Background & Aims

Prevalence of musculoskeletal and urogenital complications after gender-confirming surgery (GCS) are similar to those reported after similar surgeries in cisgender people. Transgender and gender diverse (TGD) individuals report greater levels of disability compared to their cisgender peers1 and TGD people are underserved by the health system and at-risk for disparate healthcare.2 Our previous work suggests that musculoskeletal pain and pelvic floor dysfunction are common following GCS,3 but these have not been evaluated in a large-scale study and differences between “masculinizing” versus “feminizing” procedures have not been studied. Therefore, the purpose of the current study was to explore the rates of pain and types of physical impairments reported following GCS in a geographically diverse sample of individuals.

Methods

A custom survey was built in REDCap and iteratively tested for wording and understandability by three TGD individuals who participated in a related mixed-methods GAS study. Recruiting fliers were sent to LGBTQIA+ organizations across the USA to post on social media and other online community platforms. The survey was open from March 22 to June 22, 2023. The survey collected demographic information, types of surgery, post-surgical pain, uro-genital dysfunction, and activity limitations, in addition to the types of providers accessed and interventions provided. Data were cleaned and sorted in excel and exported to SPSS. Summary statics were calculated for the entire sample using frequencies and proportions or means and standard deviations based on the data structure. Non-parametric measures were used to test associations between post-surgical care, gender identity and geographic location.

Results

584 responses from 247 people identifying as female, 293 male, and 41 nonbinary with a median of 1 GCS (range 1 to 10) were included. Average age of respondents was 28.6 (5.2) years. The majority lived in the South-East or Mid-Atlantic USA. The most common surgery was breast augmentation, followed by phalloplasty and simple mastectomy. 70% of respondents reported pain, 25% difficulty moving, 23% bowel or bladder dysfunction and 9% dyspareunia. No geographic associations were noted with type of GAS, history of other treatments, or proportion of participants reporting pain or other dysfunction. Significantly more respondents who had feminizing procedures reported dyspareunia, and difficulty moving. Of those reporting incontinence, the rate was greater in those who had masculinizing procedures. No other differences were noted except for higher proportions of people who had feminizing procedures sought physical therapist or occupational therapist services.

Conclusions

The results suggest that both individuals who undergo masculinizing and feminizing procedures report musculoskeletal pain, movement problems, and pelvic floor dysfunction following GCS. Care provided did not vary statistically by region, based on survey responses. Notably, these issues are commonly addressed in cisgender patients by physical rehabilitation providers, including physical and occupational therapists. For example, rehab providers are directly involved in both acute and post-acute care of individuals leading up to and following many types of surgery, including joint or soft tissue surgery. Less than half of our sample were referred to a physical therapist and only 20% were referred to an occupational therapist at any point. Results of the current study suggest that rehabilitation providers may be able to address the needs of TGD people after GCS surgery.

References

1.James SE, Herman JL, Rankin S, et al. National Center for Transgender Equality: Washington, DC; 2016. The report of the 2015 US Transgender survey. Available from: https://transequality.org/sites/default/files/docs/usts/USTS-Full-Report-Dec17.pdf [Last accessed: January 19, 2024].

2.Kachen A, Pharr JR. Health care access and utilization by transgender populations: A United States transgender survey study. Transgender Health 2020;5(3):141–148; doi: 10.1089/trgh.2020.0017.

3.Bishop MD, Morgan-Daniel J, Alappattu MJ. Pain and dysfunction reported after gender-affirming surgery: A scoping review. Phys Ther 2023;103(7):pzad045; doi: 10.1093/ptj/pzad045

Presenting Author

Meryl J Alappattu

Poster Authors

Mark Bishop

PhD

University of Florida

Lead Author

Meryl J Alappattu

DPT

Department of Physical Therapy, University of Florida

Lead Author

Nicole Stetten

PhD

Survey Research Center, Brown University, Providence, RI, USA

Lead Author

Adriana Rivas

Department of Physical Therapy, University of Florida

Lead Author

Harvey Chim

Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Florida

Lead Author

Topics

  • Access to Care