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Queer Doc (they/them): Hi everyone. Welcome back to the queer seamy. Vodcast, I am super excited to have Ken with me today. Ken's you want to introduce yourself.
Ken McGee: Yeah, my name is Ken. I use they he pronouns and I've been a physical therapist for the past eight years, I'm somebody where I've been actively transitioning for the last year, so I've been eight months on testosterone, two months out, from top surgery and so trans. Physical therapy is something that's really important and near and dear to me.
Queer Doc (they/them): Oh, this is very exciting and use he and they pronouns. And and like, do you have a specific label for your identity that you feel comfortable sharing with everyone?
Ken McGee: Yeah, so I consider myself Non-binary Transmasculine.
Queer Doc (they/them): Nice. Yeah it's so fun. I love Like all the different answers I've got into that question you know obviously I like my interactions are more with patience on the day-to-day level and I feel like some of the answers I've got and have just been so fun. I think one of my favorite like one of I was just working with this patient the other day and her note like where it says, like gender identity just it. I documented shrug and…
Ken McGee: Yes.
Queer Doc (they/them): it's because she's like,
Ken McGee: Totally reasonable.
Queer Doc (they/them): Like yes, I am here for this. Situation with the gender. And well thank you so much for sharing and sharing a little more about your personal journey as well. Yeah. And I think, We're focusing at queercini, we're focusing on sexual health for trains.
Queer Doc (they/them): And, and for me, like, the primary focus on this next six month is like not to talk about STI as an HIV because I think, and Just in healthcare in general, right? When we talk about sexual health like automatically clinicians, jump to infectious diseases, and then that's very true when we talk about, LGBTQ populations because of the AIDS epidemic, which had such a huge effect on our greater community. And I don't want to minimize those things by any mean, but you could people can get tons of education on those other places. And so over the next six months, I really want to talk about more about sexual hellness health. From a more holistic perspective, like both the components of sexual pleasure, discomfort pain with sex, like changes that happen with hormones and therapy for gender care and things like that. And so I really want to give
Queer Doc (they/them): Clinicians and opportunity to understand more of like the larger picture of sexual health for transgender.
Ken McGee: If?
Queer Doc (they/them): I think particularly like our hatsys allies who work in our community and if they just don't have any personal exposure to like having sex in a gender diverse body or having sex with like partners on hormones or, you know, just kind of like all the varieties and ways, in which we have sex, like this will be like some just foundational exposure for them around that. Just to give you like a giant overview of what I'm doing for the next six months.
Ken McGee: Couldn't. I love it.
Queer Doc (they/them): And but of course, I immediately thought of you, when this topic came up in my mind…
Ken McGee: Thank you.
Queer Doc (they/them): because of your work and pelvic floor, physical therapy and and so, I guess, like my first question for you would really be like um, it's like
Queer Doc (they/them): Just tell like most of our listeners are referring clinicians. So just like tell us what you think we should know about pelvic floor. Physical therapy for transgender versus folks that we don't know.
Ken McGee: Yes, so the pelvis is something that's involved in. So many intimate daily functions, be it. Bladder control bowel control, sexual function. I'm just helping support our body to move around that. Pelvis is really the connector between our lower body and our upper body. And so anytime the movement can go awry Physical therapists tend to get involved. And so, I love being involved in the pelvis because again like all right, sex is a movement and kind of leading to that sexual health. There can be a lot of challenges that people encounter. We tend to find that people who identify as transfem even if they're not on hormones yet, or haven't gone through any surgeries tend to have more pelvic pain than the general population. And so that's something that we're really curious about. We also may find say somebody has started testosterone and they're getting like extra growth and maybe that growth is uncomfortable. Great, That's a place where there can be interventions to address comfort. People may also be finding that they're having this comfort and their pelvic muscles. Just any point in their life you know what is common is common and sometimes we
Ken McGee: That when it comes to trans and gender diverse populations. And so really, just like you said, not focusing only on the big things like STDs, but focusing on wellness. And that's what I really enjoy about being a PT, is I get that chance to focus on wellness and having people live happy lives versus, just not having an infection
Queer Doc (they/them): Right. I think And I think for so long pelvic floor, physical therapy has really, really focused on pregnancy, right? And and…
Ken McGee: Yeah.
Queer Doc (they/them): postpartum periods and so I think a lot of times for referring clinicians like it gets put in that box and that's the only time they think of it. And I always like and maybe because I
Queer Doc (they/them): Big floor pt's, a little more closely and you know I've been trained well by them that everyone has a pelvis, right? And well and…
Ken McGee: Yeah.
