PT Evaluation & Treatment of Transgender Patients

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Boston, MA 02118

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Refund Policy

Refunds up to 7 days before event

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Christy Ciesla, PT, DPT, PRPC

Kristina Fitzgerald, LATC, MSPT, DPT, PRPC


Pamela Klein, RN, MSN, ACRN

Dustienne Miller, CYT, PT, MS, WCS

Summary Course Description:

This 2.5 day course is designed to equip the physical therapist with the evidenced based background knowledge, standardized forms and questionnaires, hands on skills, standardized protocols and resources to evaluate, treat and follow up Transgender patient referrals

Topics covered will include: pre-operative evaluation, treatment and education issues, intra-operative recommendations, post- operative evaluation, treatment, education and follow up.

Participants will have numerous hours of hands on lab with supervision of 8:1 ensuring that each and every skill is reviewed and supervised.

Standardized evaluation, questionnaires, treatment protocols and follow up templates, resources will be provided.


At the end of the course, participants will be able to:

  1. Define gender identity, transgender, sexual orientation
  2. Describe 2 common sexual issues for post- operative, neovaginoplasty patients and potential interventions
  3. Ask 3 open ended questions regarding transgender issues to their lab partner
  4. Demonstrate use of the standardized pelvic floor /orthopedic evaluation form
  5. Describe 4 pre-operative issues that are common for transgender patients
  6. Demonstrate accurate palpation of the male and female pelvic floor muscles and structures
  7. Describe 2 hormone related issues facing transgender patients during transition
  8. Provide a written biomechanical suggestion for their inter-operative intra-operative lab partner
  9. Demonstrate 2 manual therapy techniques appropriate for scar/ restricted pelvic floor tissues
  10. Demonstrate knowledge of the BMC dilation protocol
  11. Describe the essential components of the Yoga lab session as it relates to a Transgender patient
  12. Describe the surgical procedures for neovaginoplasty, phalloplasty, metoidoplasty, scrotoplasty, and chest reconstruction


Friday: Day 1

11:30-12:00 Registration

12-12:30:00 Introductions /Goals for Course (Goals sent out prior to course to each participant)

12:3000-1:330 Lecture-Terminology/ Partner LAB

1:30- 3:00 Lecture-Preoperative Issues: Hormones/Smoking Cessation/Electrolysis/BMI/Baseline Evaluation/Review forms

3:00-3:15 BREAK

3:15-5:3000 Lecture- Preoperative Issues, continued; Review forms LAB Surgeries

5:3000-6:00 Q&A, Dear Me Questionnaire

Saturday – Day 2

8:00-8:30 Summary of Day 1

8:30-10:15 LAB- Ppre-operative issues (related to Day 1) Evaluation/hands on Male pelvic floor model palpation/documentation

10:15-10:30 BREAK:30-10:30

10:30-11:00 LAB -Ppre-operative issues, continued

11:00-12:00 LabLAB-Intraoperative Recommendations

12:00-1:00 LUNCH

1:00-2:00 LAB- Post operative pelvic floor /orthopedic evaluation

2:00-3:00 LAB- YOGA Relaxation and Mobility for Participants

3:00-3:15 BREAK

3:15-4:15 LAB- Post operative Dilation/Irrigation

4:15-5:30 LAB- Other Post operative Issues

5:30-6:00 Q&A, Dear Me Questionnaire

Sunday- Day 3

8:00-8:15 Summary of Day 2

8:15-10:15 LAB- Scar Mobilization, Connective Tissue, Lymph Drainage

10:15-10:30 BREAK

10:30-12:00 Lubricants/Sexual toys/Stimulatorsion/Sexual Medicine/ BDSM

12:00-1:00 LUNCH

1:00-2:00 LAB- Manual Therapy, Exercise Protocols Sexual Medicine/ Position modifications

