By CHARLES DUDLEY, MPT, COMT
Pelvic physical therapy has been around for quite a long time but unlike other areas of physical therapy, with equal access to all sexes and genders, pelvic physical therapy is largely skewed toward cis women, dominating the field of research as well as trained physical therapists. According to the National Library of Medicine, there are 12,443 articles for women’s pelvic health and 2,974 articles for women’s pelvic physical therapy, compared to 80 articles for men’s pelvic health and only 22 articles for men’s pelvic physical therapy. There is even less research data for the transgender community, bringing in only 55 research articles for transgender pelvic health and only six articles for transgender pelvic physical therapy and it only gets worse. Trans men have only ONE article for pelvic health and NONE for pelvic physical therapy. Ironically the disparity we see between cis women and cis men regarding pelvic research holds true in the trans community, albeit far fewer articles for trans pelvic than cis pelvic. Trans women have 37 articles for pelvic health (Compared to 12,443 for cis women) and a mere six articles for pelvic physical therapy, a quick afternoon of reading over tea for some of you.
The problem is we all have a pelvic floor! I have heard of doctors telling their male patients they don’t have a pelvic floor and have nothing to worry about, but they do on both counts. I have also heard stories of doctors telling trans men they cannot get pregnant because of being on HRT, but if you have a vagina and sleep with someone spermy, then yes, while the chances are lower because of the HRT, you can still get pregnant.
Is it any wonder that we are unintentionally putting our patients at risk? Not out of malice but out of a lack of knowledge. I mean, it is not like there is a lot of reading involved at this point from the research article standpoint, so why haven’t you read them yet? Simple. It is not talked about. There is a social factor when it comes to how each of these groups has conversations and the more marginalized the group the more selective they become in who they trust with certain information about themselves with not just medical providers, but also with each other. You are wondering why men are lumped into this category of marginalized groups? In this instance, they are. The social pressures to be strong, masculine and invulnerable is oppressive. Men do not talk to each other in the bathroom while women share make up and chat with their friends. It is not uncommon for women to go to the lady’s room in pairs but men one at a time. If a guy is at the urinal and another guy starts talking to him, he wraps up business as quickly as possible and gets out of there! The only time I have seen men chatting in the men’s room was at Oktoberfest in Munich when everyone was drunk, and barriers were at an all time low! BTW, so was the partition between urinals. Actually, there were no urinals, it was a trough with a partial wall between you and the guy on the other side facing you. Very awkward, even when drunk.
We are social creatures and if it is not being talked about then it must not be important. This is what has led to a 28-year gap between the binary sexes in pelvic health. Don’t believe me? June Allison was the spokesperson for Depends in 1984. She was perfect because she represented their target audience, older women with incontinence. Depends for Men did not come out until 2012. In an effort to normalize their product, they did not use older men for their commercials, no, they used younger men who were active, even having professional athletes try their product and be a spokesperson.
Right question, wrong answer. U.S. sales of incontinence products were a $4.4b industry in 2020, while PDE5 inhibitors brought in $3.5b. That is a lot of people peeing themselves and getting hard!
Pelvic physical therapy treats both of these conditions, and many more. Pelvic physical therapy is the culmination of orthopedics, neurology, psychology, endocrinology, urology, and G.I. just to name a few areas they are trained because of the uniqueness of the pelvic region and its relationship to all of these systems. Pelvic floor muscles are part of our core to give us trunk stability and can lead to back and/or hip pain when weak. The same muscle group gives bladder control, as well as bowel control. The very same muscles give us sexual function, whether penile, vaginal, metoidioplasty, or neovaginal. It has an elegant system of neurological control blending conscious and subconscious systems. When was the last time you consciously coordinated the muscles for an orgasm? We don’t! We can tell if there is solid, liquid, or gas in our rectum and discriminately let out one but not the other, even though we sometimes get it wrong. We can pee without pooping, poop without peeing, and engage in sex without releasing the two sphincters when we engage the pelvic floor leading up to climax or relax it after climax.
We all have a pelvic floor with muscles that control our most intimate of needs regardless of our gender identity and I encourage you to reach out to your local pelvic physical therapist closest to you as they help patients get to the core problem and truly fix them. Don’t ignore the canary in the cave.
Charles Dudley, MPT, COMT, of Davenport Pelvic Therapy, has been a physical therapist for over 2 decades in the U.S. and London, UK. He is a certified orthopedic manual therapist specializing in men’s pelvic health as well as transgender health with training through Herman & Wallace Institute of Pelvic Rehab where he is also a teacher’s assistant.
He is also the medic/physical therapist for the Orlando Otters, RFC.