Maggioranza di uomini trans e non binari con dolore genitale nei rapporti; testosterone associato a più dolore vaginale

Uso di testosterone e funzione sessuale in uomini transgender e persone di genere diverso assegnate femmine alla nascita

Sondaggi Ormoni cross-sex

Authors: Diana M. Tordoff, Mitchell R. Lunn, Bertha Chen, Annesa Flentje, Zubin Dastur, Micah E. Lubensky, Matthew Capriotti, Juno Obedin-Maliver
Journal: American Journal of Obstetrics and Gynecology
Year: 2023
Source: https://doi.org/10.1016/j.ajog.2023.08.035

Summary

Testosterone thins vaginal tissue, which can make sex painful. This study used the US PRIDE online study to compare sex lives in 602 people born female who were currently on testosterone and 516 who had never taken it. Pain during sex was strikingly common in both groups: 65% of sexually active people had genital pain or discomfort in the past month, 67% of testosterone users and 63% of non-users. Testosterone users reported more interest in sex and easier orgasm, and slightly more vaginal pain, but no greater satisfaction with their sex lives. The group also reported very high rates of past sexual abuse (78%), depression (81%) and PTSD (40%). Because it is a one-time survey of volunteers, it shows links only, not causes. But it records a large and little-noticed problem of painful sex.

Key findings

Lo studio ha esaminato 1.219 uomini trans e persone non binarie nate femmine del PRIDE Study: 602 attualmente in terapia con testosterone, 516 che non l'avevano mai assunto e 76 che avevano smesso.
Su 1.091 persone sessualmente attive, il 65% aveva avuto dolore o fastidio genitale durante i rapporti nell'ultimo mese, più spesso in vagina (52%), poi intorno al clitoride (29%) e alle labbra (25%).
Il dolore genitale durante i rapporti era comune con o senza testosterone: circa il 67% degli utilizzatori attuali e il 63% di chi non l'aveva mai usato.
L'uso attuale di testosterone era associato a un interesse per il sesso chiaramente maggiore, a un orgasmo un po' più facile e a un po' più dolore vaginale durante i rapporti.
L'uso di testosterone non era associato a maggiore soddisfazione sessuale, lubrificazione, dolore intorno alle labbra né piacere dall'orgasmo.
Le persone hanno riferito tassi molto alti nel corso della vita di abuso sessuale (78%), aggressione sessuale (50%), diagnosi di depressione (81%) e diagnosi di PTSD (40%).
Gli autori chiedono un migliore accesso a trattamenti come gli estrogeni vaginali, che meno del 5% degli uomini trans riferisce di aver mai usato.

Abstract

BACKGROUND: Testosterone use among transgender people likely impacts their experience of sexual function and vulvovaginal pain via several complex pathways. Testosterone use is associated with decreased estrogen in the vagina and atrophic vaginal tissue, which may be associated with decreased vaginal lubrication and/or discomfort during sexual activity. At the same time, increased gender affirmation through testosterone use may be associated with improved sexual function. However, data on pelvic and vulvovaginal pain among transgender men and nonbinary people assigned female at birth are scarce.

OBJECTIVE: This study aimed to assess the association between testosterone and sexual function with a focus on symptoms that are commonly associated with vaginal atrophy.

STUDY DESIGN: We conducted a cross-sectional analysis of 1219 participants aged 18 to 72 years using data collected from 2019 to 2021 from an online, prospective, longitudinal cohort study of sexual and/or gender minority people in the United States (The Population Research in Identity and Disparities for Equality Study). Our analysis included adult transgender men and gender diverse participants assigned female at birth who were categorized as never, current, and former testosterone users. Sexual function was measured across 8 Patient-Reported Outcomes Measurement Information System Sexual Function and Satisfaction domains.

RESULTS: Overall, 516 (42.3%) participants had never used testosterone, and 602 (49.4%) currently used testosterone. The median duration of use was 37.7 months (range, 7 days to >27 years). Most participants (64.6%) reported genital pain or discomfort during sexual activity in the past 30 days, most commonly in the vagina or frontal genital opening (52.2%), followed by around the clitoris (29.1%) and labia (24.5%). Current testosterone use was associated with a greater interest in sexual activity (β=6.32; 95% confidence interval, 4.91-7.74), higher ability to orgasm (β=1.50; 95% confidence interval, 0.19-2.81), and more vaginal pain or discomfort during sexual activity (β=1.80; 95% confidence interval, 0.61-3.00). No associations were observed between current testosterone use and satisfaction with sex life, lubrication, labial pain or discomfort, or orgasm pleasure.

CONCLUSION: Testosterone use among transgender men and gender diverse people was associated with an increased interest in sexual activity and the ability to orgasm, as well as with vaginal pain or discomfort during sexual activity. Notably, the available evidence demonstrates that >60% of transgender men experience vulvovaginal pain during sexual activity. The causes of pelvic and vulvovaginal pain are poorly understood but are likely multifactorial and include physiological (eg, testosterone-associated vaginal atrophy) and psychological factors (eg, gender affirmation). Given this high burden, there is an urgent need to identify effective and acceptable interventions for this population.

Conclusion

Testosterone use among transgender men and gender diverse people was associated with an increased interest in sexual activity and the ability to orgasm, as well as with vaginal pain or discomfort during sexual activity. Notably, the available evidence demonstrates that >60% of transgender men experience vulvovaginal pain during sexual activity. The causes of pelvic and vulvovaginal pain are poorly understood but are likely multifactorial and include physiological (eg, testosterone-associated vaginal atrophy) and psychological factors (eg, gender affirmation). Given this high burden, there is an urgent need to identify effective and acceptable interventions for this population.

Methodological limitations

One-time snapshot: Testosterone use and sex life were measured at a single point, so the links cannot show that testosterone caused the differences.
Users and non-users differ: Current users were more likely to identify as men, to have had their womb or ovaries removed, to smoke and drink more, and to have fewer signs of depression. Even after allowing for these, other hidden differences probably remain.
Volunteers, not a random sample: The PRIDE Study is an online study of volunteers, 81% White, recruited through LGBTQ+ community networks. The authors admit people may not be typical, may misremember and may give answers they think are expected.
Questionnaire not tested in this group: The sex-life questionnaire was developed without trans people, and its vaginal questions were set using (presumably) female groups. The authors changed its wording about body parts.
No dose or length details: Testosterone dose was not recorded, and how long people had used it was linked to few results, possibly because of the one-time design.
Key details missing: Use of vaginal estrogen, other treatments for painful sex (such as numbing gel) and the type of vaginal activity (such as fingers or toys) were not recorded.
Small differences: The differences found were small, for example a slight increase in vaginal pain. Two of the links stopped being clear once more factors were taken into account.
Many comparisons: Eight areas of sexual function were tested in three ways without adjusting for the number of tests, which raises the chance that some findings are flukes.
Possible conflicts of interest: Two senior authors (Obedin-Maliver, Lunn) reported consulting fees from Folx Health, an online provider of gender-affirming hormones, and Hims Inc. (described as unrelated to this work).

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Summary

Key findings

Abstract

Conclusion