“Stuck in an area of physical deviation”: transmasculine experiences of chronic pelvic pain and gender embodiment

Background Chronic pelvic pain (CPP) is a common and often debilitating condition among transmasculine individuals. While prior research has examined the prevalence and management of CPP in transgender populations, little is known about how CPP shapes gender embodiment and experiences of gender dysphoria.Aim To explore how transmasculine individuals with CPP describe the relationship between pelvic pain, gender embodiment, and healthcare experiences.Methods We conducted a qualitative study of transmasculine individuals living with CPP who were 18 years or older and English-speaking. Participants completed open-ended survey questions describing how CPP influenced their experiences of gender and healthcare. Data were analyzed using reflexive thematic analysis.Results Participants described heterogeneous relationships between CPP and gender embodiment. Four themes were identified: A Constant Reminder of Organs I Don’t Want, Just Another Body Part, Society Assumes I’m a Woman, and Conditional Dysphoria, with one subtheme, Forced Outing/Forced Silence. For some participants, CPP intensified persistent gender dysphoria by serving as a reminder of reproductive anatomy perceived as incongruent with their gender identity. Others described pain and gender as largely separate experiences, rejecting assumptions that reproductive anatomy determines gender. Participants also emphasized that dysphoria was frequently socially produced through gendered healthcare environments, women-centered educational resources, misgendering, and cultural assumptions that position CPP as a women’s condition. Finally, some participants described context-dependent dysphoria that emerged during menstruation, healthcare encounters, or discussions of pelvic pain.Discussion Experiences of CPP among transmasculine individuals are diverse and cannot be understood solely through anatomical models of gender dysphoria. Findings suggest that dysphoria associated with CPP is often co-produced through bodily symptoms, healthcare interactions, and social meanings attached to pelvic pain. Gender-inclusive approaches to CPP care may help reduce barriers to support and improve patient experiences.