Sexual Satisfaction in Trans Masculine and Nonbinary Individuals: A Qualitative Investigation

Are cisnormative surveys adequate to assess sexual well-being in trans men post-genital gender-affirming surgery?

INTRODUCTION

For transmasculine spectrum individuals, there is a lack of validated surveys to assess sexual well-being (SWB) post-genital gender-affirming surgery. Currently, either providers are designing their own SWB surveys or surveys designed for cisgender men are being used.

OBJECTIVE

This study investigated the applicability of SWB surveys validated for cisgender men to transmasculine spectrum individuals post-genital gender-affirming surgery (TMSX). Recognizing the paucity of validated tools for assessing SWB in transmasculine individuals post-genital gender-affirming surgery (TMSX), we evaluated current surveys for their inclusiveness and relevance to this population.

METHODS

Our methodology involved analyzing surveys validated in English-speaking North American cisgender men. We conducted a systematic review, yielding 31 surveys, out of which 12 met our inclusion criteria. These were then assessed against the 10 domains of holistic SWB as identified by Özer et al. Each survey was scored based on its reflection of these domains, thus generating an SWB score. Additionally, we performed a thematic analysis to identify areas needing modification for better applicability to TMSX.

RESULTS

Our findings indicate an average SWB score of 5.17 out of 10 across the surveys. The surveys predominantly addressed sexual function, with a marked underrepresentation of domains like quality of life, sexuality, and sexual pleasure. This underscores the tendency of these surveys to focus more on the biological mechanisms of sex, rather than on a nuanced biopsychosocial understanding. Thematic analysis revealed significant gaps, such as the irrelevance of questions about erections and ejaculations for TMSX, and the need for greater emphasis on psychosocial factors.

CONCLUSION

Given these gaps and the inadequacy of most cisnormative surveys, we recommend the creation of a novel, validated SWB survey specifically for TMSX. This should be developed in collaboration with a multidisciplinary panel and TMSX community advisory board, ensuring a tool that truly reflects the unique SWB needs of this population.

Trans, gender non-conforming and non-binary individuals' perspectives on experienced sexuality during medical transition

How gender-affirming treatments (GAT) influence the experienced sexuality of transgender, gender non-conforming, and non-binary (TGNB) individuals remains understudied. The aim of this research was to discern factors contributing to a satisfying sexual experience for TGNB individuals, explore the influence of GAT on this process, and identify potential areas for improvement in transition-related care. We conducted interviews with 21 participants at various stages of GAT. Participants identified as (trans)men (12), (trans)women (7), transgender (1), and genderqueer/gender non-conforming/non-binary (1). Thematic analysis was conducted and involved multiple researchers. Three themes emerged from the data: (i) the role sexuality plays in understanding and affirming one's gender, (ii) satisfaction with one's physical sexual function, (iii) positive communication about sex and its subsequent influence on relationships. Many participants associated satisfaction with physical sexual function with positive sexual experiences, often describing GAT-induced changes in sexual arousal, drive, and orgasm as gender-affirming. Emotional connection and affirmation from sexual partners also contributed to positive experiences. The ability to (re-)define what sex meant individually increased satisfaction levels. Moreover, understanding and affirming one's gender identity were closely related to a satisfactory sex life. This study offers valuable insights for healthcare providers working with TGNB individuals during GAT, particularly concerning their sexuality.

'You have to trust their word': transmasculine experiences with sex partners and safety during the early COVID-19 outbreak

The early months of the SARS-CoV2 pandemic exacerbated health disparities for vulnerable populations, including transgender (trans) communities, creating unique challenges for navigating sex and dating. This paper aims to expand upon the current literature regarding transmasculine populations by capturing their lived experiences during this critical time. We interviewed 20 assigned female sex at birth (AFAB) adults of the transmasculine spectrum - men, nonbinary, and transmasculine individuals - about their social and sexual experiences in the USA in May and June 2020. Transcripts were analysed using an inductive thematic approach. We found that sex drive decreased and uncertainty about health risks increased. Some participants found alternate ways to date and hook-up that reduced their COVID-19 risk, such as engaging in online sex (e.g. sexting, dating apps). Others expressed discomfort using virtual platforms for both personal/work and sexual lives, along with nuanced feelings around being objectified, compared to pornography, and fetishised as trans bodies. COVID-related shutdowns of queer spaces also amplified pre-existing concerns about interpersonal safety and rejection. When seeking new partners, participants sought behavioural characteristics that instilled trust. Future public health communications can take advantage of safety and sexual health strategies already present in trans communities to bolster wellbeing in trans lives.

