Transgender individuals tend to report experiencing more sexual problems than the general population, according to new research published in The Journal of Sexual Medicine. But the prevalence of sexual dysfunction is highest among transgender individuals who do not receive gender-affirming surgeries.

“This study is part of a bigger project, called ENIGI (European Network for the Investigation of Gender Incongruence),” explained Els Elaut, a clinical visiting professor in psychology at Ghent University.

“This project was launched in 2007, when most Western-European gender clinics had much lower groups of transgender persons contacting them for health care. The main goal was to obtain a larger database between clinics with a similar view on transgender health care. While the project has never received any funding, our clinics try to continue this still much needed work.”

“The current study is part of a unique follow-up: four to six years after their initial contact with a specific clinic, all ENIGI participants were contacted again for an evaluation of several aspects of their well-being, but also their sexual functioning, irrespective of whether they had received gender-affirming interventions,” Elaut explained.

“This gave us a unique view on the sexual functioning of the several groups that consult gender clinics. Also, we did not just evaluate the DSM-classified sexual dysfunctions. We adapted our questions to correct for the differences in functioning between cisgender bodies and bodies after gender-affirming interventions, and we added some specific challenges we took from our clinical work with the group (e.g. a fear of rejection often leads to difficulties with initiating sexual contact).”

The researchers collected data from 518 trans persons who had visited three European gender clinics. The majority of the participants (307) were assigned male at birth, while the remaining 211 were assigned female at birth.

More than 90 percent of the participants were receiving hormone therapy when the researchers conducted their follow-up. The majority of the participants had also received some type of gender-affirming surgery. Of the trans women, 67.2% had received vaginoplasty and 55.4% had received breast augmentation surgery. Among the trans men, 90.8% had received a mastectomy, 84.3% had an ovariohysterectomy, and 21% had phalloplasty surgery.

The researchers found that the most frequent sexual dysfunctions in both trans men and trans women were difficulty with initiating sexual contact and difficulty achieving orgasm. “Although the prevalence rates of sexual dysfunctions were rather high (compared to general population studies), some transgender persons did not experience any of the surveyed sexual dysfunctions,” the researchers wrote.

The study also found that those who had not received gender-affirming surgery had higher rates of sexual dysfunctions compared to those who had.

“We have, for the first time ever, information on the sexual complaints of people who have — four to six years ago — first consulted a gender clinic. While all participants presented with gender dysphoria, it really stands out how the group that (for very different reasons) did not have any form of gender-affirming intervention experienced the highest prevalences of sexual dysfunction,” Elaut told PsyPost.

“Although we did not assess the reasons for this in the current study, this is probably due to a continuing distress from gender dysphoria during sex.”

“At the same time, the study shows us that even after gender-affirming interventions, both trans women and trans men still suffer from a specific number of sexual complaints. These individuals in the female spectrum experience orgasm difficulties (1 in 3), pain complaints during intercourse (1 in 4) and a fear of sexual contact (1 in 5),” Elaut said.

“Individuals in the male spectrum after genital interventions, mostly experienced difficulties initiating sexual contact (1 in 5), a fear of sexual contacts (1 in 5) and pain after intercourse (almost 1 in 5). When we compare this to prevalence rates in the general population, it is very clear that our participants show very elevated rates of sexual complaints.”

Like all research, the study includes some limitations. The study used a cross-sectional design — so it is unclear if gender-affirming interventions reduce sexual dysfunction or if people with better sexual functioning are more likely to undergo such operations.

“The current study was very descriptive, as we mainly wanted to assess what the prevalence was of certain sexual complaints, differentiated by treatment group. Of course, other studies need to continue this work and need to look into the reasons behind these complaints,” Elaut explained.

“For example, are the complaints mostly related to the interventions, and should surgical techniques evolve? Or are psychological processes of fear of rejection, experienced discrimination finding their way into the bedroom, and influencing the sexual experiences of transgender people?”

“Maybe a conclusion could then be that gender clinics should also invest more time in follow-up after genital surgery, and assist people in adapting to the new situation. Due to long waiting lists in the access to transgender health care, and limited resources, this is often not possible. So I think it is clear that there is a lot of work still to be done,”

The study, “Prevalence of Sexual Dysfunctions in Transgender Persons: Results from the ENIGI Follow-Up Study“, was authored by Mauro E. Kerckhof, Baudewijntje P. C. Kreukels, Timo O. Nieder, Inga Becker-Hébly, Tim C. van de Grift, Annemieke S. Staphorsius, Andreas Köhler, Gunter Heylens, and Els Elaut.