Transgender, Non-binary, and Intersex Pelvic Health

Pelvic health physical therapy is beneficial for individuals who have undergone gender affirmation surgical procedures. It can help reduce pelvic pain by treating connective tissue and myofascial restriction and by assisting with postural changes at the pelvis. Treatment aimed at increasing pelvic floor muscle control can assist with bladder and bowel dysfunction and can optimize pelvic health.


Pelvic therapy treatment can help the following:

  • Stress incontinence (urine leakage with coughing, sneezing, jumping, lifting, etc.)
  • Urge incontinence (strong sudden urges)
  • Pelvic organ prolapse
  • Dyspareunia (Pain with intercourse)
  • Pelvic pain
  • Vaginismus (painful spasms with penetration)
  • Vulvodynia (chronic pain around vulva)
  • Post-partum pain
  • Levator Ani Syndrome
  • Diastasis Recti
  • Pregnancy-related pain
  • Pudendal Neuralgia (pelvic nerve pain)
  • Post-surgical scar pain 
  • Dysfunction following gender affirmation surgery
  • Prostatitis
  • Sciatica
  • Orchialgia, scrotalgia, testalgia
  • Coccyx/tailbone pain
  • Constipation
  • Fecal incontinence


Physical therapy treatments include:

  • External and internal examination techniques
  • Pelvic floor muscle training
  • Internal and external trigger point release
  • Surface EMG
  • Manual therapy for the pelvic floor and hip musculature
  • Joint Mobilization
  • Patient-specific exercises targeting the pelvic floor musculature
  • Instruction in Vaginal Dilator use


 Frequently Asked Questions
Do I need a referral from a doctor?
Yes. Although your insurance may allow you to attend Physical Therapy without a prescription or referral, it is required that you have a provider managing your overall health care. Many conditions involving the pelvis can be medical in nature and require a physician examination to rule out more serious conditions. It is also helpful to have a medical provider with whom we can coordinate care and discuss your health as a team
What will we do on my first visit?
First, we will talk. We will review any forms that you bring in, and you will have the opportunity to share your history and concerns. The exam will be discussed with you so that you can have any questions answered right away. Your exam may include general movement like bending forward and backward, observing how you move your body, and specific tests of your joints, muscles, and nerves. If you come to the clinic for pelvic rehabilitation, an assessment of your pelvic muscles internally (through the rectum or vaginal canal) may be valuable, and you have the option to choose or refuse any part of the process with which you don't feel comfortable. This portion of the exam will be thoroughly explained to you after your history is taken and you will have an opportunity to ask questions. 
What is biofeedback?
Your therapist may use surface EMG (electromyography), a form of biofeedback. This includes placing small sensors on your body so that you and your therapist can get a better idea of you are coordinating your muscles.  Biofeedback means that you will be able to get information about how your muscles are working and this will be displayed as a graph or bar on a computer screen.
I have my period. Should I reschedule?
It is usually not necessary to reschedule if you are on your cycle, so you are welcome to keep your appointment. However, if you are uncomfortable keeping your appointment, please call to cancel as soon as possible so that we may fill your time slot.
Do you do internal work?
If appropriate and indicated based on findings from your initial evaluation continued internal muscle work may be completed as part of your treatment.
Will my insurance cover this?
Most insurance companies will cover physical therapy for pelvic rehabilitation. Please check with your insurance company or our billing department if you have any specific concerns.
Transgender, Non- binary, and Intersex Pelvic Health Provider 


Transgender Pelvic Health Physical Therapist - Kim Fletcher

Kim Fletcher, PT, DPT, PRPC

Physical Therapist | Certified Pelvic Rehabilitation Practitioner

A Moscow native, Kim returned to the Palouse following graduation from Eastern Washington University with a Doctorate in Physical Therapy.  After working many years as an outpatient orthopedic physical therapist she sought further education to allow her to better serve patients with pelvic dysfunction, pregnancy and postpartum conditions. She has gone on to earn her Pelvic Rehabilitation Practitioner Certification (PRPC) after several years of focused work in the area of Pelvic Rehabilitation.

Special interests in the area of pelvic health include pregnancy and postpartum conditions, coccyx dysfunction, incontinence, bowel dysfunction, and pelvic pain.  Outside of work she enjoys spending time with her 2 children, playing hockey and golfing with her husband.


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