Queer Doc (they/them): that might not be fully true around some of the lake and congenital anomalies that we see. But most of our patients have pelvises, right? And so in what Ken is saying is that the pelvis is intimately connected with any movement that we make. As a, as a person, just traversing the planet. And so, pelvic floor PT can be for anyone with any kind of like movement discomfort and things like that about issues. Constipation is Our control issu with all those themes and then really specific in like sexual health for trans and gender diverse patients. Like, I heard you bring up bottom growth and people on testosterone, what are some of Ends or strategies, you use to like address that.
Queer Doc (they/them): Like I haven't, I haven't heard any of these. This will be all new.
Ken McGee: Oh yeah. So there's kind of like Band-Aid interventions and then Term interventions, so like a Band-Aid intervention. Might be Okay. Can we talk about clothing? Can we talk about like tucking that How does that fit? So there's just not immediate touch that's bothering you. Then where some people go, you know, I have heard some people using like over-the-counter lidocaine now. That's something. Somebody should be discussing with their medical provider. Lidocaine can cause swelling, and some people's tissues and not like pleasant. Swelling like unpleasant swelling. And then, as far as like, more longer term intervention, it could be desensization. So, physical therapist, say You break your arm, your arm bugs, you we might use like a small, vibrating tool, and your arm, to kind of help with that distancing. People can play with different frequencies of vibration to see if that helps with sensitivity and then also just kind of explaining what to expect like early on changes might be kind of uncomfortable, but they should be improving with time.
Queer Doc (they/them): Right? That's a big one. I think as a referring clinician as a. Prescribing clinician, informed consent conversations like mine. Always include kind of Side Effects and Changes to Genitals. And I go, I go fairly detailed with this because I've had so many patients transfer care to me and like, just be like, I didn't know this was gonna happen and not not like, thus to date most, most of them have not been upset by the changes that happened but like it would have been a better experience for them over all. If they had that counseling and historically we know physicians in particular are our nurse practitioner and Pa colleagues are a little I think better at us than this when it comes to talking about sex and genitals. But physicians in particular we get a little hung up on how to talk about it, feeling awkward or uncomfortable or our own biases.
Queer Doc (they/them): so, and you know, I always get consent first, like I just say Hey, is it Okay if we talk about sex stuff or is okay, if we talk about general stuff like I get Explicit consent from my patient first. And then we dive in to like, you know, testosterone causes argument and using language that the patient chooses and, you know, and that's actually one of the first things I feel like people notice on tea It's like one of the first changes and and yeah, exactly what you're saying it can be uncomfortable, extra sensitive, while that change is happening and usually settles down after the first six to nine months, right? Depending on like your dosing regimen, how quickly you escalate your dose and things like that.
Queer Doc (they/them): I also talk about how that can change the experience of orgasm for people have you? Seen that in your work. How has that come up for you?
Ken McGee: yeah, so I guess fortunately nobody has come to me being Translate I'm having difficulty with orgasm, but what I hear anecdotally is that many people find that how they need to orgasm changes or what it takes to orgasm changes. Yeah. And so, I think being ready for that, there could be the spot like, Oh I'm starting testosterone, maybe so much more sexual but there's still a lot of thought and deliberation that has to go into it.
Queer Doc (they/them): Right. And so definitely I talk about that, like, how we how we experience orgasm and what gets us off might change, right? And solely from the like standpoint of like genital experiences. And that's because I always think, I don't know how you think about this. But I always think about like there's so many nerve endings in the clitoris and suddenly they are changing in location because things are growing and stretching and and I take care of all ages. So this is more true for like my older patients, right? Like a lot of people might have like a certain technique or tactic that has worked to get them off for many years. Right. And then suddenly we are changing that course and pattern of like clitoral. Simulation was really an important part of that strategy for orgasm achievement and so I always tell people like you might have to find that a new strategy and like this is like a
Queer Doc (they/them): We're like, wondering off into a random world in this may or may not relate to some of the work you do and but you know it's really interesting. I feel like orgasm It's back this up. This is not evidence-based. Let's be very clear. This is just like the wonderings of Dr. Bill's brain. And but I feel like orgasm is like really similar to like any other kind of physical experience with my body. There's like a huge muscle memory and neural pathway attachment right. And so like
Queer Doc (they/them): Like for me it's really, really hard for me to get off if I'm not like on my back, right? Like to be upright to be standing up to like, you know, to have to like change that like physical appropri, reception experience and like all that like my brains like wait what the f*** like this is not…
Ken McGee: Yeah.
Queer Doc (they/them): how we usually do this. And so suddenly we're kind of doing that to your whole genitals with hormones, right? And so you just have to learn a new I think of it as like a new neural pathway.
