“The truth is that there is no wrong way to have sex. The kind of sex we enjoy is the kind of sex we should be having.”

Tobi Hill-Meyer and Dean Scarborough, Trans Bodies, Trans Selves

Your Body Is the Best Body for You

Sexuality can be challenging for many transgender people. 

In addition to sexual challenges that cis-gendered people can have, many transgender people have grown up feeling shame, guilt, and fear about their bodies and sexuality. Developing a healthy sexual relationship with yourself or another person while being transgender not only involves a transition but developing a healthy and caring relationship to their body holistically, not just parts that are gendered in a way that feels comfortable. 

Transgender people may find it useful to rename body parts in a way that resonates with their identity. For example, some trans men may refer to their clitoris as their “dick” or some trans women may refer to their scrotum as their “lips”. 

Other transgender people may refer to their body parts in medical terms but not attach gendered meaning to them and derive pleasure from them sexually. For example, a trans man who has intercourse with another man using his vagina. It is important to cultivate the names for body parts that are the most meaningful and affirming to each person. 

Gender dysphoria can have a negative impact on sexuality and sexual functioning. This may manifest as a pressure to use genitals in a way that is not consistent with how one identifies with their gender or how one masturbates. 

Some transgender people can have gender dysphoria from some kinds of sexual activity because it doesn’t feel consistent with their gender. It is important during a transition period that a transgender person learns to listen to what their internal needs and desires are. It is also essential in sexually expressing themselves in their bodies, in a way that is consistent with their gender and not necessarily their sexual anatomy. 

It is important to have a healthy relationship with oneself during masturbation and bring that into a dynamic with a partner. For all people, not just transgender people, having a healthy sexual relationship with yourself is the first step to having a satisfying sexual relationship with another person.  

Universal Sexual Functioning

There are several aspects of sexual functioning that are universal for all human beings.

• Sexual pleasure starts in the brain. No matter what kind of genitals you have, the brain is the center of all systems involved in sexual function and experience; from the regulation of heart rate to hormones to the interpretation of sensory input and stimulation, the brain is at the center. 

• Any part of the body can lead to sexual pleasure. Nerve endings found on different parts of all bodies can be stimulated for sexual pleasure.

• Gender doesn’t determine what parts of the body are sexually sensitive. This varies among all people in terms of their preferences.

• Nerves found in the genital region of all people are highly sexually stimulating. No matter what kind of genitals you have, what you call them, or how they are stimulated, there will be a sexual response. 

• All genitals are in a similar position, have a similar structure and are developed in utero from the same tissue. For example, all people have a phallic structure (penis or clitoris) that is highly sensitive. The variation of how these parts are stimulated and aroused is different amongst all people, both cis and trans gendered. 

The point is that each person should find the best way to use their genitals for sexual arousal and response in a manner that is the most gender-affirming for them. 

Impact of Transition on Sexuality

Hormone therapy will cause changes in the physical body and in sexual feelings. Transgender people who start hormone therapy will undergo a “second puberty” and associated transition with how they know themselves sexually. 

Impact of Estrogen or Testosterone Blockers

Starting estrogen will stimulate the development of secondary sex characteristics such as breast and nipple development in trans women. The breast tissue during this stage of development becomes very sensitive and can be painful. This increased sensation can lead to more sexual stimulation or if too painful, may lead to less. 

Trans women who take estrogen or testosterone blockers may have changes in the size and function of their male genitals; shrinkage, a reduction in semen, less frequent erections. These changes don’t necessarily translate into fewer orgasms. Orgasms and erections are separate physiological processes and orgasm in trans women can happen without an erection. Trans women who have started taking estrogen or blockers often find that the types of orgasms they have and the ability to have multiple orgasms changes. 

Spironolactone, a frequently prescribed testosterone blocker will lower testosterone levels and lead to lower sex drive and fewer erections. Taking estrogen also causes a decrease in sex drive generally, but with the relief of gender dysphoria, some trans women report feeling more sexual desire as a result of having a body that is more in sync with their gender orientation. 

Cis-gendered women have testosterone in their bodies that contribute to sex drive. Trans women who have used or are using blockers may need to adjust their hormone therapy to find the right balance of testosterone for decreasing gender dysphoria and having a healthy sex drive. 

Impact of Testosterone 

Taking testosterone has many impacts on a trans man. The clitoris may grow up to four times the size of a typical cis-gendered female clitoris, which can lead to visible erections. The vaginal tissue may become thinner and produce less lubrication when aroused, making penetration painful or requiring artificial lubrication. 

Many trans men report having a higher sex drive upon taking testosterone. Sexual arousal may also change during the hormonal changes. Trans men can report that they need more visual stimulation and less emotional stimulation, and may start using more pornography. 

Some trans men report that they have orgasms more quickly, while others report that their orgasms are not as intense and they are no longer able to have multiple orgasms. Along with these changes, many trans men report changes in the way they like to be stimulated when their bodies start changing. 

Impact of Surgery

Transgender people who have surgery usually find that their bodies change with regard to how they experience sexual stimulation. For trans men who undergo phalloplasty, some surgical procedures allow for the erectile tissue to become erect and other procedures do not. For trans women who undergo a vaginoplasty, they are not able to produce their own lubrication and will need to use artificial lubrication. 

The impact of surgery to modify genital structure will also impact how nerves are distributed and where sexual stimulation will occur. There will be a process of relearning the body in order to achieve sexual satisfaction by oneself or with a partner. 

All people usually experience changes in sexual preferences over time. 

For transgender people, preferences will change with transition, as well. Some transgender people experience a change in sexual orientation or a change in who they are attracted to after they transition. For example, trans women who were sexually attracted to women before transition may find themselves attracted to men afterward. These changes can be due to the change in hormones or new gender identity. 

The type of sex transgender people have may also change. For example, a trans man that was in a lesbian relationship that involved more typical lesbian sexual practices such a prolonged touch and kissing may desire more penetrative activities after transition. 

Regardless of the changes, it is important to be mindful of new thoughts and feelings as the impact of transition occurs in the mind and the body and for each person to be true to and honor themselves. Seeking support is common and can be helpful.

Our certified Sioux Falls sex therapists are happy to help anyone develop their sexual health and well-being. Contact our office to meet with our team of transgender healthcare experts or join our trans/gender/diverse (TGD) psychotherapy support group.

In our next post, we discuss masturbation, abstinence, partner sex, tools for sex after transition, and transgender sexual practices.