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“I Couldn’t Imagine My Life Without It”: Australian Trans Women’s Experiences of Sexuality, Intimacy, and Gender-Affirming Hormone Therapy

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Abstract

Despite the increased visibility and knowledge in the area of transgender health, the sexual health and experiences of transgender women undergoing Gender-Affirming Hormone Therapy (GAHT) are still under-researched; often, the effects of GAHT on trans women’s sexuality are broadly miscategorised as ‘erectile dysfunction’. This study aimed to provide an exploration of trans women’s negotiation of the psycho- and physiosexual shifts which result from GAHT. Twelve participants (including one pilot) took part in hour-long semi-structured interviews, with two providing a secondary interview for further data triangulation. These interviews were manually transcribed, coded, and final themes were identified and titled from participants’ own words. The interviewer also maintained a journal that was used to provide further depth, reflection, and insight to the emerging themes. The final analysis identified four themes: overall experiences, physiological changes, psychological changes, and shifts in experiences of orgasm. Most participants had positive and/or affirming experiences of sexuality while medically transitioning. One important, and significantly under-researched, experience described by participants was the development of new erogenous zones; for many, their source of sexual pleasure and climax had shifted partially if not entirely away from their genitals and towards nipples, legs, backs, or other body parts. These findings highlight the dearth of medical knowledge in the area of sexual function and pleasure for trans women undergoing GAHT and provide an impetus for a systematic reimagining of how clinical practitioners might negotiate their treatment of a transgender client.

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Notes

  1. Genital reconstructive surgery (also known as gender-affirming surgery) significantly impacts trans women’s life quality, and sexual satisfaction particularly, and is therefore often the focus of evaluations of trans women's experiences of pleasure; however, it is also a procedure that not all trans women can afford or choose to undergo (Lawrence 2003; De Cuypere et al. 2005; Lawrence 2005; Gijs and Brewaeys 2007; Ainsworth and Spiegel 2010; Papadopulos et al. 2017). Despite this, few studies distinguish between those who have undergone, require/desire, or outright reject genital surgery [“pre, post and non-op[erative]” respectively (Wilson 2002; Denny 2004)]. In order to rectify this confoundment, and provide data specifically on the experiences of trans women who have not undergone surgery, “post-op” trans women were defined as a separate population and excluded from the study.

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Acknowledgements

The researchers would like to acknowledge the participants’ incredible openness, trust and willingness to engage. Thank you for sharing these vital and intimate experiences.

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Authors and Affiliations

  1. Department of Sexology, School of Public Health, Curtin University, Bentley, WA, Australia

    Shoshana Rosenberg & P. J. Matt Tilley

  2. Collaboration for Evidence, Research and Impact in Public Health, School of Public Health, Faculty of Health Sciences, Curtin University, Perth, Australia

    P. J. Matt Tilley

  3. School of Public Health, Faculty of Health Sciences, Curtin University, Perth, Australia

    Julia Morgan

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Rosenberg, S., Tilley, P.J.M. & Morgan, J. “I Couldn’t Imagine My Life Without It”: Australian Trans Women’s Experiences of Sexuality, Intimacy, and Gender-Affirming Hormone Therapy. Sexuality & Culture 23, 962–977 (2019). https://doi.org/10.1007/s12119-019-09601-x

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