Running after a gender affirming surgery can be freeing in unexpected ways. Transgender runner Clair M. (she/her) described how, prior to her bottom surgery, she would run as a numbing coping mechanism l. However, after vulvovaginoplasty, she started to connect with her body and the world around her. “Now I notice the way the breeze and the ground feel when I run.”
Yet despite all the emotional and physical benefits of running, there is no official guidebook to get back to sports after gender affirming bottom surgeries. When asked what guidance on return to running she received from her medical team, Clair recalls being told, “Don’t even think about running for the first three months. I was encouraged to walk a mile or less for the first 1.5 months. I was also told to go super slow and slowly build up. If anything feels off, stop.”
Unfortunately, it’s incredibly common for runners returning from bottom surgery to notice that something actually is off. Pelvic soreness, pain, and even protrusion of vaginal tissue out of the new opening can occur. In the absence of research, some of the best advice available comes from the physical therapy teams that partner with gender affirming surgeons. These therapists are in a position to see how lots of people respond to certain pieces of advice, to better formulate suggested practices.
Some advice from these physical therapists includes:
- Get as strong as possible before surgery. Surgery tends to be safer when people have better health overall. Building up muscle prior to surgery also means that the body has more reserve to deal with the strength loss that occurs with activity restrictions after surgery.
- Do assigned bed rest exercises. Bed rest exercises generally refer to movements done in the first five or so days after surgery when walking is prohibited. Bed rest exercises help reduce the risk of developing a blood clot, which, if it occurs in a leg, could permanently restrict blood flow while running. Bed rest exercises may also slow down the rate of muscle loss due to inactivity after surgery. A common exercise prescription recommends ankle pumps, quad sets, and glute squeezes for 10 minutes each hour someone is awake.
- Support wound healing. The vulvovaginoplasty wound site should be fully closed up before running is even an option. There is the real risk of opening up stitches if someone engages in excessive activity or too deep of leg stretching before healing is done. Here are some of my top tips to support wound healing.
- Consume protein. If the best someone can do is reheat frozen chicken nuggets, that’s phenomenal. Some people will also do protein drinks, powders, or bars if it is challenging to stand to prepare food. If finances are a factor in getting food/protein, some people use the website for Meals on Wheels, which has a search tool to find local no-cost food resources. Certain food banks also have options for food to be delivered rather than picked up.
- Consider a multivitamin. A multivitamin can make up for some of the nutrients that might be missed in the challenges of eating enough after surgery. It is important to check that it does not interact with any other medications before taking.
- Ask for medical providers to look directly at any wound issues. As a physical therapist, one of my biggest frustrations with wound healing is when other medical providers do not look directly at wounds to see what the problem is. If you have a wound that hurts or is taking more than a few weeks to heal up, advocate for answers and solutions to improve healing. It can be incredibly triggering to have to advocate for something as basic as wound healing support, yet it can be huge for returning to sports.
- Walk as much—but not more—than instructed. Common advice is to do about 2,000 steps per day after the end of bed rest. However, always go by the number your surgeon gives you. Steps should be spread throughout the day rather than done all at once to decrease the chance of uncomfortable pelvic soreness. Walking creates the foundation for resuming running.
- Wait until cleared by the surgeon to try running. This may be around six weeks at the earliest but could also be 12 weeks after surgery (or longer if there were postsurgical complications).
- Start with a walk-jog pattern. This might look like 4 minutes of walking to 1 minute of running repeated 3 to 4 times. If someone is able to do this and feels comfortable over the next day or so, then the amount of walking time can be gradually decreased while the jogging time increases.
- Get help, if available. Getting help can look like asking friends what they tried and found useful. It might mean connecting with a personal trainer or coach who has helped transgender people run after bottom surgery. It can also look like partnering with a gender affirming physical therapist to get targeted exercises and instructions on progressing running distances. To find a pelvic health physical therapist who works with transgender people, you can use the American Physical Therapy Association finder tool and put “transgender” as a keyword: https://www.aptapelvichealth.org/ptlocator. Another finder tool is the WOC PFPT Directory: https://www.vaginarehabdoctor.com/woc-pfpt-directory/.
When thinking about returning to running, understand that it can be a long process. Clair states, “My first actual full run was 5.5 months after surgery. That was 2 miles without stopping. It took me a week to recover from that. It was 7 months after surgery that I could run 2 miles once per week.” Similarly, transgender runner Kit M. (she/they) did not do her first 5k until 6 months after surgery.
When Clair reflects on what she would have done differently if she could do the process all over again, she says, “I think that the biggest thing would have been setting smaller milestones for myself. Having those smaller accomplishments would have helped me feel successful because my cardio wasn’t there; the strength in my legs wasn’t there. I wasn’t able to bounce back as much. But I continue to push towards goals. I’ve run a 5k now.”
Dr. Ken McGee, PT, DPT (they/he) is a highly experienced transgender physical therapist who practices from a trauma-informed perspective. They help people of all ages and genders live more active, fulfilling lives. Dr. Ken’s favorite moments are hearing clients say that they are finally back to doing what they love—be it running, playing with their kids, or getting outside.
Dr. Ken McGee received their Doctor of Physical Therapy from the University of Washington in 2014. In 2018, they became one of the few physical therapists in Washington to be board-certified in pelvic health. Dr. Ken enjoys teaching for the Herman and Wallace Pelvic Rehabilitation Institute. Click here to read about Dr. Ken’s perspective on supporting transgender clients.
Dr. McGee’s practice is B3 Physical Therapy & Wellness.
We’re thrilled to have Dr. Ken McGee back to write with us! Previous articles they have contributed to: