Academic journal article The Canadian Journal of Human Sexuality

Toward a Broader Conceptualization of Trans Women's Sexual Health

Academic journal article The Canadian Journal of Human Sexuality

Toward a Broader Conceptualization of Trans Women's Sexual Health

Article excerpt

Research on the sexual health of trans women (male-to-female spectrum transgender people), has focused primarily on sexual response and satisfaction after initiating hormone treatment or undergoing genital surgery, or on HIV-related sexual risk among trans women sexually active with cisgender (cis, i.e., non-trans) men. Given that these situations are not representative of the majority of trans women at most points in the lifecourse, a broader discussion is needed to provide sex educators, therapists, clinicians, and researchers, as well as trans women and their partners, with information needed to promote sexual health. Drawing on the theoretical constructs of cisnormativity and cissexism, as well as previously published and new data from Trans PULSE, a community-based study of trans health in Ontario, we discuss the social context and sexual realities of trans women's lives.

KEY WORDS: Trans women, health, sexual health, cisnormativity, cissexism, Trans PULSE


Research on the sexual health of transgender and transsexual (trans) women has focused almost exclusively within three areas of inquiry: postoperative orgasmic potential and sexual satisfaction among trans women who have undergone vaginoplasty (surgical construction of a vagina) as part of a medical transition (e.g., Klein & Gorzalka, 2009), sexual desire and function among those on feminizing hormone regimens (e.g., Wierckx, Elaut, Van Hoorde, et al., 2014), and HIV-related risk among trans women who are sexually involved with cisgender (cis or non-trans) men sex partners, either through commercial sex or personal relationships (e.g., Baral et al., 2013). While important, this limited focus ignores the sexual health needs of the majority of trans women at most points in their lives. It also reinforces conceptualizations that all trans women medically transition through hormones and/or surgeries, and are heterosexual with cis man partners.

In response to this limited research, our own work with the Ontario-based Trans PULSE Project uses community-based research to orient to trans women as a community with unique experiences. We showed that only 15% of trans women have undergone vaginoplasty; among those who indicated they had completed a medical transition, this rose to only 59% (Scheim & Bauer, 2014). Moreover, only 23% reported having a cis man sex partner in the year before data collection (Bauer, Travers, Scanlon, & Coleman, 2012). In fact, half had not had partner sex that year, reinforcing what we had heard in our earlier community soundings: that it can be very difficult to find a good lover and relationship for trans women.

What do we know then about sexual health and satisfaction for trans women who have not yet had (or do not intend to have) a vaginoplasty? Those not on feminizing hormones? Those who have not (yet) socially transitioned to live fulltime in their felt gender? What about lesbian trans women? Those with trans partners? Those whose recent sexual experiences are exclusively solo ones? These questions are rhetorical, as research has not yet been undertaken on most of these themes. In this paper we draw on our data, existing research, and our community knowledge to explore a broader range of issues regarding trans women's sexualities.


Many sexual health issues for trans women will be already familiar to sexual educators and therapists: body image and self-esteem, prior trauma, sexual negotiation and disclosure, reproduction and contraception, preventing infection, identifying personal desires, coming to terms with sexuality, or the need for partners to change sexual activities to accommodate changing bodies. To understand what is unique for trans women's sexual health we must start by understanding the social contexts of trans women's lives. Barriers to healthy sexuality can be complicated by a range of trans-specific factors, including beauty and body standards that favour cis bodies, structural barriers to transition, traumatic interpersonal experiences, and the internalization of all these by trans women over the lifecourse. …

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