping 
• Behavioral modification
• Therapeutic activity 
• Therapeutic modalities
• Biofeedback