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72 % des utilisateurs de testostérone déclarent des douleurs pelviennes, mais presque tous en avaient avant de commencer

Douleurs pelviennes chez les personnes transgenres sous testostérone

EnquêtesHormones croisées
Authors
Sav Zwickl, Laura Burchill, Alex Fang Qi Wong, Shalem Y. Leemaqz, Teddy Cook, Lachlan M. Angus, Kalen Eshin, Charlotte V. Elder, Sonia R. Grover, Jeffrey D. Zajac, Ada S. Cheung
Journal
LGBT Health
Year
2023
Source
https://doi.org/10.1089/lgbt.2022.0187

Summary

Australian doctors said they were seeing more testosterone users with pelvic pain, so they surveyed 486 trans-identified people born female who were taking testosterone. Nearly three-quarters said they had had pelvic pain since starting, usually cramping low in the belly, with a typical severity of 6 out of 10. Pain was more likely in people who still had periods, had PTSD, or had pain during orgasm. Some said the pain disrupted their sex lives. However, almost all of those with pain had also had pelvic pain, mostly period pain, before testosterone, and on average they rated it about the same as before. So the survey cannot show that testosterone causes pelvic pain. It does show that pelvic pain is a common and little-studied problem for this group.

Key findings

  • Sur 486 utilisatrices de testostérone interrogées (âge typique 27 ans, environ 2,5 ans sous testostérone), 351 (72 %) ont dit avoir eu des douleurs pelviennes après le début de la testostérone.
  • Parmi celles ayant des douleurs, 90 % en avaient « parfois » et 10 % « toujours ou presque toujours » ; la sévérité typique était d'environ 6 sur 10, le plus souvent des crampes dans le bas du ventre.
  • Parmi celles ayant des douleurs sous testostérone, 98 % avaient aussi des douleurs pelviennes avant de commencer, et elles évaluaient la douleur sous testostérone à peu près comme avant.
  • Les douleurs pelviennes étaient environ 4 fois plus probables chez celles qui avaient encore leurs règles, 2,5 fois plus probables chez celles ayant un TSPT, et environ 30 fois plus probables chez celles ayant des douleurs pendant l'orgasme.
  • La moitié de celles ayant des douleurs disaient qu'elles les obligeaient au moins parfois à arrêter un rapport sexuel ou à changer leur façon d'avoir des rapports.
  • La plupart des 25 ou 26 personnes ayant subi l'ablation de l'utérus ont rapporté moins de douleurs ensuite, mais elles étaient trop peu nombreuses pour tirer des conclusions.
  • Les auteurs suggèrent que des problèmes des muscles du plancher pelvien pourraient jouer un rôle et appellent à des recherches sur les causes et les traitements.

Abstract

Purpose: This descriptive study aimed to assess the characteristics of pelvic pain and explore predictive factors for pelvic pain in transgender (trans) individuals using testosterone therapy. Methods: An online cross-sectional survey was open between August 28, 2020, and December 31, 2020, to trans people presumed female at birth, using testosterone for gender affirmation, living in Australia, and >16 years of age. The survey explored characteristics of pelvic pain following initiation of testosterone therapy, type and length of testosterone therapy, menstruation history, and relevant sexual, gynecological, and mental health experiences. Logistic regression was applied to estimate the effect size of possible factors contributing to pain after starting testosterone. Results: Among 486 participants (median age = 27 years), 351 (72.2%)* reported experiencing pelvic pain following initiation of testosterone therapy, described most commonly as in the suprapubic region and as "cramping." Median duration of testosterone therapy was 32 months. Persistent menstruation, current or previous history of post-traumatic stress disorder, and experiences of pain with orgasm were associated with higher odds of pelvic pain after testosterone therapy. No association was observed with genital dryness, intrauterine device use, previous pregnancy, penetrative sexual activities, touching external genitalia, or known diagnoses of endometriosis, vulvodynia, vaginismus, depression, anxiety, or obesity. Conclusions: Pelvic pain is frequently reported in trans people following initiation of testosterone therapy. Given the association with persistent menstruation and orgasm, as well as the known androgen sensitivity of the pelvic floor musculature, further research into pelvic floor muscle dysfunction as a contributor is warranted.

Conclusion

Pelvic pain is frequently reported in trans people following initiation of testosterone therapy. Given the association with persistent menstruation and orgasm, as well as the known androgen sensitivity of the pelvic floor musculature, further research into pelvic floor muscle dysfunction as a contributor is warranted. Until further evidence is available, the authors recommend a tailored, multidisciplinary, trauma-informed approach that may include pain management, sexual function, management of persistent menstruation, and mental health.