Ken McGee: Yeah.
Queer Doc (they/them): It's like if you go to the gym and try and exercise for the first time and it's like I can't get the form and it feels really awkward but the next time I go It feels like way more. Smooth and less awkward. I don't know…
Ken McGee: Totally. Yes,…
Queer Doc (they/them): if you or…
Ken McGee: crazy. Like No,…
Queer Doc (they/them): was that just like a weird rambling?
Ken McGee: What's really fair that I teach clients is practice how you play and we say this whether it's soccer or whether it's sex. So it's like, Yes, if you want to say it, there's a person wants to orgasm a different position. It's been really tough. It's like okay, like put the time in do the masturbation time make it happen, then carry over to partnered sex if you want to.
Queer Doc (they/them): Totally, can I steal this phrase? I love this wording practice…
Ken McGee: Yeah.
Queer Doc (they/them): how you play, This is phenomenal, one of my partners and who doesn't listen to this. So, this is great. And, you know, so many of us like are interested in dirty talk and then when we get in the moment, like all the words, freeze in our throat and we're like, I can't say anything and everything. I'm thinking of saying sounds really dumb and they were like, they were like great for the next six months. When I masturbate, I have to, I have to dirty talk out loud and…
Ken McGee: I was so smart.
Queer Doc (they/them): right, I know and they are like phenomenal at dirty talk. So I,…
Ken McGee: You.
Queer Doc (they/them): I, you know, so I love that practice how you play that and then like, bring it into spaces with other people, that is amazing. that practice can also be with other people, if that's what works for, you know, your patient and as an individual
Queer Doc (they/them): Yeah, it's definitely changes with testosterone other other kind of like pelvic floor. We talked about like bottom growth, what are there other kind of pelvic floor changes. We see on testosterone therapy for folks.
Ken McGee: I know you were Ken saying Public for petite is often so linked to childbirth but I'm somebody I've stayed really close to the gestational realm. And so for example, you know somebody Sure they might have what we would call vaginal atrophy, where there are tissue changes to that front hole, that might be making it difficult for things to go in or out. And so this might come up, say If a patient wants to do reciprocal IVF. And so while you know, we might be talking about like pelvic pain, commonly insist females, all right, now you have a trans man coming in and the treatment may look very similar. You know, we might be talking about topical estrogen, maybe lidocaine vaginal dilators, that kind of deal.
Queer Doc (they/them): Nice nice. And I think, you know, I think we do just see like kind of general higher rates of pelvic, mate pain among people who have been on testosterone longer term, and I don't think we always like, I don't know if you know more about like the research into that or like kind…
Ken McGee: Yeah.
Queer Doc (they/them): what are leading theory as to why that is. You have any
Ken McGee: Yeah, they've done some studies where they compare people's pain rates before and after hysterectomy and it seems like the uterus is driving. A lot of that we don't typically see the pain from uterus pop up immediately that may develop over time. And what I tend to see is more around like five years on testosterone, if it's been like a consistent, maybe what we might think of like, traditional transmount, dosing.
Queer Doc (they/them): yeah, and this is um, you know, And not necessarily are just for referring clinicians. It's not a reason to recommend. Someone have a hysterectomy, preventively, or prophylactically, right? Like, and whether or not someone wants to have a hysterectomy or a blso is really a personal choice about whether or not that feels affirming to them and their gender and whether or not, you know, later on maybe down the road, they are experiencing pain. We do have great studies. That show, no increase risk of cancer, which used to be one of the reasons we told people historically on testosterone that they had to have, Histo. And so, Definitely.
Queer Doc (they/them): lots of people, I do know, lots of people who do start getting interested in exploring it, when they start having more discomfort, who Necessarily have one in surgery prior to that. and very cool like what other
Queer Doc (they/them): let's see what's well, we talked about changes with testosterone, let's like explore with estrogen, I was gonna say we didn't talk about like brain changes for We're talking about pelvic floor PT,…
Ken McGee: It's all connected,…
Queer Doc (they/them): so we'll click that, but yeah, yeah.
Ken McGee: right? Um, yeah, with people who are in estrogen sometimes there might not be the same filling of the erectile tissue and sometimes that leads to pain for people and so it's kind of this discussion, you know, different ways to go about it does relaxation, help does, you know, possibly focusing on other sexual activities versus activities that involve the external genitals might be meaningful. And then some people if they are wanting to possibly have that erectile tissue, totally filled up with blood, maybe making sure that's a more regular process for them if possible. So that they're not having the pain of the adhesions of all that tissue shrinks and kind of stays shrunken.
