Sandra Gallagher has served on varied committees and boards at the state and national level, most recently as the chair of the CAPP-OBC committee for the Academy of Pelvic Health of the APTA. She has presented on the role of PT in gender-affirming vaginoplasty at UCSF Transgender Health Summit, APTA Combined Sections Meeting, and at the 2018 international meeting of the World Professional Association for Transgender Health (WPATH). Join Transgender Patients: Pelvic Health and Orthopedic Considerations with instructors Sandra Gallagher, PT, DPT, WCS & Caitlin Smigelski, PT, DPT on April 29th.

In working with surgeons that perform and patients undergoing gender-affirming genital surgery I’ve had the chance to recognize that some of our most basic skills of assessing tissue and tissue healing play a huge role and optimizing healing.  I personally have loved taking another look at some of the wound healing principles that I used early in my career in the 90s, to assist in developing timelines for post-surgical recoveries of gender surgeries.

In addition to the basic science of tissue healing, we’ve integrated current and novel neuroscience to develop Graded Motor Imagery guidelines to improve the sensory outcomes of vaginoplasty and phalloplasty surgeries. Graded Motor Imagery (GMI) is a treatment approach commonly associated with treating pain. It is generated from understanding the underlying neuroplasticity of complex pain conditions such as phantom limb pain. (1) Graded Motor Imagery in rehabilitation means that the focus is placed on synaptic exercise and health. The use of neuroplasticity to change sensory experiences occurs in other parts of rehab and goes under different names.  Sensory integration, cortical integration, or mapping, are some other terms used. In addition to being used for reducing pain in complex regional pain syndrome, the techniques are used for reducing limb neglect in stroke rehab, and restoring limb function in complex hand surgeries (2,3,4,5).  In pelvic rehab, we are using these concepts with urinary urgency suppression and in cis females with vaginal pain. There are handfuls of article exploring the presence and phenomena of phantom penis in trans men (6,7,8)

Using GMI for Phalloplasty