Strategies to Optimize Sexual Function with Feminizing and Masculinizing Genital Gender-Affirming Surgery

Abstract

Many patients who identify as transgender and gender non-binary describe being unable to engage in a fulfilling sexual life before genital gender-affirming surgery. Negative feelings patients may have toward their own genitals may make it difficult (for some, impossible) to find any pleasure in activity related to their genitals (Garcia, Transl Androl Urol. 3(2):156–62, 2014, Garcia et al. Genital gender affirming surgery for transgender patients: American Urologic Association; 2017. AUA Update Series 2017, Bockting et al. N Engl J Med. 364(26):2559–60, 2011, De Cuypere et al. Arch Sex Behav. 34(6):679–90, 2005). A subset of patients may describe unambiguously negative feelings toward this part of their bodies, and many report that their genitals are the most, or among the most, significant source of gender dysphoria (Coleman. Int J Transgenderism. 13:165–232, 2012). Such feelings can preclude the ability to engage in self-pleasuring (masturbation) and/or the ability to have sexual relationships with others. Many patients describe orgasm before genital gender-affirming surgery as conflicted—offering fulfillment of physical needs but at the same time aggravating often intense gender dysphoria (De Cuypere et al. Arch Sex Behav. 34(6):679–90, 2005, Coleman. Int J Transgenderism. 13:165–232, 2012). Sexual activity, alone or with a partner, can be a reminder that an important part of their body is not as it should be and does not reflect the individual’s sense of self.