Win Your Battle With Pelvic Pain With These Tips for Trans Men & People with Vulvas

Are you a trans man or non-binary person struggling with pelvic pain? Is it difficult to find a doctor you can trust to help you? If so, you’re not alone in this battle. 

While some healthcare providers see this as primarily a cis-gender woman’s health issue, that’s just not the case. Cis-men, trans men, and non-binary folks can also struggle with vulvar and pelvic pain.

Despite many advances, the binary structures of medical care remain deeply entrenched. Thankfully, the healthcare community is slowly becoming more aware of the unique needs of trans and non-binary people. 

But it shouldn’t be left up to you to educate your doctor on the type of care you need. So working with gender-affirming healthcare providers is essential to your wellness journey.

Because you deserve compassionate care from competent providers that will get you relief.

But knowledge is power, and the more you know about vulvar pain, the better you can advocate for yourself and others.

So let’s talk about the specific challenges you may be facing when dealing with pelvic pain.

Causes of vulvar / pelvic pain in trans and non-binary folks

Pinpointing the specific cause pelvic pain is a challenge for all patients. 

Diagnosing and treating pelvic pain is similar for vulva owners of all genders. However, your doctor should be particularly aware of factors that are unique to your situation such as:

• Post-surgical complications that can cause or worsen your pelvic pain.

• Testosterone use can cause vaginal atrophy and changes to your vaginal pH, making you more vulnerable to vaginal or cervical infections.

• Increased muscle on your frame changes your posture, which may place tension on your pelvic floor muscles.

• Any recent or past history of sexual trauma or assault.

• Traumatizing past experiences with healthcare providers.

• Mental and emotional health issues like depression or PTSD.

• Current or past domestic violence.

What you can expect at the doctor's office

You are in control of your own body, and those rights don’t go away just because your doctor is used to doing things their way. 

But it is your right to speak up and refuse any procedure or exam you’re uncomfortable with. These may include:

• An exam using a speculum

• Pregnancy test

• Transvaginal ultrasound

• Bimanual exam (gloved internal exam of the uterus and ovaries)

Gender-affirming providers are very understanding if you refuse any of their recommended exams. And there are plenty of alternative methods of gaining the information they need. 

Refusing procedures/exams you’re uncomfortable with is a vital part of your emotional wellbeing. What your doctor may see as a simple exam can be triggering for some patients – being an advocate for yourself is going to be a key part of your emotional well-being toolkit!

If your doctor firmly believes a specific test is medically necessary, you also have the right to ask if you can place the speculum or ultrasound device yourself instead of your doctor doing it. Having control of the situation might make you feel comfortable enough to do the test.

Have open and honest discussions about the types of sexual activity you engage in. These discussions give your doctor valuable information and can help you avoid unnecessary tests. For example, if you are not sexually active with a partner with a penis, then a pregnancy test isn’t needed.

Hopefully, your doctor is there to give you the help you need in the most respectful and least physically and emotionally invasive way possible. However, some healthcare providers just don’t feel safe, so if you feel this way, it’s 1000% ok to find someone who you trust is really in your corner.

Now that you know what to expect on your next doctor visit, let’s take a look at some of your treatment options. 

Treatments for vulvar/pelvic pain or pain during penetration

Here are the quick points, and then more details below:

• Medications for infections

• Hormone creams applied locally

• Non-irritating vulvar lubricants or moisturizers

• Prescription pain medications

• Adjusting testosterone use

• Hysterectomy

• Pelvic floor physical therapy

• Psychotherapy

If lab tests determine that a bacterial infection is causing your pain, the fix is relatively easy. The test results let your doctor know which medication to prescribe for fast relief.

Since testosterone use often causes vaginal atrophy, the solution may be a vaginal estrogen / combinational hormone treatment. And don’t worry, the effects are local. Since the estrogen isn’t absorbed throughout your whole system, it won’t interfere with the results of your testosterone treatments.

Your doctor may recommend using vaginal moisturizers or lubricants to give you relief. In some cases, prescription pain medication is effective, too. Adjusting the dose or method of testosterone therapy can also alleviate pelvic pain in some patients.

Many trans folks have opted for a hysterectomy. It’s important to note that this does not always fully resolve pelvic pain. So talk with your doctor about all the factors involved, including your medical history, sexual health needs and any reproductive goals you may have.

If you don’t have any infections or lesions, topical lidocaine cream can do wonders. It helps the brain and the body learn that something in/around the vulva does not equal pain. 

Finding pelvic pain relief is often a team effort involving several different types of healthcare providers. Many vulva owners have found it helpful to work with a pelvic floor therapist. They’ll give you exercises and massages to do alone or with a partner to release muscle tension held in the pelvic floor.

And finally, a knowledgeable and affirming psychotherapist can help with the psychological impact of your pain experiences.

The psychology of pelvic pain for trans and non-binary folks

No matter who you are, who you have sex with or who you love, there are healthcare professionals with the knowledge, expertise, and compassion to guide you through the healing process – even if it takes some time to find them.

Because human sexuality is not just physical, it’s mental as well. This is true for those that identify as cis-men and -women, trans, and nonbinary.

So understanding the mind-body connection is an integral part of your pain relief journey. A trauma-informed therapist can help you gain valuable insights into how pain affects desire and sexuality.

Engaging in mind-body connection treatment can do wonders to help your body how to feel more safe and comfortable in your body and in sexual play. Identifying healthy communication techniques with partners, healthcare providers, and family members is also another tool needed in your affirming journey.

Moving toward a pain-free life

I’ve helped many people just like you rediscover the joy of pain-free intimacy. 

You’re on an amazing journey and you’re not going to let pelvic pain stand in your way. There is so much reason for hope because relief is possible. 

You deserve to live a pain-free and fulfilling life. And I’d love to show you how. Check out my website to get started today.