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

• Av 486 testosteronbrukere som ble spurt (typisk alder 27, omtrent 2,5 år på testosteron) sa 351 (72 %) at de hadde hatt bekkensmerter etter at de begynte på testosteron.
• Av dem med smerter hadde 90 % det «noen ganger» og 10 % «alltid eller nesten alltid». Typisk alvorlighetsgrad var omtrent 6 av 10, oftest kramper lavt i magen.
• Av dem med smerter på testosteron hadde 98 % også noen bekkensmerter før de begynte på det, og de vurderte smertene på testosteron som omtrent de samme som før.
• Bekkensmerter var omtrent 4 ganger mer sannsynlig hos dem som fortsatt hadde menstruasjon, 2,5 ganger mer sannsynlig hos dem med PTSD og omtrent 30 ganger mer sannsynlig hos dem med smerter under orgasme.
• Halvparten av dem med smerter sa at det i det minste noen ganger fikk dem til å stoppe sex eller endre måten de hadde sex på.
• De fleste av de 25 eller 26 personene som hadde fått fjernet livmoren rapporterte mindre smerte etterpå, men det var for få til å trekke konklusjoner.
• Forfatterne antyder at problemer med bekkenbunnsmusklene kan spille en rolle og etterlyser forskning på årsaker og behandlinger.

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.