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72% van de testosterongebruikers meldde bekkenpijn, maar bijna allen hadden die al vóór de start

Bekkenpijn bij transgenders die testosterontherapie gebruiken

EnquêtesCross-sekse hormonen
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

  • Van 486 ondervraagde testosterongebruikers (typische leeftijd 27, ongeveer 2,5 jaar op testosteron) zeiden er 351 (72%) bekkenpijn te hebben gehad nadat ze met testosteron begonnen.
  • Van wie pijn had, had 90% die 'soms' en 10% 'altijd of bijna altijd'; de typische ernst was ongeveer 6 van de 10, meestal krampen laag in de buik.
  • Van wie pijn had op testosteron, had 98% ook enige bekkenpijn vóór het starten, en ze beoordeelden de pijn op testosteron ongeveer hetzelfde als daarvoor.
  • Bekkenpijn kwam ongeveer 4 keer vaker voor bij mensen die nog menstrueerden, 2,5 keer vaker bij mensen met PTSS, en ongeveer 30 keer vaker bij mensen met pijn tijdens het orgasme.
  • De helft van wie pijn had zei dat het hen ten minste soms deed stoppen met seks of de manier waarop ze seks hadden deed veranderen.
  • De meeste van de 25 of 26 mensen die hun baarmoeder hadden laten verwijderen meldden daarna minder pijn, maar het waren er te weinig om conclusies te trekken.
  • De auteurs suggereren dat problemen met de bekkenbodemspieren een rol kunnen spelen en pleiten voor onderzoek naar oorzaken en behandelingen.

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.