Queer Doc (they/them): Yeah, right, and this is like in my practice like my first question. When someone this is always one of my reviews of some questions I asked him, follow-up visits, and this is, you know, And my next question is always, like, Do you want to have erections or not? Like That's like the first step for me in deciding like that treatment tree, right? Because either, I'm just gonna try to stop them or I'm gonna start encouraging Exactly what Ken's talking about, like more frequent erectant erections, and I actually not and frequently will use like low dose daily to dallas-fill to support that as well like 2.5 or 5 milligrams and if that's something someone's interested in. And so that's a really common one.
Queer Doc (they/them): That I see and definitely like similar for folks with bottom growth. If people have never had an orgasm without an erection or never had an orgasm without ejaculation that can be a process of learning how to orgasm without those things being connected, right? Because they are all actually separate processes and the body. But so often they happen at the same time that people like not quite sure how to do one without the other initially.
Ken McGee: It.
Queer Doc (they/them): And so just talking about exploring different tactics for that. Is is something I often tackle. Do you have any tips or tricks? You share with people for those kinds of things.
Ken McGee: Oh gosh. I'm You know, interestingly, I tend to be more on the side of things of like, addressing premature ejaculation and people are assigned mail at birth. And so in those cases we might be talking public floor,…
Queer Doc (they/them): Yeah.
Ken McGee: exercises. Oftentimes just the awareness that comes with squeezing those muscles releasing those muscles. This music is stronger, just more aware of their pelvis, that may help. But at the same time when we see people get more pelvic floor control that can sometimes help with orgasm as well. So orgasm again, definitely in the brain, it to significant stent also in the body. And so people, you know, experiencing different types of orgasms symptoms. There's like tension orgasm words, like think squeeze, and just sigh and release. Sometimes there's more of that rolling wave contraction and if people are aiming for more of that, rolling wave type of contraction orgasm, regardless of how they were born or what they're anatomy is. Then we'll often encourage, okay? Like begin practically play. Can you squeeze those muscles? Can you release those muscles? Can you have that whole range of muscle movement? So it's available to you during orgasm.
Queer Doc (they/them): I love this and FYI everyone can get like all my guests, get like a little preview of questions we might go over. None of these were on that preview. So ken you're like rolling with me so well, thank you and I think, like, I just heard a phrase, I like like probably intellectually like new, but have never heard termed before and just like different types of orgasms. And again, I think as clinicians, particularly are like this allies, like, um, endosys how to normativity like really prioritize sex as a biopianist going into a bio vagina, right? And like that. And that like And reproductive sex is valued high over, like all other forms of sex. I feel like in our culture and society and I think part of that, again, Endosys heteronorm
Queer Doc (they/them): Be a part of its misogyny. And and so I talk about different kinds of sex. All the time I've never talked about different kinds of orgasms.
Ken McGee: Yeah.
Queer Doc (they/them): I feel like my whole world just Opened up a little bit more. So I love that.
Ken McGee: Yeah.
Queer Doc (they/them): And, and I do think that's a really important point to make to our patients, when they're thinking about, starting hormones is like, the way in which they experience. Orgasm is probably going to change, and that's actually pretty expected. Um, yeah, okay, let me circle back to some questions. We act so you can feel like a little more on your feet and…
Ken McGee: Yeah.
Queer Doc (they/them): yeah, I think kind of what are really resources. You would recommend for referring clinicians when like thinking about pelvic floor PT stuff. Or they're like, any kind of mini courses, like, where we could get a little exposure or just like websites, or, or blogs or videos you would say. Like this is like a really useful tool to take some time towards
Ken McGee: Yeah, as far as courses, I like Medbridge Medbridge is based locally here in the Seattle area and they offer different online courses. And what's kind of nice is if you pay a fee which is pretty comparable to what, you might pay for like a one-day course, you can have access to those classes for the whole year and it could be public exam technique. So you can both get exposure to what the pelvic rehab. Therapist might be doing, but also possibly expand your own toolkit for examining the pelvis, both externally and internally, because I think a lot of providers want more of those like, external examination techniques…
Queer Doc (they/them): If?
Ken McGee: because a lot of patients, just aren't comfortable. And one thing I would say, in particular, with trans and non-binary people is that there can be bottom dysphoria and people don't want to have to focus on their pelvis. And so it's like, okay. Like I'm gonna test your functioning by having you a bridge or straight leg raise versus placing a finger in an orifice.
Queer Doc (they/them): Yeah, that's awesome. So medbridge we can find that online. Is it is medbridge only available for people who are local or is it like online resources all love this and…
Ken McGee: All over. Yep. Yeah.
