Gender affirmation surgery is often critical for trans people to alleviate gender dysphoria and live in a body that truly matches their inner self. It’s also a major surgical procedure that significantly changes the anatomy of the pelvic region and can cause a range of side effects. Some pain and discomfort is normal during recovery from gender reassignment surgery, but some patients have additional issues that impede the normal healing process and may cause pain to linger or even worsen over time. We at Pelvic Rehabilitation Medicine are absolutely committed to ensuring a reassuring and comfortable environment for all of our patients to find the best combination of treatment options to resolve pain and dysfunction and feel happy and at home in their bodies.

How much pain is normal following gender affirmation surgery?

Typically patients are cleared to resume normal activity by their surgeon after about two months, but there isn’t any catch-all answer. Each patient and surgery is different, and everyone heals at their own pace. Communication and dialogue are key – if you are experiencing worsening or debilitating pain, you should report it to your physician.

What are the most common causes of chronic pain following gender affirmation surgery?

Surgery or other trauma to the pelvis can cause the abdominal and pelvic floor muscles to go into a “chronic guarding state” in which the muscles shorten, becoming spastic and weak. This can result in pain from irritation of the pelvic nerves. Surgery can also leave behind scar tissue and pelvic adhesions which affect blood flow and can contribute to nerve pain.

Are there pre-existing conditions that contribute to a higher risk of post op pain and dysfunction?

Broadly speaking, you are more likely to experience pain symptoms following surgery if you have suffered from pelvic pain issues in the past. There are a number of pre-existing chronic pain conditions that can overlap and cause additional problems following surgery. Some of the most common include:

  • Myofascial pelvic pain
  • Fibromyalgia
  • Irritable bowel syndrome (IBS)
  • Chronic migraines
  • Interstitial cystitis (IC) or bladder pain syndrome (BPS)

Underlying gynecological disorders can also make post-operative pain more likely in trans patients who were assigned female at birth. These include:

  • Endometriosis
  • Adenomyosis
  • Fibroids
  • Polycystic ovary syndrome (PCOS)

Do post-surgery pain symptoms differ between transmen and transwomen?

The muscles and nerves are the same regardless of which gender you were assigned at birth, which means that muscle and nerve dysfunction is broadly the same across the spectrum. However, patients who were assigned female at birth are at a higher risk of underlying gynecological disorders like endometriosis, which can increase the likelihood of pelvic pain.

How is postoperative chronic pain following transgender bottom surgery treated?

We emphasize a non-operative approach to rehabilitating the pelvic muscles and nerves. This can include:

  • Pelvic floor physical therapy: We offer pelvic floor PT, often a very useful non-surgical tool in helping our patients overcome pelvic pain issues.
  • Restorative yoga: Regimens such as Dustienne Miller’s Your Pace Yoga focus on meeting the patient where they are and helping them reduce pain and improve function at their own pace.
  • Proper ergonomics: Having bad posture or sitting for long periods in an unnatural position can exacerbate many pain issues. Postural awareness is key. Specially designed cushions or other ergonomic furniture may be helpful in some cases.
  • Treating constipation: Regulation of bowels is important, as constipation and sitting on the toilet puts undue stress on the pelvic floor muscles and nerves. It’s important to stick to a diet that helps you stay regular.
  • Diaphragmatic breathing: It’s not a cure per se, but deep breathing exercises have been shown to help temporarily reduce pain, and can be an invaluable tool in tempering the severity of chronic pain flare-ups.

Pelvic Rehabilitation Medicine is a gender-inclusive practice

Pelvic pain issues are very frequently a sensitive and difficult issue to talk about, and this can be doubly true for transgender patients. We put our patients first and are committed to creating a judgment-free environment where everyone who comes to us feels safe and understood. If you are struggling with chronic pelvic pain, no matter who you are, we want you to know that help is available.