Sexual pleasure during college students' most recent partnered sexual experiences

ObjectiveWe explored college students' sexual pleasure using a new self-report measure, the Body, Emotions, Sensations, Touch/Trust (B.E.S.T.) Scale of Sexual Pleasure. Participants: Data were from 3997 randomly sampled students with a partnered sexual experience. Methods: Students completed an online survey about their most recent partnered sexual experience. Data was collected in January 2020. Results: Students find the nonphysical aspects of partnered sex (e.g., emotions, trust, connection with partners) as pleasurable as physical aspects (e.g., behaviors engaged and received, bodily sensations). Self-reported arousal, wantedness, and emotional intimacy were the strongest correlates of male, female, and transgender/gender non-binary students' sexual pleasure. Few sexual behaviors were associated with sexual pleasure and only one - cuddling for women - was associated with greater sexual pleasure. Conclusions: Students find their partnered sexual experiences pleasurable. Students' sex may be more pleasurable when they feel ready for sex, desire sex, and feel close to their partners.

Cumulative childhood trauma, sex motives and sexual satisfaction among emerging adults

BACKGROUND

To better understand sexual satisfaction in emerging adults, previous research has emphasized the importance of considering the role of developmental experiences, such as cumulative childhood trauma (CCT; the number of different forms of abuse and neglect sustained during childhood). However, the mechanisms by which CCT and sexual satisfaction are related remain unknown. Sex motives are suggested as an explanatory mechanism given the previously found associations between sex motives and both sexual satisfaction and CCT.

OBJECTIVE

This study examined the direct associations between CCT and sexual satisfaction, as well as indirect associations through sex motives, in emerging adults.

PARTICIPANTS AND SETTING

A sample of 437 French Canadian emerging adults (76 % women, mean age of 2.3) were recruited.

METHODS

Participants completed online self-reported validated questionnaires assessing CCT, sex motives and sexual satisfaction.

RESULTS

Results from a path analysis revealed that CCT was associated with a higher endorsement of the self-affirmation sex motive (β = 0.25, p < .001) which was linked to lower sexual satisfaction (β = -0.13, p < .001). CCT was also associated with a higher endorsement of the coping (β = 0.25, p < .001) and partner approval (β = 0.09, p < .05) sex motives. A higher endorsement of the intimacy (β = 0.28, p < .001) and pleasure (β = 0.24, p < .001) sex motives, and a lower endorsement of the partner approval sex motive (β =  -0.13, p < .001) were linked to greater sexual satisfaction.

CONCLUSIONS

Results suggest education and intervention targets to improve emerging adults' sexuality.

Caring, Chemistry, and Orgasms: Components of Great Sexual Experiences

Sexual satisfaction is important to individual well-being and relationship satisfaction, making it a research topic relevant for sex clinicians and relationship therapists. The current study adds to sexuality literature by asking participants questions about the factors involved in "great sex." We conducted 78 interviews via email or phone with participants ranging in age from 18 to 69. The sample included a diverse range of sexual orientations and identities, and various relationship statuses. Three primary themes emerged regarding great sex: orgasm, an emotional component, and chemistry/connection. Though some participants equated an emotional aspect as love; most participants made clear the difference between love and emotional elements in sex. Many participants shared their belief that a man only invests in his female partner's orgasm when he also invests in her emotionally. Thus, some women explained that the emotional component helped them be present enough to orgasm. Others explained the emotional component as trust and affection. Participants also elaborated to define chemistry, which they regarded as out of one's control and impossible to manufacture. A smaller number of participants stated unequivocally the lack of necessity of an emotional aspect to great sex; they stated instead that physical connection trumped an emotional component.

