Commentary: Gender transitioning needs integrative medical approach

With Caitlyn Jenner’s incredible journey commanding so much media attention, the transgender community has never been more at the forefront than it is today.

But even as acceptance begins to grow, this community faces complex issues that few fully appreciate or understand.

Following genital surgery, many patients find that they suffer pain, discomfort and an inability to use their new parts, sometimes for several months or years. They liken it to being given a Ferrari but not knowing how to drive.

Not everyone in the transgender community undergoes genital surgery. Those who do pursue it are generally advised to wait for a year after transition. Many never see the need.

But for the estimated 175,000 who do choose surgery, many report lack of blood flow and pelvic floor dysfunctions, including voiding issues, pain related to sex and difficulty using dilators, devices used to maintain vaginal depth.

More should be done so that the men and women who have finally found their way into the right bodies know how to use them. At Womanology by Hoag, for example, we have devised an integrated pelvic physical therapy program for pre- and post-gender confirmation surgery, using proven tools and techniques to treat pelvic floor issues.

Our gender confirmation program is the first to launch in California, and while we have always treated this population, we saw a necessity to start and establish a specific program to fit its unique needs.

Using an integrative treatment approach, we connect not only the physical but also the mental and emotional aspects of care. Genital surgery is usually the last stage of patients’ full transformation, and it is important that they know they are not alone on their journey and that a team of physical therapists, sex therapists, guided-imagery therapists and others can help them meet their specific goals.

That is why this is referred to as a gender-confirmation program and not a gender-reassignment program. We will work with people from the time they walk through the door based on how they identify themselves. A woman is a woman and a man is a man, no matter what “parts” they have.

However, physically we have to acknowledge that those parts do work very differently. Physical therapists and guided-imagery therapists can teach people how to retrain their muscles to lift, strengthen and relax in ways they never had to before. If you are losing or gaining a limb, the motor control involved is not intuitive. You need someone to help guide you through the process.

Also, as with any surgery, blood flow issues need addressing, and pelvic-alignment issues are common.

To further integrate the medical and the emotional, a patient’s partner should be involved with physical, psychological and sex therapy. The patient isn’t the only one undergoing a metamorphosis. It is important for a person’s partner to be there for the patient and also get the answers and resources the he or she needs.

Caitlyn Jenner has said that as Bruce, she had been living a lie. Now that she has transitioned, she can finally be who she was meant to be. We in the medical profession need to be just as brave and forward-thinking.

In orthopedic medicine, best practices dictate incorporating physical therapy pre- and post-operatively to maximize function and healing. This should be the standard of care in patients who undergo sexual confirmation surgery as well.

As transgender people gain acceptance, undoubtedly more people will find the courage to transition and seek surgery. When they do, I hope they find not only a society but a medical community ready to embrace them.

Hoag Hospital employee SHERINE AUBERT is a physical therapist at the Fullerton location of Womanology + Restore Him.