Queer Doc (they/them): Yeah, and I think you make such a great point and I Again, thank you. I think I learned this from one of my certified. Way of colleagues. And, and
Queer Doc (they/them): Just like techniques for doing pelvic exams rate that don't involve using like a traditional table in stirrups and stirrups and we don't call them in that foot rest now. But Whatever, they're still f****** stuck, no matter what we call them. So And that can be super traumatic and triggering for lots of patients. And so um, you know, definitely like what I was you know taught was like having some kind of bolster to put under someone's right under their low back to lift their hips up off the table and having them like in a butterfly like position. Like you can still get a really thorough pelvic exam with that kind of technique. And it doesn't involve someone kind of being back in a potentially traumatic body position. And so I think tips and…
Ken McGee: If?
Queer Doc (they/them): tricks like that for clinicians are phenomenal. Also, for referring clinicians, like never. I feel like You know.
Queer Doc (they/them): Benzodiazepines definitely have some risk associated with them in the context of like everyday, use and physical, physiologic dependence, and things like that. I am, I am never afraid to give like, you know, a tablet though, for pre-examination experiences, right? And for people who have a long history of trauma and have found that helpful as well, Yeah. Yeah, that's exciting. Okay. Medbridge um, is there any like are there any podcasts you listen to or…
Ken McGee: Yeah. Oh
Queer Doc (they/them): like things like that? You're like Oh you protect this out?
Ken McGee: I'll be honest and we're looking Instagram person. So there's a good one, which is Dot pt. So queerly Dot, pt and another one. I like to follow is the vagina rehab or no? Sorry vagina rehab doctor all just together, vagina rehab doctor and I think both of those do a good job of covering things from a non-gendered perspective of most the time. And then also just kind of going to things that we might not expect, like, you know, how what we eat, could possibly influence some of our flora and our genitals, and how that might relate to you, say back to your vaginosis, over grow through, that kind of deal.
Queer Doc (they/them): Okay, I love that. I love and I know I've heard I think this was Dr. Peters, I'm from Ohsu. Maybe was talking about this,…
Ken McGee: Yes.
Queer Doc (they/them): you have players great and I'm just talking about like prehab. So for people who are going to have genital gender, affirming surgeries, actually getting their pelvic floor, PT started pre-operatively and right? Which I think you actually helped write a series for clinical side of things about like pre-top surgery stuff you can do and…
Ken McGee: Yeah.
Queer Doc (they/them): but I think for referring clinicians thinking again, There are lots of reasons to refer someone to pelvic floor, PT that have nothing to do with surgeries. Like I want to be very clear about that, but if someone is considering General Gender-performing surgery.
Queer Doc (they/them): You know, talking to him about, when they want to start working with pelvic floor. PT like and a lot of times people are traveling for general gender reforming surgery, and some surgeons have a PTV really. Want you to work with at some point. But like, also having a local PT to like, where the patient lives is. I think a really beneficial tool and I think for them to get to know that person before they've had a major surgery and are maybe dealing with like actual active issues from that is like a really Positive Way to Start Building that relationship. Have you been getting any of those referrals in our area fingers?
Ken McGee: Not so much prehab but it does make me want to do prehab so much more for people. I didn't get more prehyped for top surgery than bottom surgery. So prehab for bottom surgery. I want people to be able to do like child's pose, if that's how they're lower, body moves. And like belly breathing into their pelvis. And just any softening relaxing, I would say the number one complication I see after Vaginoplasty is just pelvic floor muscle tightness and it's hard because people may have granulation tissue. Granulation, tissue hurts like crazy people guard, even more. And so it's like pain later on top of pain. And so, if we can give people all the relaxation tools ahead of time, they can feel you have a more comfortable experience, even if it's still going to be a tough experience.
Queer Doc (they/them): I I love those tips. Have you and what do we think about like pre-hop for like metas or phalloplasties like,…
Ken McGee: You know.
Queer Doc (they/them): Which I know is a much, much less common. Both are much less common. last year at this point, I recognize that but I'm curious like about similar prehab approaches
Ken McGee: Yeah, so I'll be honest, you know, there is no protocol on it, there's no research I've seen. And so, you know, if it was my body, that was gonna go through that. Some of the things that were traditionally, talk about are pumping. Okay, you have like, the tissue length, um, you know, mini gender, firming pts are willing to talk about pumping technique, how to do it. Like Are you doing it right? The other thing that we considers tissue mobility. So like on my arm I can like pick the skin up and roll it and sometimes people have adhesions in the tissue that's more external you know, labia majora and manure. And so we might want to have somebody doing some skin rolling. Just that tissue is really pliable and…
Queer Doc (they/them): If?