2:00-3:00 LAB- Exercise ProtocolsManual Therapy

3:00-3:15 BREAK

3:15 -4:00 LAB- Asking Open –ended Questions Exercise Protocols

4:00-4:45 LAB – Case Studies/Resources/Collecting data

4:45-5:00 Course evaluation, Dear Me Questionnaire/Finish


The course will include 5 sections: Introductory material; pre-operative, intra-operative, and post-operative care; and yoga/breathing techniques. Theses sections are described below:


A. Introductory Material – Includes LAB for partner interviews

  • Review of gender identity, cultural competence, terminology, self- bias, and skills in asking open-ended questions in a professional manner
  • Overview of gender transition-related medications and their potential impact on the whole body including relevant laboratory values
  • Overview of gender transition-related surgeries including pre-operative requirements

B. Pre-operative care

  • Learn how to evaluate the patient in preparation for surgery, including: pelvic floor evaluation and orthopedic screening evaluation from the cranium to the foot
    • o Special attention paid to assessing pelvic pain, straining during defecation and urination, bladder, bowel, sexual function
    • o Special attention paid to transition-related behaviors such as tucking and binding
  • Participants will be able to educate/support the patient about the following, if indicated:
      • o conditioning exercise programs for weight loss
      • o neo-vaginal care, rectal care, what to expect during and post-surgery
      • o breathing exercises for relaxation
      • o perineal hair removal
      • o smoking cessation

C. Forms

  • 1 hour LAB Participants will discuss the FGSIS, FSFI, NIH Chronic Prostatitis Male and Female forms, Edinburgh Depression Scale, and Sexual Distress Scale forms they filled out prior to class.


A. 3 hour LAB (related to Day 1)

  • Participants will use models and course members for evaluation of male genitalia and female genitalia and conduct orthopedic screening using the standardized form.

B. Intra-operative Care - Includes 1 hour LAB

  • Participants will practice pelvic, hip, lower extremity and upper extremity positioning and modifications on each other and write a paragraph as a mock referral documenting restrictions found and suggestions to the surgeons for optimal comfort during surgery.

D. 1.0 hour LAB Yoga/ meditation/ relaxation and toning


A. Post-operative Care – Includes 3 hr LAB

  • Overview of post-operative care such that the therapist understands the altered anatomy, immediate wound care, sites of surgical scars, status and care of tissues, as well as irrigation and dilation techniques
  • 1 hour LAB Participants will practice with GRS rigid and silicone dilators and follow written protocols on themselves and lab partners.
  • Participants will gain the skills to engage their patients in discussion of safe sex and changes that will occur in the sexual response cycles. Lubricants, tissue osmolality, and best practices for pain-free vaginal and anal penetration will be discussed in detail, including a review of sexual toys, clitoral, vaginal, anal, penile vibrators, stimulants and BDSM practices.
  • 2 hour LAB, covering:
    • o specific manual therapy release and strengthening techniques
    • o electrical stimulation
    • o exercise programs
    • o bowel, bladder demonstration
    • o bladder and bowel logs

B. Sexual Activity and Function– Includes 2 hour LAB:

  • sexual positioning for specific musculoskeletal conditions
  • application of lubricants
  • Demonstration of education and explanation to the post- operative patient relative to their body changes post-surgery, including tissue and scar mobility

C. Follow up visits and data collection

  • In-depth discussion regarding intervals for PT follow up, evaluation, and data collection.
  1. D. Resources
  • Discussion of resources and support group templates

Materials/ Sponsors:

  • Didactic information via pdf manual /you tube videos/articles will be sent online to participants 1 month in advance for participants to preview and bring to the course. A lab manual with specific checklists of each lab skill will be provided for each participant to use as a workbook during the course.
  • Soul Source Company has agreed to supply the rigid and silicone dilators for the course at a minimal cost.
  • YesYesYes.com has agreed to supply lubricants for the course for no cost.

©Holly Herman, Pamela Klein, Christy Ciesla, Kristina Fitzgerald, Dustienne Miller

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Boston, MA 02118

Refund Policy

Refunds up to 7 days before event

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