Sexual Health

Discovering your female sexuality can be really exciting. Remember, wherever your are in your transition, you are entitled to have sex that's safe and enjoyable. You should never be pushed into anything that you feel uncomfortable with.

Sexually Transmitted Infections (STIs)

Sexually transmitted infections (STIs) are passed on during unprotected vaginal, anal or oral sex – although some, like genital warts, can be passed on through close skin contact.

Most STIs are easily treated and can be cured (apart from HIV) although they can cause serious health problems if you ignore them.

Hepatitis C is a blood borne virus which can lead to serious liver problems. Doctors think it can be transmitted through sex if blood is present.

Not all STIs have symptoms but you should go to a sexual health clinic for a check-up if you notice:

• Discharge from your genitals
• A rash on or around you genitals
• Itching or sores on or around you genitals

Condoms and Lube

Whether or not you have had lower surgery, the best way to protect yourself and your partner against STIs and HIV is to:

• Use a condom or Femidom for vaginal or anal sex
• Use water-based or silicone-based lube with your condom or Femidom
• Avoid using silicone-based lubricant with silicone sex toys, as it can degrade the surface of the toy
• Consider using a condom or dental dam (latex square) for oral sex
• If you are sharing sex toys with someone, use a new condom each time the sex toy is used by a new person or if it is moved between a vagina and an anus (as this can transfer bacteria)
• Similarly, always change condoms between partners, or if a penis is moved between an anus and a vagina during sex

Condoms, Femidoms, dental dams and lube are available for free from Trade here, and at sexual health clinics. However, not all trans women can use Femidoms – it will depend on the depth of your vagina.

If you have multiple partners during one sex session, or if you like rougher sex:

Use a different condom with each partner.

If you enjoy bondage, fisting or S&M be aware that any bleeding or tearing of the anus, vagina or mouth can provide routes for STIs, HIV and hepatitis into you or your partner’s body.

If you are fisting, use latex gloves and don’t share a pot of lube as minute traces of blood can be transferred onto your hands, making it easy to pass on hepatitis C.

Vaginal Sex

You may find vaginal sex causes bleeding (a way for STIs and HIV to get into or out of the body) especially if you have recently had surgery.

Using dilators to stretch the vaginal skin will help, as will using plenty of water-based or silicone-based lube during sex.

Dilators may sometimes cause bleeding, so if you have sex after using one make sure you use a condom or Femidom. Free safer-sex packs, condoms & Femidoms can be ordered from Trade here.

Anal Sex

During anal sex, the lining of the rectum can tear, providing a way for infections such as HIV to get into the body.

If you have had lower surgery, remember that your anus (as well as your vagina) might be delicate afterwards while your genital area recovers.

A lot of nerve endings in the genital area are close together, so it’s possible that anal sex will hurt if your body hasn’t recovered properly from surgery.

Oral Sex

Oral sex is a lower risk sexual activity than anal or vaginal sex but it is still possible to get or pass on STIs or HIV this way. There have been a  few cases of people acquiring HIV from oral sex.

If you give someone oral sex, don’t clean your teeth or use mouthwash beforehand as your gums may bleed, providing a route into your body for an STI or HIV.

If you have a sore throat and a cough, or if you have had recent dental work, avoid giving someone oral sex for the same reasons.

Ideally use a condom or dental dam if you are giving someone oral sex. If you don’t, ask your partner not to come in your mouth. It is also a good idea to avoid brushing your teeth directly after giving oral sex, especially if you partner has ejaculated in your mouth.

If someone gives you oral sex when you have recently had lower surgery, any unhealed wounds could provide a way for STIs to get into your body or theirs.

Viagra

Some trans women who have a penis use Viagra during sex. If you take hormones, check with your doctor whether you can use Viagra and how much is safe.

Sexual Health Clinics

Going to a sexual health clinic can be daunting and may be particularly difficult for trans people; but if you think you have an STI or HIV it it important to have it diagnosed and treated.

You may feel awkward talking to staff about your sexual health but you will need to let them know your history so that they can diagnose you correctly.

HIV

Everyone can be affected by HIV, regardless of age, gender, sexual orientation or ethnicity.

There’s lots more information on HIV here. It’s important to remember that many people are not diagnosed with HIV until they become unwell – it is best to have regular HIV tests so that if you are HIV positive you can find out before your immune system is damaged.

The anti-HIV drugs we have today are excellent at suppressing HIV and people can now expect to live a normal lifespan if they are diagnosed early and start treatment on time.

PEP

If you feel you have been recently exposed to HIV (within the last 72 hours) then you may be eligible for PEP. You can find out all about PEP here.

Unprescribed Hormones or Silicone

If you inject yourself with unprescribed hormones or silicone, do not share needles as HIV and hepatitis C can be passed on through blood.

It is dangerous to carry out these procedures on your own as they can go wrong. Injecting yourself with silicone is potentially life-threatening.

