Transforming Sexuality: Handling Sexual Changes for Trans Folks

You know what we don’t talk about enough? Sex when you’re trans. I mean, we don’t talk much about queer sex at all, but trans sex comes with its own special considerations and challenges. A lot of time, folks who transition are unprepared for the changes in sexual desire and interest that can come with gender-affirming medical interventions, which can be frustrating. Even more rarely do they receive guidance on how to work around these changes and maintain a satisfying, pleasurable sex life. This is a huge disservice to trans folks and their partners! Other people experiencing sexual changes, like women in menopause and people who are pregnant, have readily available information on the subject. Why not trans folks?

More than half of trans adults use gender-affirming hormones. The purpose of this treatment is to develop secondary sex characteristics associated with their gender identities, like increased or decreased body hair and changes in body fat distribution. Taking estrogen or testosterone (T) also affects sexual anatomy and function. People assigned female at birth who take testosterone may see growth in their clitoris, where it enlarges to resemble a small phallus; physiologically, T can also increase sex drive, sometimes by quite a lot. Estrogen on the other hand may initially cause changes in mood and decreased sex drive. Both types of hormones can bring about changes in sexual interests when it comes to gender preference, type of sex, and even kinks.

Bottom surgery—the general term for vaginoplasty and phalloplasty—creates big sexual changes, too. Reconstruction of the genital area is a major adjustment. The healing process is long, and afterward the person will have to relearn how to use their new parts. It can be difficult to find information on sex with a neophallus or neovagina, since they function differently than their biologically occurring counterparts. A constructed vagina does not self-lubricate in the same way as a vagina a person is born with, and a constructed penis may not be able to become erect, or includes an internal pump to simulate an erection.

If you are a trans person dealing with changes in sexuality, it may be alarming at first, but it doesn’t have to be a bad thing. It’s a great time for sexual exploration and creativity! For example, a person whose estrogen makes it difficult to maintain an erection may explore bottoming for anal sex, or pegging (penetrating another person with a dildo harnessed around their groin). A surgically constructed vagina may not stretch enough to accommodate a penis, but that doesn’t mean they can’t explore penetration. They may find that a finger or small dildo is more comfortable, or only be interested in clitoral stimulation.

Psychologically, changes in sexual function and desire can be difficult to process. While people who access gender-affirming care overwhelmingly report better quality of life, there are still challenges. Finding sexual partners can be harder. Trans people are unfortunately still heavily discriminated against. The majority of people are interested in cisgender partners only and may have never even entertained the idea of dating a trans person. Once they do find a partner, trans folks may experience frustration when their partner is unsure what to do in the face of differences in sexual function and having to teach each new partner about their body can be tiresome.

This can take a toll on mental health, which, in turn, can affect sexual health and satisfaction. It can negatively impact sex drive and sexual function, but even more dangerously, it can lead to reduced healthcare seeking, like STI testing. This is a safety issue for both the affected individual and their partner(s). That doesn’t have to be the case, though. If you are a trans person navigating transitioning, lean on your support network of friends and family, and seek care from a trans-competent mental healthcare provider as needed. Having a background of support can give you the strength you need to process changes and cope.

Equally as important is education. Read everything you can get your hands on about the changes you can expect when transitioning. Be sure to brush up on safer sex basics like condoms, birth control, and PrEP, and then move on to more advanced topics like the physiological challenges (and benefits!) you may experience when it comes to sex. One of the books I recommend is Trans Bodies, Trans Selves. It’s an informational book written by and for trans people, and loosely based on the format of the famous book Our Bodies, Ourselves.

Talk to other trans people. Not everyone will want to be open about their experiences, but folks who do will be a wealth of information. Plus, it can help you realize that you aren’t alone! Lots of other people are willing to share their similar experiences and provide advice. And of course, please bring up any serious sexual health concerns or questions to your healthcare provider. A good provider will be able to give you with a comprehensive answer or direct you to someone who can.

Culturally, sexuality is not celebrated the way it should be, and when it comes to trans sex, things are very hush-hush. This is not the world I want to live in. I want to see a world where information about sexuality for everyone, no matter their gender, orientation, or sexual practices, is readily available and freely distributed. This is why I became a sex educator. My hope is that by providing you with information and resources on trans sexuality, I can provide you with the knowledge you need to help others around you and educate your community.

—Kim Adamski