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72%使用睪固酮者報告有骨盆疼痛，但其中幾乎所有人在開始前就有骨盆疼痛

使用睪固酮治療的跨性別者的骨盆疼痛

問卷調查跨性激素治療
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

  • 在接受調查的 486 名睪固酮使用者（典型年齡 27 歲，使用睪固酮約 2.5 年）中，351 人（72%）表示開始使用睪固酮後有骨盆疼痛。
  • 有疼痛者中，90% 是「有時」，10% 是「總是或幾乎總是」；典型的嚴重程度約為 10 分中的 6 分，最常見的是下腹絞痛。
  • 使用睪固酮後有疼痛的人中，98% 在開始前也有一些骨盆疼痛，而且他們評定使用睪固酮時的疼痛與之前大致相同。
  • 仍有月經的人出現骨盆疼痛的可能性約為 4 倍，有 PTSD 者為 2.5 倍，高潮時疼痛者則約為 30 倍。
  • 一半有疼痛的人表示，疼痛至少有時使他們中止性行為或改變性行為的方式。
  • 25 或 26 名切除子宮的人中，多數回報術後疼痛減輕，但人數太少，無法得出結論。
  • 作者提出，骨盆底肌肉的問題可能起了作用，並呼籲研究原因和治療方法。

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.