Transgender theory revisited: Current applications to transgender issues

In addition to social determinants and cognitive constructions of social identities emphasized by earlier theoretical frameworks, transgender theory emphasizes the importance of physical embodiment in gender and sexual identity, as well as the integration of embodied experiences with the self and socially constructed aspects of identity through the lived experiences of those with fluid, often intersecting identities. The present paper considers important recent topics in research on transgender identities through the lens of this theory, including embodiment in understanding fluid gender and sexual identities, the intersectionality of multiple oppressed social identities, barriers to healthcare for transgender individuals, and ethical issues with regard to social policies impacting transgender individuals and with regard to media portrayals of and research on such individuals.

Sex & relationships in trans people

Everyone has sexual rights and is entitled to enjoy sex, regardless of gender identity or expression. It is therefore encouraging to witness a recent growth in research on sexuality in transgender individuals. We provide a short overview of extant research on sex and relationships in this population and argue that current research has mostly been conducted from a medical and functional approach; there is a strong focus on negative experiences and prevention; and there is a lack of data regarding psychological and socio-relational variables. Furthermore, many studies have been conducted in a cis- and hetero-normative setting and have methodological shortcomings such as applying questionnaires that have not been validated in a transgender population. We encourage researchers to expand their focus to positive variables such as sexual pleasure and (in accordance with the biopsychosocial model) investigate subjective experiences and relationship variables when studying sexuality in transgender individuals.

Pleasure please! Sexual pleasure and influencing factors in transgender persons: An ENIGI follow-up study

Background: While the importance of sexual pleasure for physical and mental health becomes increasingly evident, research on sexual pleasure in transgender persons is lacking. Recently, the first version of the Amsterdam Sexual Pleasure Index (ASPI Vol. 0.1) was validated in cisgender persons. This questionnaire aims to assess the tendency to experience sexual pleasure independent of gender, sexual orientation or anatomy. Aim: The aims of this study were threefold. First, to perform exploratory scale validation analyses of the ASPI in transgender persons. Secondly, to compare transgender sexual pleasure scores to reference data in cisgender persons. Finally, to identify factors that are associated with sexual pleasure. Methods: In a follow-up study conducted within the European Network for the Investigation of Gender Incongruence (ENIGI), online questionnaires were distributed to persons who had a first clinical contact at gender clinics in Amsterdam, Ghent or Hamburg four to six years earlier. Internal consistency of the ASPI was assessed by calculating McDonald's omega (ω_t). ASPI scores were compared to scores from the cisgender population using a one sample t-test, and linear regressions were conducted to study associations with clinical characteristics, psychological wellbeing, body satisfaction and self-reported happiness. Results: In total, 325 persons filled out the ASPI. The ASPI showed excellent internal consistency (ω_t, all: 0.97; transfeminine: 0.97, transmasculine: 0.97). Compared to data from cisgender persons, transgender participants had significantly lower total ASPI scores (i.e., lower sexual pleasure; transgender vs. cisgender, mean(SD): 4.13(0.94) vs. 4.71(0.61)). Lower age, current happiness and genital body satisfaction were associated with a higher tendency to experience sexual pleasure. Conclusion & discussion: The ASPI can be used to assess the tendency to experience sexual pleasure and associated factors in transgender persons. Future studies are needed to understand interplaying biopsychosocial factors that promote sexual pleasure and hence transgender sexual health and wellbeing.

Daily Sexual Behavior, Sexual Esteem, and Body Image in Transgender and Cisgender Individuals

Multiple surveys have suggested that transgender individuals show lower sexual well-being than cisgender individuals. Most studies, however, are limited in terms of ecological validity and memory bias and cross-sectional in nature. These issues are less prevalent in diary studies monitoring responses over time at home. For three weeks, 47 transgender (M age = 29.00, SD = 11.62) and 52 cisgender individuals (M age = 32.90, SD = 11.44) reported daily on their sexual behavior, sexual esteem and body image. Using multilevel model analyses, we investigated the daily associations between these variables, and addressed differences between transgender and cisgender individuals. We found that in transgender individuals, intimacy predicted sexual esteem; sexual openness predicted sexual esteem and body image; and sexual esteem predicts intimacy, masturbation, and sexual openness on the daily level. While transgender individuals scored lower on daily sexual esteem and body image than cisgender individuals, groups did not differ in daily sexual behavior. They also did not differ in any of the predictive relations described above, but we did find that the association between masturbation and body image was moderated by a cisgender identity, and sexual esteem predicted sexual activity more positively in cisgender compared to transgender individuals. These results complement findings from cross-sectional studies and indicate how transgender individuals struggling with sexuality can increase sexual openness. Implications for clinical practice are that clinicians discussing sexuality with their transgender patients should not define sexual activity too narrowly, and that sexual esteem might be a relevant factor in determining sexual behavior.

