It is important for people of any gender identity to use protection during sexual activity to safeguard themselves and others. Good sexual health can ensure that people have a safe and enjoyable sex life.

Regular testing, access to treatment, and sexual healthcare can help prevent and address many sexually transmitted infections (STIs), and assist people with maintaining good sexual health.

This article looks at sexual health topics for transgender men, transmasculine people, and non-binary people assigned female at birth (AFAB).

Transmasculine is a term that refers to those who were AFAB, but identify with masculinity, or masculine identity.

Some transgender men, transmasculine people, or non-binary people assigned female at birth (AFAB) may find identifying a part of their body with the word “vagina” triggering. In this article, we will be using the term “front hole/vagina.”

Anyone who is sexually active is at risk of transmitting and contracting STIs. STIs can easily transmit from one person to another through any type of sex, body part, or sex toy.

The best way for a person to protect themselves from STIs is to use barrier methods alongside a water-based lubricant.

Not all STIs show symptoms. Regular testing through a sexual health screening is important to help detect any STIs.

The Terence Higgins Trust recommends testing at least once a year, and more regularly if people have new or casual partners.

Using condoms and dams

Correctly using condoms and dams can help to protect against STIs.

Types include:

  • External condom: A person can use an external condom over a sex toy or penis, including a phalloplasty or metoidioplasty. External condoms are the safest to use on a penis. People should use a new condom when switching between anal and front hole/vaginal sex, sex lasting for more than half an hour, or sex with any new partner.
  • Internal condoms: People can use internal condoms inside the front hole/vagina or anus. They are the safest option for anyone with a metoidioplasty or testosterone-enhanced clitoral growth.
  • Dental dams: A dental dam is a sheet of latex that people can use as a barrier to protect against STIs during oral-front hole/vaginal sex and rimming.

Using lubricants

People can use a water-based or silicone-based lubricants when using condoms. People should avoid using an oil-based lubricant with latex condoms, as it could weaken the latex.

Internal condoms made from nitrile are suitable to use with an oil-based lubricant.

People should avoid using silicone-based lubricants with any silicone dildos or sex toys, as the lubricant could damage the items’ surface.

According to the Terrence Higgins Trust, if people have had recent bottom surgery, they may have unhealed skin which could increase the risk of STIs entering the body.

People can discuss recovery times with their surgeon to make sure any surgery has time to properly heal.

Additionally, taking hormones can increase the chance of bleeding during penetrative anal and frontal/vaginal sex. A person should use a lubricant and condom and regularly check for tears.

If people are taking testosterone, it can reduce the amount of front hole/vaginal lubrication and may increase the chance of contracting certain infections, such as cystitis, for the first few years.

Additionally, lower levels of estrogen can alter the thickness in the walls of the front hole/vagina and the rectum.

This may make it easier for tiny tears to occur during sexual activity, so the use of condoms and lubricants is very important to help prevent contracting an infection.

What are the effects of long-term testosterone use without surgery?

The long-term use of testosterone can affect healthy bacteria inside the front hole/vagina, which may cause unusual discharge and make penetrative sex feel painful.

Using an estrogen cream can counter these effects without affecting testosterone levels.

If people have not had a hysterectomy, then getting an ultrasound of the abdomen every two years can check for any abnormalities in the uterus.

Although testosterone decreases fertility, it is not effective as a contraceptive. For those still able to become pregnant but who do not wish to do so, it is important to use contraception, such as condoms.

Contraceptives such as coils, implants, injections, or the pill are all effective and safe methods to use alongside testosterone.

A person can discuss their options with a healthcare professional.

Hormonal factors and types of surgery can affect pregnancy for transgender men.

If transgender men are taking testosterone and want to become pregnant, they will need to stop taking testosterone and may need to take estrogen to support the reproductive system.

According to a 2014 review, transgender men who stopped taking testosterone started menstruating within 6 months.

If people have undergone top surgery, this may affect the ability to chestfeed a baby, and people may require additional support, such as an at-chest supplementer.

There is a risk of cervical cancer for any person with a cervix.

The Centers for Disease Control and Prevention (CDC) recommend that those with a cervix get regular cervical screening in line with current guidelines.

Those aged 21–65 should get cervical screening with cytology every 3 years. Those aged 30–65 should get cervical screening using a combination of cytology and HPV testing every 5 years.

Clinics may offer an option for people to self-collect swabs for testing.

According to a 2018 article, more than 1 in 10 transgender people who are HIV-positive are transgender men.

According to the CDC, risk factors for HIV in transgender people may include:

  • a lack of support and knowledge from healthcare professionals
  • stigma surrounding HIV
  • cissexism

Testing for HIV

Getting HIV testing at least once a year can ensure people know their HIV status. It can also allow them to begin treatment if they test positive for HIV.

People can get tested by:

  • going to a sexual health or family planning clinic
  • going through a local health department
  • going to an HIV testing center
  • ordering a self-test online to take at home

People can find out where to take an HIV test through a CDC search page here.

Treatment

HIV treatment is very effective and people who get treatment can live a long, healthy life. Consistent, daily use of HIV medication can lead to an undetectable viral load. This means there is no risk of passing HIV onto a sexual partner.

There are no known interactions between testosterone and HIV medications, so it is safe to take testosterone alongside HIV treatment.

Pre-exposure prophylaxis (PrEP) is a medication people take before exposure to HIV to prevent contracting HIV. It may be suitable for people who have a high risk of HIV exposure.

Post-exposure prophylaxis (PEP) is a medication to prevent an HIV infection if people think they have had exposure to HIV.

If people think they have had exposure to HIV they will need to take PEP 24–72 hours after exposure. People can get PEP from a sexual health clinic or the emergency department.

People who want to take PrEP will need to take an HIV test and a kidney function test to check the medication is suitable for them.

It is safe for transgender men to take PrEP and:

  • use gender-affirming hormones alongside daily PrEP
  • use contraception, including hormonal birth control
  • become pregnant
  • chestfeed

How to take

People can take PrEP daily if they are taking gender-affirming hormones, or having frontal/vaginal sex. People will need to take PrEP daily for 7 days before the drug is fully effective against HIV.

People who are not taking gender-affirming hormones, and only having anal sex, can take on-demand PrEP. This means they take a set number of tablets at certain times before and after sex.

How to get PrEP

People can get PrEP from their local healthcare provider or sexual health clinic. People can search for a local provider through the CDC website.

People can find a list of transgender-friendly clinics in their area through the CDC website.

Transgender men can take care of their sexual health through regular testing for STIs and HIV, and by using barrier methods every time they have sex.

If people test positive for HIV or any STI, prompt treatment can help control an infection and prevent passing it on to others.

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