Trans Sexual Health
All of Trade’s services and support groups are open to and inclusive of trans*, non-binary, and gender diverse people. Historically, Public Health departments commission specialist sexual health support for ‘Gay, Bisexual and other men who have sex with men’ – this category is a legacy of 1990s’ HIV prevention priorities. In practice, most sexual health clinics include both trans women and gay and bi trans men/trans masculine individuals in these services (but this is not always as clear as it could be). Here is some specific sexual (and reproductive) health advice for trans people.
Sexual health for trans feminine people
The information in this section is appropriate for trans women, trans feminine people, and anyone assigned male at birth who now identifies differently.
Exploring your sexuality as you transition can be exciting, and you may be exploring new things or new parts of your body. Wherever you are in your transition, and whether you have decided to have surgery or not, you’re entitled to have sex that is safe and pleasurable.
Whether you’ve had lower surgery or not, the best way to protect yourself and your partner against STIs is to use a condom. But other prevention methods are available and effective, especially when used in combination with condoms.
DoxyPEP and PrEP
DoxyPEP (doxycycline post-exposure prophylaxis) is a dose of antibiotics taken after sex that reduces the risk of acquiring syphilis and chlamydia.
Guidelines recommend that doxyPEP is made available for trans women at increased risk of syphilis. Currently, doxyPEP is only recommended to prevent syphilis not chlamydia, as the health risks of untreated syphilis are far more severe.
PrEP (Pre-Exposure Prophylaxis) is a medication taken by HIV-negative people that prevents you from getting HIV. Taking PrEP before being exposed to HIV means there’s enough drug inside you to block HIV if it gets into your body. It’s highly effective at stopping HIV from being transmitted when taken correctly.
PrEP offers protection during vaginal/frontal and anal sex. It’s safe to use for trans feminine people and is effective regardless of any gender-affirming surgeries that you’ve had, including vaginoplasty.
PrEP doesn’t affect or interact with your hormone treatment.
PrEP can be taken in different ways to protect against HIV:
- Daily: taking one pill a day, starting with a double dose.
- Four pills a week: taking four pills a week consistently.
- On-demand/ event-based: aking PrEP only around the time you have sex. Pills are taken a few hours before sex and for up to seven days after.
On-demand/ event-based PrEP has different dosing recommendations depending on the type of sex you are having:
- Receptive anal and insertive vaginal/neovaginal or anal sex: PrEP started with a double dose (two pills) 2-24 hours before sex, one tablet 24 hours later and a further tablet 48 hours after that.
- Receptive vaginal/neovaginal sex: PrEP started with a double dose (two pills) 2-24 hours before sex, then one tablet daily for seven days afterwards.
Contraception advice for trans feminine people
If you haven’t had an orchidectomy or vasectomy, you should use contraception for insertive vaginal/frontal sex with a partner who is not using contraception and is at risk of pregnancy.
Key information
Estradiol therapy and hormonal therapy (such as gonadotrophin-releasing hormone [GnRH] analogues, finasteride or cyproterone acetate) don’t provide adequate contraceptive protection to prevent pregnancy.
Sexual health for trans masculine people
The information in this section is appropriate for trans men, trans masculine, and anyone assigned female at birth who now identifies differently.
Exploring your sexuality as you transition can be exciting, and you may be exploring new things or new parts of your body. Wherever you are in your transition, and whether you have decided to have surgery or not, you’re entitled to have sex that is safe and pleasurable.
Condoms
Condoms can stop STIs from being passed on when used correctly. Use a new condom for each partner and never use the same one for anal and frontal sex. External condoms can be used on a neo phallus, post phalloplasty or metoidioplasty. They come in a variety of sizes and materials (including latex-allergy free), so you can find one that fits you best.
Testosterone can change vagina/front hole lubrication, so you might find you don’t produce enough. It may be because the natural acidity in the lubrication has changed, making you more vulnerable to infections like cystitis. This seems to be more of an issue during the first few years on testosterone. Make sure you always have enough lube.
Reduced levels of oestrogen affect the thickness of the walls of the front hole, which may result in tiny unnoticed tears happening more easily if you’re having frontal sex. The walls of the rectum can be affected in the same way. Making it even more important to use condoms and lube.
In addition to condoms, there are a number of other ways you can prevent STIs and HIV transmission.
DoxyPEP and PrEP
DoxyPEP (doxycycline post-exposure prophylaxis) is a dose of antibiotics taken after sex that reduces the risk of acquiring syphilis and chlamydia. DoxyPEP involves taking 200mg of the antibiotic doxycycline within 24 hours and no later than 72 hours after sex.
Current guidelines recommend that doxyPEP is only made available for cis gay and bi men and trans women at increased risk of syphilis, but should be considered on a case by case basis for people assigned female at birth who are at an increased risk of syphilis.
PrEP (Pre-Exposure Prophylaxis) is a medication taken by HIV-negative people that prevents you from getting HIV. Taking PrEP before being exposed to HIV means there’s enough drug inside you to block HIV if it gets into your body. It’s highly effective at stopping HIV from being transmitted when taken correctly.
PrEP offers protection during frontal and anal sex. It’s safe to use for trans masculine and non-binary people and is effective regardless of any gender-affirming surgeries that you’ve had.
When you take PrEP, you can safely:
- Get pregnant. PrEP prevents HIV, not pregnancies. Continue to use contraception to avoid pregnancy.
- Take hormonal birth control. It’s safe and both will work if taken correctly.
- Conceive and carry a baby. It’s safe for you and your baby.
- Chestfeed.
Contraception advice for trans masculine people
Being on testosterone will decrease your fertility, and long term use can lead to infertility. Within a few months of starting testosterone, periods usually stop. Over time the reproductive system will go through a process similar to the menopause, which will thin the lining of the uterus and cause the ovaries to shrink.
Key information
However, testosterone is not an effective form of contraception and, if you don’t want to get pregnant, you should use an effective form of contraception. Consistent condom use will prevent pregnancy but there are other things, such as the coil, implant, injection or pill, which can be safely taken with testosterone and are more effective than condoms at preventing pregnancy. Trans masculine people can access contraception support through Trade’s weekly Clinic xtra service – if you are interested in exploring contraception options, please state this when you book your appointment (so that the doctor can bring appropriate
Cervical screening
Everyone who has a cervix between the age of 25 and 64 has a right to go for cervical screening. Cervical screening is a free health test that can help prevent cervical cancer. While there is no evidence that trans masculine people are at higher risk of cervical cancer, they have often experienced barriers to accessing cervical screening – either because they have not automatically been invited for screening, or because they find the experience distressing and provokes dysphoria.
Trans men and non-binary people who were assigned female at birth are routinely invited for cervical screenings if they are registered at their GP as ‘female’.
Trans men and non-binary people who were assigned female at birth who are registered at their GP as male can now opt-in to receive regular, routine cervical screening invitations. You can either opt-in through the GP surgery where you are registered, or at your local sexual health clinic. You might find that staff at the sexual health clinic have more experience of supporting trans masculine people with a cervical screening.
Useful links
TransActual provide extensive information on healthcare for trans people:
Trans HealthInformation for Trans People – TransActual
Queer Health/theLoveTank produce a ‘Little Backpocket Guide’ series which contains several guides relevant to trans+ health:
‘Little Back Pocket Guide To’ Series — QueerHealth
CliniQ in London is the UK’s first dedicated sexual health clinic for trans and gender diverse people:
cliniQ – Inclusive trans sexual health & wellbeing