Components of Good Sex in Young Urban Trans People Assigned Female at Birth: A Qualitative Interview Study

BACKGROUND

Prevalence of sexual dissatisfaction and dysfunction is high in trans people, as reflected in lower sexual pleasure scores compared to cis people.

AIM

The aim of this study is to explore components of good sex and sexual pleasure in young, urban trans people assigned female at birth (AFAB).

METHODS

16 semi-structured interviews were conducted with young urban AFAB trans people. The interviews were analysed using qualitative content analysis.

OUTCOMES

Main outcomes were providing participants components of good sex and sexual pleasure.

RESULTS

Regarding components of good sex, the participants of this study described various influences on their ability to relax as well as strategies to increase relaxation during sex. Next to general influences on relaxation, the ability to relax was influenced by the way their partners interacted with them and thus how accepted they felt in their identities and feeling safe. Further, transition and coming-out status, physical and sexual function changes due to hormone therapy and gender affirming surgeries, specific sexual techniques and aids, social constructs and the circumstances in which sex took place were important. Strategies to increase relaxation included using aids such as penis prostheses, preferring certain sexual practices, that is, being more dominant or on eye-level, reducing visual aspects, drinking alcohol, and deconstructing gender and sexual norms.

CLINICAL IMPLICATIONS

When working with trans clients, inhibitors of relaxation should be assessed and addressed, which could include working on clients believes about trans sexuality, gendered sexual scripts or various techniques to reduce body dysphoria, if present, during sexual practices.

STRENGTHS & LIMITATIONS

Following a non-clinical community sampling with no treatment-related dependency between researchers and participants, the sample provides an open access to the participating trans people's sexuality. However, the sample is small, selective, and it includes only able-bodied trans people from Christian religious backgrounds.

CONCLUSION

Next to sexual problems and dysfunctions, future research on the relationship between medical transition and sexuality should additionally address positive aspects of sexuality, such as sexual pleasure and sexual satisfaction, and its possible function as a resource pre, during and post transition.

They "Don't Know How to Deal with People Like Me": Assessing Health Care Experiences of Gender Minorities in Indiana

Purpose

Within the LGBTQ+ community, the transgender and nonbinary (TGNB) population experience a disproportionate amount of discrimination when seeking health care. Such disparities may arise from lack of proper medical training and resources for providers or biases. In this study, we examine the health care experiences of TGNB individuals living in Southern Indiana.

Methods

We analyzed responses from TGNB respondents to an LGBTQ+ health care needs assessment survey in Southern Indiana. Respondents were asked about demographic data, their self-assessed health status, quality of health care received, whether they have a provider with whom they feel comfortable sharing their gender identity with, and if they have to commute to see their provider. Finally, respondents were asked an open-ended question about their health care experiences while living in Southern Indiana. Responses were coded and several themes emerged and were analyzed.

Results

Eighty-five TGNB individuals completed our survey. Less than half of respondents indicated that they had an LGBTQ+-welcoming provider (44.7%). Individuals with an LGBTQ+-welcoming provider were more likely to report their self-assessed health as excellent/good (p=0.02) and quality of health as excellent/very good (p=0.03) compared to individuals without an LGBTQ+-welcoming provider. Five themes emerged from the write-in responses (n=64): discrimination (34.4%), invalidation (32.8%), distrust (28.1%), logistic concerns (35.9%), and positive experiences (35.9%).

Conclusion

The TGNB community living in Southern Indiana reports numerous barriers related to provider attitudes when obtaining health care. Additional training is needed to address provider biases and improve LGBTQ+ community health disparities.

