When you think about health and well-being, the pelvic floor probably isn’t the first thing that comes to mind. But this group of muscles plays a substantial role in our everyday lives—supporting our organs, controlling bodily functions, and even impacting our sexual well-being. Queer and trans-identified folks are often excluded from mainstream discussions about pelvic health, leaving many people unaware of how pelvic floor therapy can be an integral component of our healthcare. 

As a licensed clinical social worker and occupational therapist, I’m here to offer you an introduction into pelvic health—and explain why it’s for EVERYONE. 

What Is the Pelvic Floor and Why Does It Matter for Your Health?

The pelvic floor is a network of muscles, ligaments, and connective tissues from your pubic bone to your tailbone that supports the pelvic organs, including the bladder, urethra, vagina, cervix, ovaries, rectum, uterus, prostate, and seminal vesicles. Imagine a hammock across your pelvis— a very important hammock that plays a crucial role in bowel and bladder control, sex, and core stability.

If you haven’t been pregnant or had medical concerns related to your pelvic organs, you may not have heard about the pelvic floor before. But your pelvic floor muscles have still been working hard for you and your body. Here’s some of what the pelvic floor does:

1. Support – Holds up and supports pelvic organs (e.g. bladder, intestines, and reproductive organs) to maintain their position and function properly.
   
   
2. Bladder & Bowel Control – Helps regulate urination and bowel movements by contracting and relaxing muscles.
   
   
3. Sexual Function & Pleasure – Plays a role in arousal, orgasm, and overall sexual health by providing sensation and muscle control.
   
   
4. Stability & Posture – Works with the core muscles to stabilize the pelvis, spine, and hips, contributing to balance and movement.
   
   
5. Pressure Management – Assists in managing intra-abdominal pressure, which is crucial for breathing, lifting, and core engagement.
   
   
6. Pregnancy & Birth – Supports a growing fetus and plays a key role in childbirth by stretching and contracting during labor.
   
   
7. Recovery & Healing – Helps in recovery after surgeries, injuries, or trauma to the pelvic region, including gender-affirming procedures.

What Is Pelvic Floor Therapy? 

Pelvic floor therapy is a specialized form of physical therapy (PT) or occupational therapy (OT) that focuses on assessing and treating dysfunction in the pelvic floor, as well as surrounding structures like the lower back, hips, and core. Pelvic floor PTs and OTs use a combination of manual therapy, exercises, behavioral strategies, and education to help clients improve function, reduce discomfort, and support overall well-being. 

You can expect a pelvic floor session to involve:

• A comprehensive evaluation
  
• An external and/or internal examination (if you’re comfortable), and
  
• Development of a personalized treatment plan, which may include pelvic floor muscle exercises, stretching, manual therapy, bowel and bladder training, postural and movement modifications, breathing exercises and training, pain management techniques, stress reduction and nervous system regulation techniques, and dry needling.

It’s important to remember that pelvic floor therapy should always be consent-based and move at your own pace. You are in charge of your body, and you get to decide what your boundaries are. If you work with a sex therapist or psychotherapist, you may also be interested in having them consult with your pelvic floor therapist for more coordinated, integrated care. 

The Main Reasons to Seek Pelvic Floor Therapy

Like any other muscles in the body, the pelvic floor can become too tight, too weak, or uncoordinated, leading to issues such as pain, incontinence, constipation, and sexual discomfort. Pelvic floor dysfunction is quite common, yet many people go years without getting the care they need, often as a result of societal stigma and a lack of accurate medical information. 

Just because pelvic floor dysfunction is common doesn’t mean you should deal with the symptoms alone. Someone might seek out professional support for their pelvic health if they experience:

• Urinary or bowel incontinence—leakage, urgency, or frequency (e.g., leaking urine when you laugh, sneeze, jump, or cough; not making it to the bathroom)
• Pain during sex (i.e. dyspareunia) or other pelvic pain (e.g. vaginismus, endometriosis)
• Managing changes in sexual function
• Pre- and post-operative recovery for pelvic organ and/or gender-affirming surgeries
• You plan to be pregnant, are currently pregnant, or are postpartum
• Core instability
• …and more!

Often, the first stop in finding treatment is going to a physician or other medical provider to diagnose, treat, and refer patients with pelvic floor dysfunction. This may be a urologist, urogynecologist, OB/GYN, primary care provider, oncologist, gastroenterologist, or other type of specialist. Depending on their speciality, they may do diagnostic tests, provide non-surgical or surgical treatments, or refer you to pelvic floor therapy.

How to Find Affirming, Queer-Inclusive Pelvic Floor Therapists

If you have a pelvis, you have a pelvic floor. All people, regardless of their sex, gender identity, or interest in reproduction may benefit from pelvic healthcare and/or pelvic floor therapy. 

Queer and trans-inclusive pelvic floor therapy acknowledges the diverse ways people experience their bodies. A knowledgeable, affirming provider will create a safe, judgment-free space to address your concerns. This kind of care is about empowerment—helping you reconnect with your body on your own terms and improving your quality of life.

If you’re curious about pelvic health but feel any anxiety or hesitation about finding an affirming provider, Notice and Ask. Notice if they explicitly use expansive, affirming language related to gender and sexuality, and consider asking directly: “What is your experience providing pelvic health services to (trans/non-binary/queer) people?” Many pelvic health therapists are working to make this essential care more accessible to all people. Affirming care is out there! 

To find inclusive care, consider:

• Pelvic health provider directories such as Pelvic Rehab, OT Potential, Pelvic Global, and the Pelvic Health PT locator.
• The WPATH (World Professional Association for Transgender Health) Provider Directory 
• LGBTQ+ Healthcare Directory
• Referrals from your local LGBTQ+ health centers or Planned Parenthood clinics

• Local queer and trans social groups, including social media groups
• Referrals from your LGBTQ+-affirming primary care provider or therapist

Depending on the state you live in and the provider you’re hoping to work with, you may need a referral from a medical provider to begin pelvic floor therapy. 

Pelvic health therapy is for everybody, and you deserve a provider who makes you feel safe, respected, and heard. If you’re experiencing discomfort, pain, or just want to strengthen your connection with your body, pelvic floor therapy could be a powerful tool in your self-care.

Photo Credit: The L Word