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72% користувачів тестостерону повідомили про тазовий біль, але майже всі з них мали тазовий біль ще до початку

Тазовий біль у трансгендерних людей, які приймають тестостерон

ОпитуванняГормони протилежної статі
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

  • Із 486 опитаних користувачів тестостерону (типовий вік 27 років, близько 2,5 року на тестостероні) 351 (72%) сказали, що мали біль у тазу після початку тестостерону.
  • З тих, хто мав біль, 90% мали його «іноді» і 10% «завжди або майже завжди»; типова сила становила близько 6 із 10, найчастіше спазми внизу живота.
  • З тих, хто мав біль на тестостероні, 98% також мали певний біль у тазу до його початку, і вони оцінювали біль на тестостероні приблизно так само, як і до нього.
  • Біль у тазу був приблизно в 4 рази імовірнішим у людей, у яких ще були місячні, у 2,5 раза імовірнішим у людей із ПТСР і приблизно в 30 разів імовірнішим у людей із болем під час оргазму.
  • Половина тих, хто мав біль, сказала, що він принаймні іноді змушував їх припиняти секс або змінювати спосіб, яким вони його мали.
  • Більшість із 25 чи 26 осіб, яким видалили матку, повідомили про менший біль після цього, але їх було замало, щоб робити висновки.
  • Автори припускають, що проблеми з м'язами тазового дна можуть відігравати роль, і закликають до досліджень причин і лікування.

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.