Standards of Care for the Health of Transgender and Gender Diverse People, Version 8

Background: Transgender healthcare is a rapidly evolving interdisciplinary field. In the last decade, there has been an unprecedented increase in the number and visibility of transgender and gender diverse (TGD) people seeking support and gender-affirming medical treatment in parallel with a significant rise in the scientific literature in this area. The World Professional Association for Transgender Health (WPATH) is an international, multidisciplinary, professional association whose mission is to promote evidence-based care, education, research, public policy, and respect in transgender health. One of the main functions of WPATH is to promote the highest standards of health care for TGD people through the Standards of Care (SOC). The SOC was initially developed in 1979 and the last version (SOC-7) was published in 2012. In view of the increasing scientific evidence, WPATH commissioned a new version of the Standards of Care, the SOC-8. Aim: The overall goal of SOC-8 is to provide health care professionals (HCPs) with clinical guidance to assist TGD people in accessing safe and effective pathways to achieving lasting personal comfort with their gendered selves with the aim of optimizing their overall physical health, psychological well-being, and self-fulfillment. Methods: The SOC-8 is based on the best available science and expert professional consensus in transgender health. International professionals and stakeholders were selected to serve on the SOC-8 committee. Recommendation statements were developed based on data derived from independent systematic literature reviews, where available, background reviews and expert opinions. Grading of recommendations was based on the available evidence supporting interventions, a discussion of risks and harms, as well as the feasibility and acceptability within different contexts and country settings. Results: A total of 18 chapters were developed as part of the SOC-8. They contain recommendations for health care professionals who provide care and treatment for TGD people. Each of the recommendations is followed by explanatory text with relevant references. General areas related to transgender health are covered in the chapters Terminology, Global Applicability, Population Estimates, and Education. The chapters developed for the diverse population of TGD people include Assessment of Adults, Adolescents, Children, Nonbinary, Eunuchs, and Intersex Individuals, and people living in Institutional Environments. Finally, the chapters related to gender-affirming treatment are Hormone Therapy, Surgery and Postoperative Care, Voice and Communication, Primary Care, Reproductive Health, Sexual Health, and Mental Health. Conclusions: The SOC-8 guidelines are intended to be flexible to meet the diverse health care needs of TGD people globally. While adaptable, they offer standards for promoting optimal health care and guidance for the treatment of people experiencing gender incongruence. As in all previous versions of the SOC, the criteria set forth in this document for gender-affirming medical interventions are clinical guidelines; individual health care professionals and programs may modify these in consultation with the TGD person.

Ownership, Enjoyment, Arousal Troubles, and Robust Education: Pleasure in LGBTQ+ Alt-Sex Members’ Responses to Consent Violations

Background: Alt-sex practitioners are a diverse group with diverse unconventional sexual behaviors including consensual non-monogamy (CNM), kink, fetishism, and bondage/discipline dominance/submission, sadomasochism (BDSM). Perhaps because of their openness to non-normative sexuality, these communities often comprise a large proportion of lesbian, gay, bisexual, trans, queer, among others (LGBTQ+) individuals. LGBTQ+ individuals experience higher rates of sexual violence and consent violation than their cisgender, heterosexual peers both inside and outside of formalized alt-sex communities. Pleasure, including but not limited to sexual pleasure, is often a motivator for engaging in sexual and alt-sex activities. This study examines how consent violations influence pleasure among LGBTQ+ alt-sex members. Methods: We conducted an electronic one-time survey of LGBTQ+ alt-sex practitioners (N = 1354). In this study, we analyze open-ended responses for ways pleasure was described in response to questions about consent violations. We use thematic analyses in Dedoose online software. Results: Two subthemes emerged related to the violation itself, (a) pleasure as a motivator for violating consent and (b) pleasure in spite of consent violation. As the second theme that emerged, pleasure was a component of the aftereffects of the violation in two ways: (1) pleasure was reduced or inhibited by consent violations; (2) pleasure was a motivator for healing and advocacy. Conclusions: We discuss practical and research implications based on the complex relationships between violations and pleasure reported by participants.

Concerns About Internal Erectile Prostheses Among Transgender Men Who Have Undergone Phalloplasty

BACKGROUND

Transgender men who undergo gender-affirming phalloplasty have limited options for attaining sufficient rigidity for sexual penetration.

AIM

The goal of this study was to understand interest in and concerns about internal erectile prostheses among transgender men who had undergone phalloplasty.

