LGBTQ+ persons are typically thought of a cohesive group, however sexual orientation and gender identification are completely different. Sexual orientation describes who an individual prefers to be sexually intimate with. Gender identification, however, describes their sense of themselves as male, feminine, or one other gender. Transgender and different gender numerous (TGD) folks, whose gender identification is just not aligned with their recorded intercourse at delivery, can have any sexual orientation. (The identical is true, after all, with cisgender folks, whose gender identification aligns with their recorded intercourse at delivery.)
What’s sexual well being?
Sexual well being is an idea that goes past being pregnant and sexually transmitted an infection prevention. The World Well being Group describes it as “the potential of having pleasurable and secure sexual experiences, freed from coercion, discrimination, and violence.” This isn’t assured for many individuals, notably TGD folks, who face larger dangers for discrimination and interpersonal violence, together with inside their intimate relationships.
This weblog publish discusses two points of sexual well being: how sure kinds of gender-affirming care might have an effect on sexuality and fertility.
Can gender affirmation by means of medical or surgical means have an effect on your sexuality?
The lived expertise of each TGD individual is exclusive, as are their approaches to gender affirmation. Whereas some folks might select to affirm their gender solely socially, or in no way, others use quite a lot of medical and surgical procedures to take action. Some analysis exhibits that gender-affirming care, when accessible and desired, might scale back misery and might make it simpler to dwell in a typically hostile world.
Persons are extra more likely to get pleasure from intimacy with others when they’re happier and really feel comfy in their very own pores and skin. Those that select to pursue gender-affirming care might discover it impacts their sexuality in each constructive and destructive methods. The examples beneath communicate to each potentialities, though it’s greatest to debate the vary of choices out there to you with a physician who supplies gender-affirming care, should you’re questioning about your individual state of affairs.
- Gender-affirming hormone remedy (GAHT) that features testosterone has been related to a rise in intercourse drive. But testosterone remedy might trigger vaginal atrophy, which has the potential to result in sexual ache or discomfort. For transfeminine people, therapies designed to scale back testosterone might decrease intercourse drive, and may lower or get rid of spontaneous erections. This may occasionally or might not be skilled as a constructive change.
- Gender-affirming surgical procedures even have varied advantages and tradeoffs for sexual well being. Transmasculine individuals who have chest surgical procedures might expertise much less or no nipple sensitivity, however discover their general sexual perform will increase — probably by means of making an individual extra comfy having companions see and contact their chests. Vaginoplasty restructures the pinnacle of the penis right into a clitoris and creates a vaginal cavity. In one examine of 119 vaginoplasty sufferers, 90% of transfeminine individuals who had the surgical procedure reported that they have been nonetheless in a position to have an orgasm, and 75% stated their orgasms have been both the identical or extra intense than earlier than. Nevertheless, their expertise of arousal could possibly be fairly completely different.
Totally different strategies can be utilized to create a neophallus, a construction that resembles and serves as a penis. Throughout a phalloplasty, the clitoris is embedded within the base of the penis, which permits for sexual sensation. Many surgeons additionally connect one of many clitoral nerves to the flap. With metoidioplasty, the hormonally enlarged clitoris used because the physique of the penis maintains its sensitivity and pure erectile perform, however most individuals should not have enough size to interact in sexual penetration. In each circumstances, analysis suggests most individuals are able to orgasm after surgical procedure, however metoidioplasty is just not typically advisable for sufferers who want the power to interact in sexual penetration.
If you need genital surgical procedure, inform your surgeon about your sexual objectives in addition to your curiosity in different points of surgical procedure (similar to having the ability to stand to pee).
Gender-affirming hormones and your fertility
If you’re interested by having kids who’re genetically linked to you, it’s greatest to debate fertility together with your medical doctors earlier than beginning therapy with gender-affirming hormones. GAHT typically reduces, however doesn’t get rid of, fertility.
- Transmasculine folks have been proven to have the ability to produce viable eggs even after years on testosterone therapy, resulting in deliberate or unplanned pregnancies. Small case research have reported on transmasculine individuals who selected to cease testosterone therapy in an effort to develop into pregnant and provides delivery. How typically ovulation happens in folks taking testosterone constantly isn’t effectively understood but.
- Transfeminine folks may nonetheless make viable sperm after lengthy durations on estrogen. How typically this occurs is unclear.
Nevertheless, should you transition after puberty and want to protect eggs or sperm, it’s normally best to do that previous to beginning hormone therapy, if such a delay is tolerable.
Additionally remember the fact that gender-affirming hormones shouldn’t be counted on as contraception, and everybody ought to be conscious of sexually transmitted infections. Moreover, medical doctors advocate that transmasculine people who nonetheless have their uterus and ovaries use a dependable methodology of contraception if they’ve intercourse in ways in which may trigger being pregnant, even when testosterone use has eradicated menstruation. Transfeminine people who can nonetheless ejaculate might be able to get somebody pregnant, and will talk about that risk with related companions. Speak to your medical staff about what’s greatest for you.