Sexual function

Young transgender people are at elevated risk of contracting HIV and other STDs.

Young transgender people are at elevated risk of contracting HIV and other STDs. Expand
Young transgender people are at elevated risk of contracting HIV and other STDs.

Transgender adolescents and young adults, particularly trans females, are at a disproportionately high risk of contracting human immunodeficiency virus [1] and other sexually transmitted diseases [2].

REFERENCES

[1] Poteat, T., Scheim, A., Xavier, J., Reisner, S. & Baral, S. (2016). Global Epidemiology of HIV Infection and Related Syndemics Affecting Transgender People. Journal of Acquired Immune Deficiency Syndromes 72 (Suppl 3). [Link]

[2] Reisner, S.L., Vetters, R., Leclerc, M., Zaslow, S., Wolfrum, S., Shumer, D. & Mimiaga, M.J. (2015). Mental Health of Transgender Youth in Care at an Adolescent Urban Community Health Center: A Matched Retrospective Cohort Study. Journal of Adolescent Health 56 (3): 274-279. [Link]

Vaginoplasty can result in fistula, stenosis, necrosis, prolapse and even death.

Vaginoplasty can result in fistula, stenosis, necrosis, prolapse and even death. Expand
Vaginoplasty can result in fistula, stenosis, necrosis, prolapse and even death.

Male-to-female genital surgery (vaginoplasty) is associated with significant long-term complications: there is a 2% risk of fistula, 14% risk of stenosis (abnormal narrowing), 1% risk of necrosis (tissue death) and 4% risk of prolapse [1].

One systematic review [2] found an overall complication rate of 32.5%.

A Dutch study [3] of 55 (out of an original 70) adolescents treated with puberty blockers, cross sex hormones, and genital surgery, showed that among 22 male-to-female patients who underwent vaginoplasty, one adolescent died as a result of necrotizing fasciitis after the surgery.

REFERENCES

[1] Manrique, O., Adabi, K., Martinez-Jorge, J., Ciudad, P., Nicoli, F. and Kiranantawat, K. (2018). Complications and Patient-Reported Outcomes in Male-to-Female Vaginoplasty—Where We Are Today. Annals of Plastic Surgery 80 (6): 684-691. [Link]

[2] Dreher, P.C., Edwards, D., Hager, S., Dennis, M., Belkoff, A., Mora, J., Tarry, S. & Rumer, K.L. (2018). Complications of the neovagina in male-to-female transgender surgery: A systematic review and meta-analysis with discussion of management. Clin Anat. 31 (2):191-199. [Link]

[3] de Vries, A., McGuire, T., Steensma, E., Wagenaar, T., Doreleijers, P. & Cohen-Kettenis, P. (2014). Young adult psychological outcome after puberty suppression and gender reassignment. [Link]

Feminizing hormones reduce sexual function in males.

Feminizing hormones reduce sexual function in males. Expand
Feminizing hormones reduce sexual function in males.

Feminizing hormonal treatments lead to a lessening drive, erectile dysfunction, and shrinking of testes and penis [1], significantly compromising sexual function.

A Belgian doctoral thesis study [2] found that 69.7% of transwomen reported a decrease in sexual desire — while the opposite effect is found in transmen.

REFERENCES

[1] Levine, S. (2018). Informed Consent for Transgendered Patients. Journal Of Sex & Marital Therapy, 45(3), 218-229. [Link]

[2] Elaut, E. (2014). Biopsychosocial factors in the sexual desire of contraception‐using couples and trans persons. Doctoral thesis, University of Ghent. [Link]

Genital surgeries tend to reduce the capacity for orgasm in males, and may do so in females.

Genital surgeries tend to reduce the capacity for orgasm in males, and may do so in females. Expand
Genital surgeries tend to reduce the capacity for orgasm in males, and may do so in females.

One study showed that around 30% of male-to-female genital surgeries result in the inability to orgasm [1].

Figures on female-to-male transitioners are less clear. However, a clinical follow-up study [2] of 38 transmen – 29 of whom had received phalloplasty, and 9 metoidioplasty – found that reported loss of orgasmic capacity was more marginally common than reported gain of orgasmic capacity.

