Pelvic Floor Rehabilitation for Transgender and Nonbinary Patients Following Gender-Affirming Vaginoplasty: A Scoping Review.

introduction and hypothesisThis scoping review aimed to explore the literature on pelvic floor physical therapy (PFPT) and document clinical outcomes in transgender and nonbinary patients following gender-affirming vaginoplasty.

methodsCINAHL, Embase, and Medline databases were searched from inception to February 5, 2025. Included studies focused on transgender and nonbinary patients undergoing vaginoplasty, who received PFMT and had pelvic floor dysfunctions evaluated. Studies were screened and critically appraised by two independent reviewers using the Mixed Methods Appraisal Tool.

resultsEight studies were included. The literature was sparse and characterized by high methodological heterogeneity: seven studies lacked a control group (consisting of cohort, case series and single case studies), while one was a randomized control trial (RCT) comparing postoperative sham to a PFPT intervention group (subdivided into one receiving pre- and postoperative PFPT and one receiving postoperative PFPT only). Descriptive outcomes varied across the literature. For pain, the RCT found no significant difference between groups, one case series reported worsening, and three single case studies observed improvement. For urinary and anal function, the RCT found no significant difference between groups, whereas a case series and a cohort study observed improvement. For pelvic floor function, one cohort study, two case series, and three single case studies observed improvement following PFPT. For dilation, although there were no difference between active and sham PFTM in the RCT, participants receiving both pre- and postoperative PFPT reported significantly greater ease of dilation than those receiving postoperative PFPT only. Further, a case series and a single case study also observed easier dilation following PFPT. For sexual function, a case series and a single case study also found improvement. The RCT found no significant difference in participant-perceived improvement between groups. Finally, one cohort study found a satisfaction rate of 89.9% following PFPT.

conclusionsCurrent literature on PFPT post-vaginoplasty is sparse and relies heavily on small, uncontrolled study designs, making it difficult to isolate the true effects of PFPT from natural surgical recovery. The highly variable and heterogeneous data and methodological limitations highlight major knowledge gaps. These findings emphasize the clear need for large well-powered, controlled research to evaluate the specific benefits of intensive perioperative PFPT.