Sexual Health

Discovering your male 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.

Safer Sex and Sexually Transmitted Infections (STIs)

The highest risk for getting sexually transmitted infections (STIs) or HIV is through unprotected anal or vaginal sex. Having safer sex will reduce the risks of getting an STI.

The best way to protect yourself and your partner is to:

• Use a condom or Femidom (a ‘female’ condom) for vaginal or anal sex
• Use water-based lube with your condom or Femidom
• Consider using a condom or dental dam for oral sex

STIs, including HIV, can be passed on through the following bodily fluids:

• Semen
• Pre-cum
• Vaginal fluids
• Anal mucus
• Blood

Skin usually acts as a barrier against these fluids, except for a type of skin called a mucous membrane which is found inside the vagina, penis, anus, and mouth and can allow these fluids into the body.

Vaginal and anal skin is also fairly easily damaged with tiny unnoticed tears during sex, making vaginal and anal sex especially risky unless you use condoms and lubricant.

Some infections, such as herpes, genital warts and syphilis, can be transmitted through regular skin-to-skin contact. Using a barrier method – such as a condom, dental dam (a latex square that can be placed over the genital or anal area) or a latex glove – will reduce the risk but will only protect the areas covered by the barrier.

When fingering, make sure you don’t have any cuts on your hands or fingers, keep your nails short and use plenty of lube.

You can find more information about how to correctly use condoms, Femidoms, dental dams and other protection methods here.

Other infections

Not all genital infections are sexually transmitted. Thrush, cystitis (a bladder infection) and bacterial vaginosis (BV) can all affect someone with or without sexual contact.

Sometimes BV can be misdiagnosed as thrush but it won’t respond to thrush treatments. If you have a persistent infection, get it checked by your GP or sexual health clinic so they can give you the correct treatment.

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 such as herpes, syphilis, gonorrhoea or HIV in this way.

Bleeding gums, ulcers or recent dental work can allow infection into the body. You should aim to avoid oral sex in these circumstances.

To reduce the risks from oral sex, avoid letting your partner ejaculate in your mouth. You can also use flavoured condoms or dental dams for oral sex to reduce the risks further.

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 a STI or HIV. 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 or other infections to get into your body or theirs.

Condoms and Lube

Whether a penis is the ‘standard issue’ type, surgically-constructed or bought in a shop, the safest option is to always use a condom.

Condoms are available in a wide range of shapes and sizes. If you have trouble finding one to fit, you or your partner can wear a Femidom. This is a condom worn inside the body of the partner being penetrated, and can be used in the vagina or anus (if the top ring of the Femidom is removed).

The best information we have is that Femidoms are the safest option for those with a metoidioplasty (a type of genital surgery that creates a small penis) or enough testosterone-enhanced clitoral growth for penetration.

Using water-based or silicone-based lubricant with condoms helps to reduce the risk of damage to the skin during sex and also reduces the chance of the condom breaking.

Avoid using silicone-based lubricant with silicone sex toys as it can degrade the surface of the toy.

Always change condoms between partners, as infectious fluids can transfer on the surface of a condom. Never use the same condom from anus to vagina, as bacteria in the rectum can cause vaginal infection.

You can order free safer-sex packs, Femidoms, gloves, dental dams and flavoured condoms from Trade here.

Safer Sex & T

Testosterone (or ‘T’) can change vaginal lubrication, so some transmen find they don’t produce enough. Some also report more thrush or cystitis. While there is no conclusive proof, this may be because the natural acidity in the lubrication has changed, making them more vulnerable to infection. This change seems to be more of a problem during the first few years on testosterone.

Reduced levels of oestrogen affect the thickness of the walls of the vagina which may result in tiny unnoticed tears happening more easily during sex. Some also report the walls of the rectum are affected in the same way. This all means that you need to take extra care to use condoms and lube.

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 by clicking here.

