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

• 調査したテストステロンの使用者486人（典型的な年齢27歳、テストステロン使用約2.5年）のうち、351人（72%）が、テストステロンを始めてから骨盤の痛みがあったと答えました。
• 痛みのある人のうち、90%は「ときどき」、10%は「いつも、またはほぼいつも」ありました。典型的な重さは10点満点で約6点で、大半は下腹部のけいれん性の痛みでした。
• テストステロン使用中に痛みがある人の98%は、開始前にも何らかの骨盤の痛みがあり、テストステロン使用中の痛みは以前とほぼ同程度と評価しました。
• 骨盤の痛みは、月経がまだある人で約4倍、PTSDのある人で2.5倍、オーガズムの際に痛みのある人で約30倍起こりやすくなっていました。
• 痛みのある人の半数が、それが少なくともときどき、性行為をやめたり、やり方を変えたりする原因になったと答えました。
• 子宮を摘出した25人または26人の大半は、その後は痛みが減ったと報告しましたが、結論を出すには少なすぎます。
• 著者らは、骨盤底筋の問題が関係している可能性を示唆し、原因と治療についての研究を求めています。

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.