The negative intrapsychic and interpersonal consequences of anorgasmia (the inability to climax) is well-documented, and applies equally to transgender individuals [3].

REFERENCES

[1] Manrique, O., Adabi, K., Martinez-Jorge, J., Ciudad, P., Nicoli, F. and Kiranantawat, K. (2018). Complications and Patient-Reported Outcomes in Male-to-Female Vaginoplasty—Where We Are Today. Annals of Plastic Surgery 80 (6): 684-691. [Link]

[2] van de Grift, T., Pigot, G., Kreukels, B., Bouman, M., & Mullender, M. (2019). Transmen’s Experienced Sexuality and Genital Gender-Affirming Surgery: Findings From a Clinical Follow-Up Study. Journal Of Sex & Marital Therapy 45 (3): 201-205. [Link]

[3] Levine, S. (2018). Informed Consent for Transgendered Patients. Journal Of Sex & Marital Therapy, 45(3), 218-229. [Link]

Long-term testosterone use in natal females can cause vaginal atrophy, which makes sex painful.

Long-term testosterone use in natal females can cause vaginal atrophy, which makes sex painful. Expand
Long-term testosterone use in natal females can cause vaginal atrophy, which makes sex painful.

A study [1] of 16 female-to-male transgender individuals concluded that long-term testosterone administration leads to vaginal atrophy (Baldassarre et al., 2013). The study noted that:

Vaginal samples from FtM showed a loss of normal architecture of the epithelium, intermediate and superficial layers were completely lost, and glycogen content was depleted.

Vaginal atrophy, characterized by thinning of vaginal walls and poor lubrication of vaginal tissues, leads to tearing, micro abrasions, bleeding, and painful intercourse.

REFERENCES

[1] Baldassarre, M., Giannone, F., Foschini, M., Battaglia, C., Busacchi, P., Venturoli, S., & Meriggiola, M. (2013). Effects of long-term high dose testosterone administration on vaginal epithelium structure and estrogen receptor-α and -β expression of young women. International Journal Of Impotence Research, 25 (5): 172-177. [Link]

Female-to-male genital reconstruction surgery has a high negative outcome rate, including urethral compromise and worsened mental health.

Female-to-male genital reconstruction surgery has a high negative outcome rate, including urethral compromise and worsened mental health. Expand
Female-to-male genital reconstruction surgery has a high negative outcome rate, including urethral compromise and worsened mental health.

The results of a 2021 international survey [1] of 129 female-to-male patients who underwent genital reconstruction surgery support anecdotal reports that complication rates following genital reconstruction are higher than are commonly reported in the surgical literature. 

Complication rates, including urethral compromise, and worsened mental health outcomes remain high for gender affirming penile reconstruction. In total, the 129 patients reported 281 complications requiring 142 revisions.

Another paper [2] found a 70% complication rate in one type of female-to-male genital reconstruction surgery.

Even with the “radial forearm free flap” method of creating a synthetic penis — “considered by many as the gold standard for phalloplasty” [3] — there are high rates of complications, with up to 64% urethroplasty related complications [4].

REFERENCES

[1] Robinson, I.S., Blasdel, G., Cohen, O., Zhao, L.C. & Bluebond-Langner, R. (2021). Surgical Outcomes Following Gender Affirming Penile Reconstruction: Patient-Reported Outcomes From a Multi-Center, International Survey of 129 Transmasculine Patients. J Sex Med 18 (4): 800-811. [Link]

[2] Bettocchi, C., Ralph, D.J. & Pryor, J.P. (2005). Pedicled pubic phalloplasty in females with gender dysphoria. BJU Int. 95:120–4. [Link]

[3] Rashid, M. & Tamimy, M. S. (2013). Phalloplasty: The dream and the reality. Indian J Plast Surg 46 (2): 283-293. [Link]

[4] Fang, R.H., Lin, J.T. & Ma S. (1994). Phalloplasty for female transsexuals with sensate free forearm flap. Microsurgery 15: 349–52. [Link]