Trans Sexual Health
It’s worth defining sexual health as a first step. The World Health Organisation (WHO) says it ‘is a state of physical, mental and social well-being in relation to sexuality. It requires a positive and respectful approach to sexuality and sexual relationships, as well as the possibility of having pleasurable and safe sexual experiences, free of coercion, discrimination and violence’.
So, is ‘Trans sexual health’ any different to anyone else’s?
In terms of the WHO definition, then the answer is ‘no’ but there may often be issues that put obstacles in the path of achieving ‘good’ sexual health. There are plenty of statistics showing HIV infection rates among gay men, or men who have sex with other men, but currently in the UK there are no statistics showing similar trends amongst the Trans community. This might be seen as being ‘no big deal’ but it’s worth remembering that globally, transsexual women are 49 times more likely to be infected with HIV than any other adult group.
What particular issues may arise with Trans people in regard to sexual health? For example, a Trans woman who has not had surgery but has been on female hormones for many years may find difficulties in attaining an erection so if taking part in sexual activity may be the ‘receiver’, if penetrative anal sex is involved. Condoms (and importantly, lube) may well be used but if not this is the most risky sex act in terms of HIV transmission. (The same risk scenario would apply to a transman having condomless, penetrative anal sex).
I think it’s fair to say that a transman who is taking testosterone may find their libido kicking into overdrive, and the urge to scratch that particular itch may prove over whelming, and that does carry its own risks (and, it has to be said of course, its own rewards).
With regard to a trans woman who has had surgery to ‘create’ a vagina, it should be borne in mind that the ‘created’ vagina will not self-lubricate so it is crucial to use lube if having penetrative sex. And deploying a condom should still be on the list of things to do!!
Accessing mainstream health services let alone sexual health services can be a challenge for Trans people. From being misgendered, having incorrect pronouns being used, to being met with ignorance and a lack of knowledge as to anything to do with a Trans identity, it can be an emotionally and psychologically traumatic process to go through. If you have that experience say at your GP’s it may well be the case that you would not want to repeat it, so visiting a sexual health clinic may fall off the list of things to do. This could prove to have some negative consequences as to one’s own sexual health and also to any sexual partner.
It is important that Trans people look after their sexual health. But as noted this may not be as straightforward as we would like. So, to address this issue Birmingham LGBT together with University Hospital Birmingham and Umbrella (the new providers of sexual health services across Birmingham and Solihull) have developed a sexual health service specifically for Trans people.
ClinicTrans is a safe, confidential space for those who may not feel comfortable accessing general sexual health services. The clinic is consultant or nurse led and facilitated by our Trans Sexual Health Outreach Worker and Trans volunteers. The clinic, based at Birmingham LGBT Centre, runs on the 4th Friday of every month from 1600 – 1900. Some of the services offered at the clinic include screening for STI’s (including HIV and Hepatitis B), access to PEPSE, liver function tests and cervical smear testing (for any person with a cervix). Further details of other services provided at the clinic can be found at http://blgbt.org/.
This is an important and innovative service for the WHOLE of the Trans community, and all of us here at Birmingham LGBT Centre are extremely proud that this exciting new service has come to Birmingham.
Alexus Savage – Trans Sexual Health Outreach Worker, Birmingham LGBT