Introduction: Medical providers may not be familiar with the sexual health needs and preferences of transgender patients. This may hinder chances to provide comprehensive care since many patients require prompting to discuss such sensitive issues. To increase awareness and improve care, we aimed to describe the sexual experiences and preferences of transgender individuals.
Methods: IRB approval was obtained to develop (with feedback from the transgender community) and administer a 58-item questionnaire assessing urinary and sexual health. Participants were recruited from the local community and the Philadelphia Trans Wellness Conference and given a $20 gift card for their time. Sexual preferences, symptoms, and quality of life (QOL) responses were compared among respondents who had vaginoplasty, orchiectomy, or no procedure. Patients who had orchiectomy or no procedure were evaluated based on responses to the International Index of Erectile Function (IIEF) categories: erectile function, orgasmic function, and sexual desire.
Results: 53 transfeminine individuals (11 vaginoplasty, 10 orchiectomy, 32 no procedure) with a mean age of 40 (range 21-80) finished the survey. Patients who had not undergone vaginoplasty were more likely to engage in sexual activity with others and penetrative anal sex than those who did (p < 0.05). Most gave high QOL scores for sexual function, sexual desire, and orgasm, with more than 17 (36%) participants indicating no problems (n=42). However, 25 (48%) patients reported dissatisfaction if they were to retain their current sexual function for life (n=52). For non-vaginoplasty patients, all of whom were on hormone replacement therapy, 23 (55%) said that penile function was important to them. In this group, IIEF erectile function, orgasm, and sexual desire categories had mean scores of 13.3, 5.8, and 5.6, respectively, compared to 25.8, 9.8, and 7.0 from the cis-gender controls from the initial IIEF study. 5 individuals (11.9%) affirmed using oral medications for erectile assistance, while 1 had a penile prosthesis.
Conclusions: We found differences in sexual preferences between transfeminine individuals while QOL differed depending on which aspect was explored, highlighting the variability in this population. While many transgender individuals reported penile function was important, only a minority were on treatment. This highlights an opportunity for improvement for providers by discussing sexual health with their transgender patients and offering treatments if desired.
Source of Funding: World Professional Association for Transgender Health