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研究対象のトランス男性とノンバイナリーの人の大半が性交中の性器の痛みを経験；テストステロンは膣の痛みの増加と関連

出生時に女性とされたトランスジェンダー男性およびジェンダー多様な人々におけるテストステロンの使用と性機能

調査研究性別適合ホルモン療法
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

  • この研究は、PRIDE Studyの女性として生まれたトランス男性とノンバイナリーの人1,219人を調べました。現在テストステロンを使っている602人、使ったことのない516人、やめた76人です。
  • 性的に活動している1,091人のうち、65%が過去1か月に性交中に性器の痛みまたは不快感があり、最も多いのは膣（52%）で、次いでクリトリスの周り（29%）、陰唇（25%）でした。
  • 性交中の性器の痛みは、テストステロンの有無にかかわらず一般的でした。現在の使用者の約67%、使ったことのない人の63%でした。
  • 現在のテストステロンの使用は、性への関心が明らかに高いこと、やや達しやすいオーガズム、そして性交中のやや多い膣の痛みと関連していました。
  • テストステロンの使用は、性生活への満足度の向上、潤滑、陰唇の周りの痛み、オーガズムの快感とは関連していませんでした。
  • 人々は、生涯の性的虐待（78%）、性的暴行（50%）、うつ病の診断（81%）、PTSDの診断（40%）の非常に高い割合を報告しました。
  • 著者らは、トランス男性の5%未満しか使ったことがないと報告する、膣エストロゲンなどの治療へのアクセスの改善を求めています。

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.