Hormone therapy can bring many positive changes, but it can also influence how your body feels and functions, including your pelvic health. Changes to bladder, bowel, sexual health and pelvic pain can occur as your body adapts to different hormone levels. For people taking testosterone, lower oestrogen levels can affect the tissues of the vagina and vulva, sometimes causing dryness, irritation, discomfort with penetration or changes in bladder function. Some people may also experience increased pelvic floor muscle tension, which can contribute to pelvic pain, bowel or bladder concerns, or discomfort during intimacy. For people taking oestrogen, changes in sexual function can occur as the body adjusts to treatment. This may include changes in libido, arousal, erections or ejaculation. After gender affirming surgery, pelvic health physiotherapy can also support recovery by helping with pelvic floor function, bladder and bowel health, scar management and vaginal dilation where appropriate. These changes do not happen to everyone, but if something feels different, uncomfortable or is affecting your daily life, it is worth paying attention to. Pelvic health physiotherapy can help you understand what may be contributing to your symptoms and provide practical strategies to improve comfort and function. Your body is constantly changing, and hormone therapy is one part of that picture. Understanding those changes can help you feel more informed and confident in looking after your pelvic health.

Pelvic Health Is for Everyone Pelvic health is often talked about as a women’s issue, but in reality it affects people of all genders across every stage of life. The pelvic floor is a group of muscles and connective tissues that support the bladder, bowel, and reproductive organs. These muscles also play a role in sexual function and everyday movements like lifting, bending, coughing, or laughing. Because they are involved in so many aspects of daily life, looking after pelvic health is important for everyone. Pelvic health concerns can show up in many different ways. Some people experience bladder leakage, urgency, constipation, or changes in bowel habits. Others may experience pelvic girdle pain, including discomfort around the sacroiliac joints, pubic symphysis, or coccyx (tailbone). Pelvic pain can also occur in the lower abdomen or in the genitals and may affect comfort with sitting, exercise, or sexual activity. These symptoms can affect people of any gender, yet they are often not openly discussed. Pelvic floor challenges can appear at different stages of life. Children may experience constipation, bedwetting, or daytime bladder accidents. Adolescents and adults may notice pelvic pain, bladder urgency, or bowel changes. Men may experience pelvic pain or bladder symptoms, including leakage, particularly after prostate surgery. Older adults may notice changes in bladder or bowel control or pelvic comfort as the body changes with age. While these experiences are common, many people are surprised to learn that help is available. Hormones also play an important role in pelvic health for people of all genders. Changes in hormone levels; during puberty, pregnancy, menopause, or as part of gender-affirming hormone therapy, can influence tissue health, bladder control, sexual function, and comfort in the pelvic region. Understanding these changes and supporting the body with the right care can make a meaningful difference. Pelvic health physiotherapy offers practical support, education, and treatment for many of these concerns. Physiotherapists can help people better understand their pelvic floor, improve bladder and bowel habits, manage pelvic girdle or pelvic pain, and support comfortable movement in daily life. Often, small changes can make a big difference to daily comfort and confidence. Pelvic health isn’t limited to one gender or one stage of life. By talking about it more openly and recognising the many ways it can affect the body, we can make it easier for everyone to seek support and care for their pelvic health.

Supporting Transmasculine and Transfeminine Clients Through Bottom Surgery: The Role of Physiotherapy Bottom surgery is a powerful and deeply affirming step for many both transmasculine and transfeminine individuals. Whether someone is preparing for vaginoplasty, vulvoplasty or phalloplasty, the journey is not just surgical—it’s physical, emotional, and functional. Physiotherapy can play a key role in optimising outcomes and supporting a safe, confident return to daily life. At our clinic, we work closely with clients before and after gender-affirming surgeries to ensure their pelvic and overall health is considered throughout their surgical journey. Pre-Surgery Preparation: Laying the Foundation Before surgery, our physiotherapy sessions focus on building a strong foundation. This includes: Understanding Your Body’s Baseline We begin by gaining a thorough understanding of your current: Bladder and bowel function – Are there any concerns with urgency, leakage, constipation, or straining? Pelvic floor tone and coordination – We assess whether your muscles are overactive, weak, or uncoordinated, which can impact recovery. Intimate or sexual function – If relevant and comfortable for the client, we explore areas of sensitivity, pain, or tension that may influence post-op outcomes. These baseline assessments guide us in creating a tailored prehabilitation program that optimises your function and supports a smoother recovery. Optimising Pelvic Health Pelvic health plays a crucial role in: Managing urination and bowel habits post-surgery Supporting circulation and tissue healing Reducing pelvic pain or tightness Preparing muscles for dilation (if applicable) We also look at core strength, breathing, posture , and general mobility —especially important for improving blood flow, wound healing, and reducing post-op complications. Post-Surgery Recovery: Gentle, Guided Support After surgery, our work shifts to supporting your healing and helping you return to your life with comfort and confidence. Wound Care & Scar Management We guide you through: Gentle scar tissue mobilisations (when appropriate) Promoting circulation to reduce swelling Supporting healing around graft or donor sites (e.g., arm, thigh) Dilation & Tissue Care For clients undergoing phalloplasty or metoidioplasty involving a urethral lengthening or neo-vaginal closure, pelvic physiotherapy may include: Education around dilation (where applicable) Pain management strategies Breathwork and relaxation techniques to reduce muscle tension Returning to Life and Movement We support: Safe return to walking, lifting, cycling, gym or sports Managing fatigue and pacing during recovery Addressing any bladder, bowel or sexual function changes We also hold space for the emotional aspects of recovery. This is a major life transition, and our approach is compassionate, gender-affirming, and always client-led. We Are With You All the Way Our goal is to make your body feel more like home. Whether you're months away from surgery or already on the other side, we’re here to walk beside you with skilled hands, open minds, and affirming care. If you’re considering bottom surgery or in the recovery phase, get in touch to see how pelvic physiotherapy can support your goals and wellbeing.