Ken McGee: ready to be moved around. Would probably be working on relaxation training too. If it is the type of surgery that might also say be having vaginectomy done at the same time and then also saying, expectations around bladder function and then managing constipation too.
Queer Doc (they/them): wow, so many things to think about, like I feel like you should be writing Maybe I mean,…
Ken McGee: Yeah. Thank you.
Queer Doc (they/them): just the like suggestion.
Queer Doc (they/them): Handout our resource to have right for patients who don't have access to someone like Ken who is like this is so thoughtful about all these things and also like I'm very experienced right? It can be in other areas, it can be hard to find just a pelvic floor, PT in general and then to find a public floor. PT who has any experience or training working with gender diverse people again. So much of it focuses on the pregnancy in part.
Queer Doc (they/them): Postpartum periods and Awesome! I love, I love these ideas. Let's see what other like tips or tricks you have up your sleeves about pelvic floor, PT for referring providers.
Ken McGee: Oh gosh. Always feel free to refer. There are different tools for finding pelvic rehab providers because I know students have to track us down the American Physical Therapy Association Academy of Public Health. Long name has a provider lookup. There's also pelvic rehab.com, which is a shorter URL, to remember, for looking at providers, and then just saying that, you know, there may be options too. Again, this time of covid for virtual care as well.
Queer Doc (they/them): Awesome. Yeah. I feel one of my pelvic floor pts was talking about, like, Self-release techniques like All soft release techniques with like. some tool that like unfortunately is like not I think their favorite tool for is like not the best like in the context of gender inclusivity, but it might be called the rose or something like this and…
Ken McGee: Or intimate Rose Brand probably.
Queer Doc (they/them): it's definitely Yeah. yes, I'm like Okay. But um, yeah. So like Things that people can potentially learn on a travel visit or virtually and then do at home for themselves.
Ken McGee: Yeah.
Queer Doc (they/them): Awesome. Oh my gosh I love all the other programs like, write all these like resources you have down. So people will be able to find them in the kind of links on the bottom of the page. Um, what like does your website YouTube.
Queer Doc (they/them): Instagram have like resources things you would recommend, we check out as referring providers.
Ken McGee: There are a few. Yes, there's a few blogs on my website, and then definitely my instagram and hoping to get tiktok going in this year 2023 goals.
Queer Doc (they/them): Yeah, right. Yes I just we yes. The Tiktok. Uh-huh, that's the thing. We're trying to do that as well. Me three goals.
Ken McGee: It.
Queer Doc (they/them): So I'm there with you. Um yeah phenomenal. What else like are there? Anything like anything else? I feel like we've had a shorter episode today. Are there anything else you think we should bring up or review or…
Ken McGee: Yeah. So overlapping identities can mean even more isolation.
Queer Doc (they/them): go over?
Ken McGee: And so, one thing that I think about is you're being transured on binary can lead to the public for maybe not being as much attention paid to it,…
Queer Doc (they/them): It.
Ken McGee: but so can cancer treatment. And so people that maybe perhaps have had prostatectomy could benefit from physical therapy that could again be for bladder control pain, getting back to sexual activity sexual rehab after prostatectomy. And but also people have had hysterectomy. And the other thing I want to reflect on is that the surgical techniques used. If somebody is having mastectomy related to cancer the chest versus gender firming care may be a little bit different and so somebody could be non-binary, you find out, they have, you know, breast cancer and then need additional treatment. And so pts can also be involved in some of that rehab as well.
Queer Doc (they/them): Yeah, I think like the point of overlapping identities or intersectional identities is really, really important. And and Ken's specifically referencing that into like other healthcare conditions and diagnoses. I think like it's also so true right? Of any other like marginalized population as well and whether that's like race, just do economic status and rate, all of those kinds of things and definitely among different cultures, talking about these things and like, sexual health and pelvic floor, Pt can be very different when we're working outside of our culture of origin. And so I always encourage
Queer Doc (they/them): Like clinicians, right? Like I do specific the populations. I see in larger swat like larger percentages of my practice. I definitely do like culturally specific training to work with those. And do you have any like good resources on like pelvic floor PT and like this? Probably have you done. Like Have you seen anything? I know it's like we're getting like really niche. We're asking people to do a really nice training for us right now. But have you seen anything like that?
Ken McGee: Yeah, the short answer is, No, I really appreciate Sandy Gallagher at Oregon, Health Sciences University because she's spearheading a lot of the training in pelvic rehab and even just early today, we're like, talking about another course, like, things are, you know, in the works but it's so slow, too.
