A satisfying and safe sex life is important for many adults’ wellbeing, regardless of age, physical ability, sexual preferences or gender identity.
Transgender people face several barriers to accessing appropriate healthcare, including overt discrimination and a scarcity of cultural and clinical competence by some service providers.
Sexual and reproductive healthcare is particularly personal and must be tailored to meet the needs of individuals. There are a few fundamental considerations that go a long way to help provide appropriate and informed care to transgender people.
There’s no need to make assumptions about a person’s gender identity. Forms to collect information from new patients can include an option to select ‘other’, rather than simply ‘male’ or ‘female’, for gender. This provides an opportunity to ask clear and direct questions about a new patient’s gender identity and the words they use to refer to themselves and their body parts, which can lead into a conversation about their sexual and non-sexual healthcare needs.
Transgender people have diverse sexual partners and practices. Taking a sexual health history is critical to assess risk and provide appropriate care. Being clear about why you need to ask specific questions may help a patient feel more comfortable with providing information.
Language that focuses on parts (specific anatomical structures) and practices (what goes where during sexual activity) can help avoid assumptions about individuals’ gender and sexuality.
Of course, an individual’s gender or sexuality is not always relevant when they seek healthcare. Some transgender people will seek medical assistance to affirm their gender and others will not.
Providing healthcare for transgender people does not require special expertise but some healthcare providers lack basic knowledge about transgender people and their healthcare needs. Familiarity with the terminology used by transgender people to refer to themselves helps to make them feel included and considered and is critical for overcoming barriers to communication.
Sexual health education for young people might not adequately address transgender issues, creating a need for education by health practitioners for some patients.
Patients’ anatomy dictates the preventive health practices and screening tests required to maintain wellbeing. Some risk of disease may be attributable to a patient’s anatomy (i.e. cervical or prostate cancer) so surveillance and disease screening must be appropriately individualised.
As a group, transgender people have a higher risk of sexually transmitted infections and blood-borne viruses than cisgender people. An individual’s risk is determined by their own behaviour though, so testing for sexually transmitted infections should be matched to sexual activity.
Transgender men who have sex with men can get pregnant, and some transgender women can get their female partners pregnant.
Transgender patients may require assistance with choosing and accessing an appropriate contraceptive method to avoid pregnancy and minimise risk of sexually transmitted infections. Pre- and post-exposure prophylaxis against HIV infection may be appropriate for some transgender people.
Gender affirming treatments can influence sexual function and fertility. Some effects may be welcomed by some people and unwanted by others (i.e. effects on sex drive by masculinising or feminising hormonal therapies). Adjustment of hormonal treatments might be necessary to avoid unwanted effects for some people, or counselling to understand the effects and how to live with them might be suitable for others.
Patients seeking medical or surgical intervention for gender affirmation should be counselled about the impacts of treatment on their fertility. Hormone treatment might not always suppress fertility, and a spontaneous return of fertility upon cessation of gender affirming hormonal therapy is possible. However, gamete cryopreservation is a feasible and desirable option for fertility preservation for some transgender people.