Your body is unique, and in spite of possible discomfort, we want to help you understand it and take care of it so it can carry you at it's best, either as it is or to a more affirming place if that is your path! We use certain words here, and we know these may not be the words you use, so we hope you will do a mental substitution if you don't like them. Another is to use a text replacement tool—here's a few, and drop us a note if you know of others so we can add them!
Tell us what words you use in our Trans
Health Forum! Or, you can send words you use to tpower@tpride.org
and submit at our contact page and we will try to include them!
Body parts listed here are by identity, so boys have a penis regardless of the size or shape,
and girls have a clit that can be similarly diverse. Anyone can potentially be
penetrated from the front in what is for the women called a vagina and for the men the front
hole or bonus hole.
Cisgender partners of trans persons should understand these terms too! Be supportive and
affirming of your partner—use the words they use, and ask if you don't know!
If you are HIV-negative, you have a choice of a few doctors around Dallas to go to for your general healthcare. None are great at the moment, but Trans Pride is using opportunities to advocate for better services when we can. The Nelson-Tebedo Clinic runs a trans health program, and although we know there are some problems, it is the best general trans health program we have at this time. Call the main number (214-528-2336) and ask for JP Cano for details and to see about getting on the waiting list. You can also ask JP to send you the list of local doctors that they maintain. The GEAR transgender program also provides healthcare scholarships (see their web page for more info), which will pay for participation in the healthcare program for a year.
Dallas also has a trans health program for children at the Children's Medical Center. Called the Gender Education and Care, Interdisciplinary Support (GENECIS) Program, children and youth under 18 can receive puberty suppressants and hormones when deemed appropriate.
We are working on encouraging Parkland to provide trans healthcare as part of their services, but after a year they are still dragging their feet. We hope to see some progress by the end of 2015, but unfortunately Parkland does not offer a low-income alternative at this time.
For chest and breast exams for tissue cancer, we highly recommend the good folks at the UT Southwestern Center for Breast Care. We have worked with them for several years, and the staff are wonderful. Call for an appointment and mention you are transgender, and they will make sure your experience is comfortable and affirming, just as healthcare should be!
If you are HIV+, the best places for trans affirming care are Parkland's Amelia Court Clinic and Prism Health's Trinity Health and Wellness Center and Peabody Health Center. These three locations will work with HIV meds and hormone therapy.
A person's mouth is good for a lot more than drinking and eating and talking shade, you know? As in sex. Oral sex with your partner's genitalia can be a great way to get off.
But your mouth is also a warm moist place, so it's a good spot for STIs like syphilis and gonorrhoea to grow if they get started there. If you are going to have sex without a condom, oral sex is safer than front hole or anal sex because there is less risk of HIV infection, but you can still catch other STIs. So, get tested regularly if you are having unprotected oral sex!
[ Image credit Sophia Banks ]
Your entire body can be sexual, including your fingers and toes, your chest or breasts, your thighs and hips and curvy bottom—and anywhere else that turns you or your partner on!
Although you can catch HIV and STIs from body fluids on skin, it's rare. The main worry is that if you have any open sores or wounds, infection can get into those places much more easily because of the broken skin. If you are playing without a condom and getting body fluids on skin, try to keep those fluids away from areas where you might have a cut or scrape or a sore.
[ Image credit FTM Magazine ]
Your genitals may include original equipment, T-enhanced equipment, a metoidioplasty penis, a neo-phallus, or a prosthetic penis combined with any of these! Sensation may be quite different from that of a non-trans man, so how you enjoy stimulation and sex can differ as well. You may have to be persistent if your partner is not listening, and we want to always encourage both partners to negotiate, discuss, and check in often. For a handy worksheet that can help you negotiate with partners, Autostraddle has this great tool!
Remember also that the skin of a metoidioplasty penis is generally not as thick and resistant to damage as a guy's neo-phallus, which can mean you may have greater risk of being infected with STIs and HIV. A phalloplasty should result in a penis with an outer skin slightly more resistant to damage and infection.
Remember that even if you have a metoidioplasty or phalloplasty penis and you are penetrating or rubbing against genitals where there is a chance of contacting body fluids, you run a risk of infection. Unfortunately, condoms are not going to work for most meta penises so you may have to be creative with dams and the cling wrap. Be sure to use non-microwaveable cling wrap because the "safe for microwave" cling wraps have small holes to let moisture out. Another option is to snip the fingers off a medical glove leaving the thumb, cut it up along the little finger side, and use the thumb to push over your meta penis. Not the best aesthetic, but laugh and have fun with it!
[ Image credit The Butch Life ]
Some folks, especially those who are strongly femme identified, may be uncomfortable using their clit to penetrate—or at all in sex—but we want to assure you that you are no less a woman if you use the body parts that give you pleasure during sex. Celebrate what makes you unique!