Queer Doc (they/them): I definitely, I think it's like rate. Um, it would be I feel like so relevant When I was in residency, I worked with a lot of patients who had immigrant refugee status and a lot of my patients had experienced genital mutilation from a, You know, a young age. And so I'm kind of their needs around like talking about sexual health talking about sexual pleasure talking about All of those kinds of things. And then also like the rehab. Kid of approaches that they needed were very different as well. and a lot of my patients had a lot of stricture because of that and so yeah like definitely gaps and in that area if anyone wants to dive in and start the training programs like we're here for it will will definitely give them a shout out other tips or…
Ken McGee: Yeah. Okay,…
Queer Doc (they/them): tricks you have for us Ken
Ken McGee: yes, a lot of times as healthcare providers were dealing with information that comes up online and like, is it true? Is it not true? And so, one thing that's kind of interesting is people come to me these days saying, Oh, I've heard, I shouldn't do pelvic floor exercises for this condition and you may find that a lot. I conditions actually will get better and more with hip strengthening belly breathing. So it used to be, if somebody had a bladder issue, you know, the medical provider. Might give them a one hand page on kegels. Like, Here's how you go try it. And that approach just doesn't really work for the vast majority of people. And so, I would say appreciating, If you are gonna tell your clients, anything for their public health, maybe say Go do some hip strengthening go, do some yoga to get some down training, breathing to the pelvis versus like, jumping straight towards straight. The exercise, unless you're provider where you've done an exam, you know, that the client or patient can correct. Moment, doing an exercise program of the pelvis.
Queer Doc (they/them): Yeah, so it sounds like, if we're gonna say like, Oh, you need some pelvic floor, strengthening. It might actually be detrimental to the patient if we, don't really know what we're talking about. Which is not.
Ken McGee: Yeah, and Disney Club your urgency, for example, like the muscles may be kind of tight and people just don't know how to control them. And so, then we're seeing leaking. I've also seen people have great muscle book, but still have stress here and cons, because their muscles are gripped like to 90% closure 100% of the time. And so we really like, Oh, we just gave that person's muscles a break. Then they would kick in automatically when we needed them to kick in.
Queer Doc (they/them): Yeah, nice. And and so again I think there's so much more to the pelvis than like, God right? As like a physician who does like more like general medicine and so just really like always remembering that like referring is always an option like instead of maybe giving a handout asking if the patient would be interested in that or it's like maybe they don't have time energy or access to a pelvic floor PT again like pointing to some of these other resources like yes, you know,
Ken McGee: I want to pull your resource Non-normative, Body club and non-normative body club if you look that up has a bunch. Either free or donation based exercise classes and many of them are, you know, donation based. And then they include like for people of like exercise or of ex background. And so, it can be really great way for people to find Exercise environments that aren't maybe bringing up trauma of white supremacy or…
Queer Doc (they/them): Yeah, awesome.
Ken McGee: of thin privilege.
Queer Doc (they/them): I love this so not Normative Body. Club is a great resource to hand out to patients and definitely maybe also some of the queerly PT and Instagram resources that Ken mention. And then I think that the biggest thing too, as like again as referring providers or as primary care providers, as hormone prescribing providers, right? I think one of my big roles and my patient's life is to be like a source of referrals and resources, right? So to build that network of clinicians and providers, and that I know that, like, I worked with that, I am not worried about my patients, having a non-affirming encounter with, or sometimes the reality is, I know they're gonna have an on-informing encounter and so I can prepare them for that. And I can say, Look, you know, you're in Alaska.
Queer Doc (they/them): Right? And the only place we can get an orchiectomy in Alaska is the Men's Health Clinic, so already problematic. And and your experience There is like, the one PA who does the intakes is actually going to be pretty good with names,…
Ken McGee: Here.
Queer Doc (they/them): pronouns and like affirming practices, but the rest of the staff, And rate. And so like is that experience you want to tackle and rate or what are the ways you can support yourself and going through that process in that? Experience. And You know, you you will be able to access the surgery through them, they will do the surgery. They're not gonna like say no, by any means and but like that process, not might not be a deal. And so I think that is part of my role and so getting to know your local pelvic floor, PT and folks who work with trans and gender diverse patients. I think is a really great resource. Is there like a conference for all
Queer Doc (they/them): That's like not focused on like pregnancy.
Ken McGee: Oh, I mean, we have combined sections meeting and it's coming up. It might be in San Diego right now or the next week or so here. And so a lot of those topics will be public health for people to sign mail at birth. Some gender inclusive topics. So yeah,…
Queer Doc (they/them): Yes, awesome.