If you are a trans woman living with HIV

Antiretrovirals and Hormones

If you are living with HIV, the antiretroviral treatment you receive will be tailored so that it can be taken safely alongside your hormone treatment.

Antiretrovirals can alter the hormone levels in your body, so it is important your HIV healthcare team knows about any hormones you are taking (including any that are unprescribed) as well as the quantities.

Some antiretrovirals increase oestrogen levels in your body, others decrease them, so your HIV doctor will need to find the right combination for you. Most antiretrovirals are not affected by hormones apart from Amprenavir and Fosamprenavir, neither of which should be prescribed to you because your hormone treatment will stop them from working.

Trans women might be prescribed a higher dose of oestrogen if they take antiretroviral treatment. If you stop taking your antiretrovirals for any reason you must tell your healthcare team as they may need to reduce the dose of oestrogen.

If your oestrogen levels are too high, blood clots can form which could cause a stroke or heart attack. Remember, it is important to have your oestrogen levels monitored by your healthcare team.

Body Fat Changes

If you are taking antiretrovirals you may be concerned about body fat changes and facial fat loss. Although this is linked to older antiretrovirals, it still happens sometimes. Facial fat loss can be upsetting, especially if it leads to a more masculine appearance. It is important to go to your HIV doctor if you notice any signs of this or any side effects.

Safer sex reminders if you have NOT had lower surgery

If you have a penis, you can avoid STIs and HIV by using condoms (or Femidoms) and lube if you penetrate someone vaginally, anally, or orally.

If your partner has a penis, ask them to use condoms and lube when having penetrative sex with you.

You can order free safer-sex packs, condoms, lube and Femidoms from Trade here.

Safer sex tips if you are planning surgery

Pubic Hair Removal

If you’re planning to have lower surgery where your penile skin will be used to line you vagina, it’s important that you discuss with your surgeon which areas of hair need to be removed. Discuss this well in advance of your surgery date, as it can take many months for hair to be permanently removed. If the hair isn’t removed it can continue to grow inside your vagina, where it will be impossible to remove permanently. This can be uncomfortable and may lead to ingrown hairs. Also hair growing in the vagina might be pulled out accidentally during sex, causing irritated skin – which can provide a route for STIs and HIV to get into your body.

Get Sexually Transmitted Infections Treated

It is important to have any STIs treated before going for lower surgery, as an infection might delay your operation.

Get Warts Treated

If you have genital warts on or around your penis, make sure they are treated before surgery. If the penile skin is used to line your vagina and you have genital warts, they can continue to grow inside your vagina, where they will be harder to treat.

Safer sex reminders if you HAVE had lower surgery

Depending on the type of vagina you have, you may be more vulnerable to STIs.

If you vagina was made using skin from your colon (an intestinal implant) it may be easier to get some STIs. This is because intestinal skin is a mucus membrane and some STIs can easily penetrate it.

A vagina created from penile and testicular skin is less vulnerable to STIs as it isn’t made from a mucus membrane. However, if the skin tears, this could be a way for STIs and HIV to enter your body.

If your partner penetrates your vagina or anus during sex, they should use a condom or you can use a Femidom, if appropriate, to protect you both from STIs and HIV.

Use a water-based or silicone-based lube as, depending on the type of surgery you have had, your vagina may not naturally lubricate.

Lube will help prevent tearing and will make sex more comfortable.

You can order free safer-sex packs from Trade here.

Post-surgery hygiene tips

Preventing Bacterial Infections

When using the toilet, wipe from front to back – otherwise bacteria from your anus could be transferred to your vagina or your urethra, which could cause a bacterial infection.

Douching

After surgery, you will need to douche your vagina to keep it clean. Your healthcare team will advise you how often to do this, but many trans women douche daily after surgery then reduce the frequency to twice a week.

Douching will not protect you from STIs or get rid of any you already have.

Using Dilators

A dilator is a cylindrical piece of plastic which you insert into your vagina to stretch the skin and prevent the vagina from closing after lower surgery. Your surgeon will advise you how often to do this, although most trans women use them two or three times a day immediately after surgery and reduce this to twice a week later on.

Dilators can be uncomfortable but will help stop your vaginal tissue shrinking and keep your vagina open. Using them daily will help you to have comfortable penetrative sex.

Remember to be gentle when using dilators (and when you insert anything into your vagina) as tearing can be a route into your body for STIs or HIV.

Fistulas

A rare complication after surgery can be a fistula between the vagina and the rectum. This is where an opening forms and can lead to bleeding and faeces leaking into the vagina. If this happens, seek urgent medical help, as the fistula will need to be operated on.

Finally…

A healthy, satisfying sex life is a lifelong journey of discovery and pleasure, and an essential part of living life to the full as a trans woman. Remember, it’s your body, your sexuality, your choice.

 

Information on this page is based upon that provided by THT in 'Trans Women; Trans Health Matters'