As pelvic rehabilitation therapists, we are uniquely positioned to deliver care that honors both the physical and emotional complexities of each patient's body. Our field often involves working intimately with anatomy, which means it's essential to provide affirming, informed, and inclusive care for all individuals, including those who are intersex.
The intersection of pelvic rehabilitation and intersex health demands not only biomechanical insight but also a sophisticated, embodied understanding of trauma, identity, and consent. As clinicians working within the intimate landscapes of the pelvis, we must widen our therapeutic lens to serve the needs of intersex individuals — those born with variations that fall outside binary definitions of male or female bodies.
Intersex variations (sometimes referred to as DSDs, or differences of sex development — though this term remains controversial) include a wide spectrum of chromosomal, gonadal, hormonal, and anatomical variations. These include, but are not limited to: Androgen Insensitivity Syndrome (AIS), Congenital Adrenal Hyperplasia (CAH), Klinefelter syndrome (XXY), Turner syndrome (XO), 5-Alpha-Reductase Deficiency, and mixed gonadal dysgenesis.
Medicalization, Trauma, and the Pelvic Therapist’s Role
Historically, intersex bodies have been subject to significant medical pathologization — often resulting in non-consensual “normalizing” surgeries in infancy or early childhood. These procedures, which aim to produce phenotypically male or female anatomy, are increasingly condemned by human rights organizations and intersex-led advocacy groups as unnecessary and harmful.
These non-consensual, non-medically necessary procedures can cause lifelong trauma, and can result in chronic pelvic pain, scar tissue, altered sensation, urinary or bowel dysfunction, and profound psychological trauma.
As pelvic therapists, we are uniquely positioned to address not only the myofascial and neurovascular sequelae of such surgeries but also to support patients in reclaiming agency, sensation, and choice in their own bodies. Clinical goals might include:
Clinical Considerations
Advanced internal assessment should always be prefaced with explicit, iterative consent. In some cases, conventional intravaginal or intrarectal assessment is neither appropriate nor psychologically safe. Use external and visual inspection, gentle palpation, biofeedback, and motion-based functional assessment to build rapport and collect data noninvasively.
Customized, layered intervention may include myofascial mobilization, visceral manipulation, pelvic floor retraining, bowel/bladder retraining, and somatosensory reintegration techniques that emphasize curiosity, neutrality, and embodiment.
Avoid defaulting to protocols. Build safety through co-created treatment plans, anchored in shared language, flexible pacing, and ongoing attunement.
Coordinate with endocrinology and gyne/urology to stay updated on hormone dosing, surgical outcomes, and relevant lab findings.
Inclusive Documentation and Systems Change
Advanced practice extends beyond the treatment room. Systems must reflect inclusive, patient-centered values. This includes:
If your clinical environment does not support this yet, consider yourself the culture-change agent. Clinical excellence includes advocacy.
Reflective Practice and Positionality
As clinicians, our understanding of “normal” anatomy, function, and gender is shaped by our training and culture. Working with intersex patients requires ongoing reflection:
Deeply inclusive care requires humility, curiosity, and cultural literacy. It asks us not just to treat, but to listen, witness, and validate the lived reality of bodies that have too often been pathologized.
Intersex patients are not rare; they are underserved. As pelvic rehab providers operating at the nexus of anatomy, trauma, and embodiment, we have a profound opportunity — and responsibility — to make our care spaces safer, more skillful, and more just. This is not a fringe issue. It is core to ethical, person-centered pelvic health care.
For pelvic health professionals seeking to deepen their knowledge and clinical competency, the Intersex Patients: Rehab and Inclusive Care course instructed by Molly O'Brien-Horn, PT, DPT, CLT provides an essential next step. This course expands on the clinical and ethical considerations discussed here, offering advanced instruction in trauma-informed care, inclusive communication, and hands-on strategies for working with diverse intersex anatomies. By engaging in this training, clinicians not only sharpen their therapeutic skills but also actively participate in a broader movement to dismantle medical harm and restore autonomy, dignity, and agency to intersex individuals in the healthcare system.
Intersex Patients: Rehab and Inclusive Care is scheduled for August 23 and November 8, 2025.
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