Ken McGee: a lot of I am working with one school, physical therapy to try and make it not so gendered. So there's hope
Queer Doc (they/them): So reaching out to your local clinicians and really building those relationships. So you have places to send your patients. It's great. And then if you you know, you mentioned a couple of resources where people can find people. But also reaching out and you know, unlist serves or with other providers in your area, I think is super important and other thoughts. Can I feel like I've done? I've been the worst interviewer today, I'm sorry, I've had like seven cups of coffee. I maybe not the best podcaster today but you've been lovely. Yeah. Do you have any other thoughts closing thoughts for us?
Ken McGee: Well, thank you.
Ken McGee: Let me think. All right. So well I didn't catch phrase, We've done practice how you play. Number two is what's common is common. You brought that one up which is really helpful. Um, and then I would say, cultural humility, You know, ask like, it's always okay to ask like, you know, are you happy with this? Some people, you know, could be asexual. Like, You know, don't you have to worry about my sexual functioning? I feel good, but it doesn't hurt to ask people and I think that comes up so often in sexual health too, is like so many providers can be like afraid to ask but patients are just like dying or waiting for us to ask. I had somebody called the other day and they we're calling for hysterectomy prehab and rehab and they do that was gonna be an issue for them. And I was like, You know what, you're having your service. You moved. Something that concerns people and their cervix removed. Is there a good orgasm? How does that sit with you? And this person on the phone was like, Oh my gosh. That's what I was actually worried about, but nobody would talk to me about it. And so sometimes when we start by leading with, Are you, okay, we talk about this. All right, here are some common things you might.
Ken McGee: Encounter people are so relieved.
Queer Doc (they/them): yeah, right, I think exactly what kind so, And like I said, I always get explicit consent before I talk about sex or genitals with my patients and you know, and then and if they say no, I say fine, we move on, right? But if they say yes, like I get like, as detailed as I can and based on like what my knowledge basis is. And because I do think it is a topic that is so avoided by so many clinicians, and it's such an important part of our health and wellness, and so I love that. Um, so practice how you play, what's common is common and ask, you know, and I love these catchphrases any other catchphrases for us.
Ken McGee: Okay, yeah, I'm blow before you go, that's one of my favorites. And that's something that provides can be teaching. So say you have somebody who lifts weight, but they like leak when they lift weight, we'd be like, Okay, like blow air out if you hold your breath, more likely to leak urine or in some cases, even leak stool. But this doesn't just apply to weightlifters.
Queer Doc (they/them): If?
Ken McGee: I work with people where they leak urine, when they go to stand up maybe they've, you know, giving birth or something recently. And so, just to create like, don't hold your breath when you move like keep that air moving.
Queer Doc (they/them): I love that. I I immediately assumed it had something to do with b*******, but no,…
Ken McGee: Okay. I have some more crafts ones.
Queer Doc (they/them): it did not.
Ken McGee: Our other crafts, one is a tits over toes and what that does is that kind of stacks the bladder so that people are a little bit less likely to leak when they go running. It's over toes.
Queer Doc (they/them): We say it for us. One more time. I was laughing. Hits over a toes. I feel like we could say, like, nips over toes.
Ken McGee: Yes, let's do nips of it.
Queer Doc (they/them): Not all. Big nipples when they do gender differing past surgery and…
Ken McGee: Yeah.
Queer Doc (they/them): you absolutely do not have to infer my surgeons who are freaked out by that, feel free to contact me. We can talk about it and I definitely was talking to a surgeon the other day and and he was like, well if someone asked me for just one nipple, I definitely went and do that. And I was like, I was like, okay, I was like, do you ask them like what?
Ken McGee: Yes.
Queer Doc (they/them): Why they're interested in that as opposed to just saying no right away, right? Like because sometimes we find like Right. That queer exactly what you're saying. Like ask, right? Like what is your goal? What are you hoping to achieve from this?
Queer Doc (they/them): Because sometimes when I ask that question, what I find out is what the patient's hoping to achieve is not actually going to be achieved by the thing. They're asking for or other times I find like they have this amazing thoughtful like approach of like why this is important to them and I'm like, f*** yeah, let's do that. And so To that surgeon and people are born with odd numbers of nipples all the time. It's one of the more common actual right, and I'm super numering effects and in development and so I think if someone wants one nipple or three nipples, I don't necessarily Know why you would be opposed to that. And some people choose not have nipples, but nips over toes and I love, Okay. Can it's been phenomenal to have you, I will make sure we get all of your socials websites and stuff like that. Um, links for everyone plus some of the resources you recommended. Um, thank you so much.
Ken McGee: if so appreciate getting to talk,