The "functionality" of an original clit may vary according to hormone regimens, surgeries, and desire. However, just because one's clit may not get hard, or as hard as it once did, doesn't mean one can't experience sexual pleasure, and it's possible for a completely soft clit to be stimulated to orgasm. The sensations can be different, and hormones can change the nature of your orgasms, so if you are adjusting your hormones, be creative and explore the new ways you experience sensations!
Note that decreased sensation, and decreases in the amount of cum due to hormones or surgeries such as removal of the testicles (orchiectomy), don't necessarily mean you have less of a chance of passing on or acquiring HIV and STIs. Although it seems reasonable to think that decreased amounts of cum may reduce the risk of transmission, we haven't heard of studies that support that, so it is best to be safe, even if you have little to no cum. Remember, precum can transmit HIV and STIs as well. Take care of yourself and your partners!
[ Image credit Activist Reina Gossett ]
You can still be a man and find pleasure in your front or bonus hole—all trans folks should feel empowered to use whatever parts they are comfortable with and find pleasure using! If you are gay/bi/pan identified or just experimenting, you can certainly use both the front and back holes with persons (cis or trans), and that will not make you any less a man.
But you should know that reduced estrogen and increased testosterone can dry out the tissues there and make damage more likely, meaning if your partner has HIV or an STI, you can be at increased risk of infection. Inner tissue can become more fragile even for guys who are not taking testosterone if they have had a hysterectomy or oophorectomy. Some guys have used creams and local applications of estrogen (such as insertable estrogen rings) to try to better maintain natural lubrication and tissue health with minimal impact on estrogen levels elsewhere in the body. We have not heard if this is effective or not.
Another important consideration is that if you are using a medicine for PrEP (pre-exposure prevention) for HIV prevention, realize that the tissue in your front hole is different than that of the back door, so the dosage and number of days before full effect is reached can be different. No studies have been done on the effectiveness of PrEP treatments for trans men on testosterone, so understand that a treatment window of at least 20 days is not unreasonable. Considerations for trans persons are not even mentioned in the CDC's clinical practice guideline for PrEP.
Remember that you can also still become pregnant, even if on testosterone, if you haven't had reproductive organs removed. Additionally, even if your partners are all cis women and trans men, everyone has body fluids that can carry infections. For these reasons, it's always advisable to play safe; take care of yourself and use a condom or a dam! You can also cut up a medical glove and use the thumb as a condom for a metoidioplasty penis :)
[ Image credit goes to Amanda Trull ]
Trans women who have a vagina may enjoy sex with cis or trans men or women or enby folks or all of the above. Neither your gender identity nor your surgical status determines your orientation.
One thing trans women are usually aware of is that their vagina may not self-lubricate as well as would be ideal, so some application of lubricant is usually needed for insertion. If not enough lube is used, there is a higher risk of damage and additional risk of HIV and STI infections. Remember that even if you or your partner won't get pregnant, that does not mean you shouldn't use protection!
Another important consideration is that if you are using a medicine for PrEP (pre-exposure prevention) for HIV prevention, realize the tissue of a neo-vagina is different from that of a cisgender woman. No studies have been done on the effectiveness of PrEP treatments for trans women with a vagina, so understand that a treatment window of at least 20 days is not unreasonable. There is some chance the treatment window may be far less for someone with recent (but fully healed) genital surgery because the inner tissue may be less susceptible to damage than a cis woman's vagina or a trans man's bonus hole, but over time, the inner tissues of the vagina become less like external skin (if the inversion method is used) and more like the tissue found in a cisgender woman's vagina. Considerations for trans persons are not even mentioned in the CDC's clinical practice guideline for PrEP.
[ Image credit: trans activist Laxmi Narayan Tripathi celebrating recognition of a third gender in India. ]
Anal sex is something folks of all genders can participate in. Some like it, some don't.
The anus is situated at the base of the spine, and is a nerve center with sensitive connections linking all over the body—that's part of why anal sex can feel so good. The opening is actually two bands of muscles called sphincters (an outer and an inner) a little over an inch apart. Inside these is the rectum, where a toy or penis or fingers go once past the inner sphincter. The tissue surrounding the sphincters and rectum can be somewhat easily damaged, and that is a reason lots of lube is important during anal sex. Remember, even tiny tears during sex can let bacteria and viruses into your body, so prep well to reduce the chance of that happening.
Anal sex is one of the most common ways people catch HIV and STIs. The tissue there can be fragile and easily broken, which allows infection in. So make sure to use condoms when engaging in anal sex. If a condom breaks, make sure to get tested a few weeks later. See our test sites here for locations!
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