Department of Urology and the Division of Plastic Surgery, Transgender Health Program, and the Department of Physical Therapy and Rehabilitation, Oregon Health & Science University, Portland, Oregon.
Obstet Gynecol. 2019 May;133(5):1003-1011. doi: 10.1097/AOG.0000000000003236.
To describe the incidence of pelvic floor dysfunction in transgender women undergoing gender-affirming vaginoplasty and outcomes in a program providing pelvic floor physical therapy (PT).
We conducted a retrospective, single-institution study on vaginoplasty patients between May 1, 2016, and February 28, 2018; all were referred for pelvic floor PT. We reviewed medical records for baseline demographics, medical comorbidities, prior surgeries, insurance data, attendance at pelvic floor PT, and dilation success at 3 and 12 months.
Seventy-two of 77 patients (94%) attended pelvic floor PT at least once. Preoperative pelvic floor PT identified a high incidence of potential problems: 42% had pelvic floor dysfunction, 37% had bowel dysfunction. Of those patients found to have dysfunction preoperatively, the rate of resolution by the first postoperative visit of pelvic floor and bowel dysfunction were 69% and 73%, respectively. There were significantly lower rates of pelvic floor dysfunction postoperatively for those patients who attended pelvic floor PT both preoperatively and postoperatively compared with only postoperatively (28% vs 86%, P=.006). Patients reporting a history of abuse had a significantly higher rate of preoperative pelvic floor muscle dysfunction (91% vs 31%, P<.001). Successful dilation at 3 months in all patients was 89%.
Pelvic floor physical therapists identify and help patients resolve pelvic floor-related problems before and after surgery. We find strong support for pelvic floor PT for patients undergoing gender-affirming vaginoplasty.
描述接受性别肯定性阴道成形术的跨性别女性盆底功能障碍的发生率，并介绍一个提供盆底物理治疗（PT）的项目的结果。
我们对 2016 年 5 月 1 日至 2018 年 2 月 28 日期间进行阴道成形术的患者进行了回顾性单机构研究；所有患者均转介接受盆底 PT。我们回顾了病历，以了解基线人口统计学、合并症、既往手术、保险数据、盆底 PT 就诊情况以及术后 3 个月和 12 个月的扩张成功率。
77 例患者中有 72 例（94%）至少接受过一次盆底 PT。术前盆底 PT 发现了很高的潜在问题发生率：42%存在盆底功能障碍，37%存在肠功能障碍。术前发现有功能障碍的患者中，盆底和肠功能障碍在术后首次就诊时的缓解率分别为 69%和 73%。与仅术后接受盆底 PT 的患者相比，同时术前和术后接受盆底 PT 的患者术后盆底功能障碍的发生率明显更低（28%比 86%，P=.006）。报告有虐待史的患者术前盆底肌肉功能障碍的发生率明显更高（91%比 31%，P<.001）。所有患者术后 3 个月的扩张成功率为 89%。
盆底物理治疗师在手术前后发现并帮助患者解决与盆底相关的问题。我们强烈支持为接受性别肯定性阴道成形术的患者提供盆底 PT。
