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研究中大多數跨性別男性和非二元者在性行為中有生殖器疼痛；睪固酮與更多陰道疼痛相關

出生時被指定為女性的跨性別男性和性別多元者使用睪固酮與性功能

問卷調查跨性激素治療
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

  • 研究觀察了 PRIDE 研究中 1,219 名出生時為女性的跨性別男性與非二元性別者：602 人目前使用睪固酮，516 人從未使用，76 人已停用。
  • 在 1,091 名有性生活的人當中，65% 在過去一個月的性行為中有生殖器疼痛或不適，最常見於陰道（52%），其次是陰蒂周圍（29%）和陰唇（25%）。
  • 無論是否使用睪固酮，性行為時的生殖器疼痛都很常見：目前使用者約 67%，從未使用者 63%。
  • 目前使用睪固酮與明顯較高的性趣、稍微更容易達到高潮和稍微更多的性行為時陰道疼痛有關。
  • 使用睪固酮與更高的性生活滿意度、潤滑、陰唇周圍的疼痛或高潮的愉悅無關。
  • 人們回報了極高的終生比率：性虐待（78%）、性侵害（50%）、憂鬱症診斷（81%）和 PTSD 診斷（40%）。
  • 作者呼籲改善陰道雌激素等治療的取得，而回報曾經使用的跨性別男性不到 5%。

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.