METHODS

As part of a pilot study of an external erectile device, transgender men (n = 15) were surveyed about their interest in, and concerns about, getting an internal prosthesis. Descriptive analyses were performed for structured questions and content analysis was used to analyze open responses.

OUTCOMES

Measured outcomes included closed- and open-ended questions assessing patient attitudes about internal erectile prostheses.

RESULTS

Before starting the study, approximately half the men stated they were interested in getting an internal device, 20% said they weren't, and 33% said they didn't know. More than half of this postphalloplasty population stated they were somewhat or very concerned about the need for additional surgery (73%), side effects (pain, damage to the phallus; 100%), and the risk of device failure (100%). An additional 47% stated they were somewhat or very concerned about cost and 33% stated they were somewhat or very concerned about finding a surgeon.

CLINICAL IMPLICATIONS

There is a need to develop appropriate alternatives to current internal prostheses for penetrative function after phalloplasty.

STRENGTHS & LIMITATIONS

Generalizability of results is limited by the fact that data are from men who had enrolled in a pilot study to test an external erectile prosthesis, and as such were explicitly interested in exploring nonsurgical alternatives to attain an erection. The combination of quantitative and qualitative data demonstrates that transgender men's concerns about internal prostheses are grounded in the current evidence.

CONCLUSION

Transgender men who have undergone phalloplasty have substantial concerns about the risks of getting an internal prosthesis and there is significant interest in alternatives to current devices. Boskey ER, Mehra G, Jolly D, et al. Concerns About Internal Erectile Prostheses Among Transgender Men Who Have Undergone Phalloplasty. J Sex Med 2022;19:1055-1059.

Gender Dysphoria and Sexual Well-Being Among Trans Masculine and Nonbinary Individuals

Prior qualitative research has noted that gender dysphoria impacts sexual engagement and satisfaction for many trans masculine and nonbinary individuals. As such, the current cross-sectional study aimed to investigate the exact relations between distinct aspects of gender dysphoria (i.e., genital, chest, other secondary sex characteristics, and social) and engagement in, and enjoyment of, specific sexual acts. To achieve this aim, a sample of 141 trans masculine and nonbinary participants who were assigned female at birth and whom had not undertaken a medical transition were recruited. Participants were identified as trans masculine (n = 52), nonbinary (n = 72), and agender (n = 17). Participants completed a survey rating both body and social gender dysphoria and their engagement and enjoyment of receptive and performative roles across six partnered sex act domains (i.e., insertion, oral sex, sex toys, manual stimulation, nipple stimulation, and anal stimulation), as well as masturbation and noncoital activities. The overall results demonstrated that gender dysphoria is more salient to sexual acts that involve receiving versus providing sexual pleasure. In addition, genital and chest dysphoria were often significantly related to lower ratings of engagement and enjoyment. These results support the understanding that trans masculine and nonbinary individuals are likely negotiating sexual encounters to avoid sexual acts that involve areas of their body they find most distressing and marks an important area for future interventions and research.

Sexual Self-Concept Discrepancies Mediate the Relation between Gender Dysphoria Sexual Esteem and Sexual Attitudes in Binary Transgender Individuals

Sexual responding in transgender people has typically been investigated from a medical and functional perspective. Aligning with the biopsychosocial model, it is however equally important to consider psychological aspects of sexuality in this population. We propose that the Sexual Self-Concept (SSC) theory offers a valuable framework to understand (sexual) wellbeing in transgender people, while Self-Concept Discrepancy (SCD) theory could offer an explanation of the mechanisms underlying negative SSCs related to gender dysphoria. We investigated differences in SSC (consisting of sexual esteem, sexual attitudes, and sexual self-efficacy) in 197 binary transgender and 205 cisgender individuals using an online survey and explored the mediating role of actual/ideal self-discrepancies in explaining the relation between gender dysphoria and SSC. Transgender and cisgender individuals differed significantly in seven out of eight components related to sexual esteem and sexual attitudes. Actual/ideal self-discrepancies mediated the relationship between gender dysphoria and the SSC in transgender individuals for the sexual esteem components related to body perception, conduct, and attractiveness, as well as for sexual anxiety. We found no relation between gender dysphoria and the other SSC components in this group. We conclude that SSC discrepancies could be a valuable treatment target to improve transgender individuals' sexual esteem and sexual attitudes.