Drugs and Unprescribed Hormones

HIV can be passed on through sharing injecting equipment. Whether you are injecting testosterone or drugs, never share syringes or needles. You can get syringes, needles and special containers to dispose of them from your GP or a local community drug & alcohol organisation. Many areas will have a needle exchange where you can take you used syringes or needles and get new ones. If you’d like more information on local needle exchanges you can visit here.

Sexual Health Clinics

When visiting your local sexual health clinic, you don’t have to tell the receptionist that you are trans – you can wait to tell the clinician this in private.

Some clinics have gender-specific waiting and treatment rooms and they might not have the equipment needed to do all the necessary treatment in a ‘male’ treatment room. If concerned, call the clinic beforehand to discuss their facilities and your requirements. You can also have someone come with you, and ask to see a male or female clinician.

When you see the clinician treating you, it is a good idea to discuss any genital surgeries and the sex you have been having, as this will affect what samples are taken. It’s best to be completely honest so that they can give you the best care.

During your examination, the clinician may want to take some swabs from you throat, rectum and genitals, including the inside of the vagina if you still have one.

Vaginal swabs are usually done using a speculum. Some clinics now allow you to take some swabs yourself. You may be offered blood tests to check for infections such as HIV, hepatitis or syphilis. You will be told how to get all the results.

You can find out more about Leicestershire’s sexual health clinics here.

Cervical Screening

No-one enjoys a cervical screen (smear test) and for transmen it can be really difficult. But if you still have a cervix you should have a regular test (every three years up to the age of 50 and every five years if you are older). Remember, a few minutes of discomfort and embarrassment could save your life.

The cervix is the bottom part of the uterus, at the top of the vagina, and is usually (but not always) removed during a hysterectomy. The cervix is a common place to get cancer and very often this is related to Human Papilloma Virus (HPV) – also known as genital warts – but it can occur even if you haven’t had HPV. The test is usually done by your GP or practice nurse but may also be available at a sexual health clinic.

A smear test involves inserting a speculum into the vagina to open it so that the nurse can see exactly where the cervix is and make sure they are getting cells from the right place. The cells are collect using a small brush swab and the whole process should be painless, although it may be a little uncomfortable.

Some transmen find that after some time on testosterone the vagina becomes smaller and less flexible, and they worry that this will make the test more painful or even impossible. However, speculums come in a range of sizes and there are some much smaller ones. If you can’t face having a smear test, please talk to the practice nurse.

Contraception and Fertility

While most transmen taking testosterone will find that their periods stop after a while, it is still possible to become pregnant. Contraceptive pills or implants are oestrogen and/or progesterone-based so transmen can’t use them. Condoms (with lube) and other barrier methods are reliable contraceptives when used properly. Intra-uterine devices (the IUD or ‘coil’) may be another option.

For contraception advice, including emergency contraception, go to a sexual health clinic and speak to a doctor or nurse to see which type would be suitable for you. Emergency contraception needs to be used within 72 hours of sex.

If you are taking testosterone and plan to become pregnant, you will most likely have to come off it for some time to allow your body to regulate to female hormones, which should always be dome with the support of your GP or endocrinologist.

There has been no medical research directly around transmen and pregnancy, so it is unknown whether taking testosterone will reduce your chances when you stop taking it. However, several transmen have had children after years on testosterone so it is not impossible.

If you might want to have children and you are pre-transition, talk to your doctor or fertility clinic about different options.

Chest Awareness

Alongside your sexual health, don’t forget other important issues. Many transmen bind their breasts to create a flatter, more masculine shape, for some this is a part-time process, for others it may be for years. Binding too tight or for long periods can cause tissue damage and breathing problems as it squashes the lungs. Try to take binding breaks whenever you can.

Any man can get breast cancer, and a man who has breast development is at higher risk. Breast cancer can be more aggressive in men, as there is less tissue for it to spread through before it moves into the chest and becomes harder to treat. Even after chest surgery, you may still have some breast tissue remaining, so get any lumps or changes checked out straight away. Most of the time these are absolutely fine, but it is always better to be sure.

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 transmen. Remember, it’s your body, your sexuality, you choice.

 

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