Resisting Trans Medicalization: Body Satisfaction and Social Contextual Factors as Predictors of Sexual Experiences among Trans Feminine and Nonbinary Individuals

Past research has constructed a medicalized model of trans women's sexuality, where trans women are believed to be hyposexual and distressed by their bodies pre-transition, and are cured of their sexual dysfunction as a result of gender affirmative medical procedures. The current study engaged a community sample (N = 169) of trans feminine and nonbinary individuals assigned male at birth (TFNB) to investigate predictors of sexual experiences after addressing methodological biases of prior studies, including body satisfaction (using a modified Body Image Scale) and social contextual factors. Hierarchical regressions were conducted to test the hypothesis that after accounting for demographic variables and social contextual aspects (i.e., body satisfaction, social dysphoria, and fetishization), medical transition (i.e., hormone therapy) would not significantly predict five outcomes of sexual experience (i.e., receptive penetration, insertive penetration, importance of sex, sexual pleasure, and sexual intimacy). Across all models, medical transition was not a significant predictor of sexual experiences; however, sexual orientation, age, body satisfaction, and experiences of fetishization were frequent predictors. Results suggest that the sexual experiences of TFNB individuals do not align with the medicalized model and that demographic and contextual factors play an important role in the sexual outcomes for this population.

FOREST protocol: a qualitative study exploring health and sexuality of transmasculine individuals in France

INTRODUCTION

While current research on sexuality and health often explores sexual behaviours among heterosexual and gay cisgender individuals, little is known about the sexualities of transgender people, especially transmasculine people. When data are available, sexual health is often reduced to risk exposure, not considering in detail social context and determinants that could contribute to a more comprehensive approach, such as general health, class, race, exposure to violence or social representations. Recognising this gap, identified in both national (French) and international scientific literature, this study aims to explore the sexual health of transmasculine people, employing an intersectional approach and considering both positive and negative health determinants.

METHODS

This 2-year research based in the disciplinary field of social psychology, with a gender perspective, and will apply qualitative methods. We adopt a community-based research approach, integrating one university and one community-based organisation in the coordination of the study. In a triangulation perspective, two rounds of semistructured interviews will be performed with key informants (medical practitioners, community-based support services workers, etc) and with people self-identifying as transmasculine. Focus groups will complement data collection.

ETHICS AND DISSEMINATION

FOREST protocol was approved by the Comité d'Évaluation Éthique (CEEI) de l'Institut National de la Santé Et de la Recherche Médicale (CEEI/International Review Board 00003888). The research adopts the principles of open science, and findings will be published assuring participants' confidentiality. Informative flyers and videos will be elaborated to communicate study findings to participants, stakeholders and the transcommunities at large, and data will be stored in lasting archives.

Mental and sexual well-being in non-binary and genderqueer individuals

BACKGROUND

Non-binary and genderqueer (NBGQ) individuals do not identify with a binary gender identity. Some but not all NBGQ individuals identify as transgender, and it is currently unclear on which aspects of mental and sexual well-being NBGQ and binary transgender individuals may differ.

AIM

To compare NBGQ, binary transgender and cisgender individuals on variables related to mental well-being, sexual well-being, and sexual self-concept discrepancies.

METHODS

We conducted an online questionnaire study in 125 transgender men, 72 transgender women, 78 NBGQ individuals, 98 cisgender men, and 107 cisgender women.

RESULTS

For most variables, NBGQ individuals did not differ from binary transgender individuals. These two groups differed only on gender dysphoria and transgender specific body image worries, which were both lower in the NBGQ group. Compared to the cisgender group, NBGQ individuals scored higher on gender dysphoria, actual/ought sexual self-concept discrepancies, and actual/ideal sexual self-concept discrepancies, and lower on general life satisfaction and sexual esteem related to body perception.

DISCUSSION

These results offer a first quantitative analysis of sexual well-being in NBGQ individuals, and highlight that - while both groups face unique challenges - NBGQ individuals encounter similar difficulties concerning mental and sexual well-being as binary transgender individuals.