Terrence Higgins Trust uses cookies to improve your experience of our websites. For more information or to change the use of cookies, please click here.

Accept and Close

HIV and STIs

woman smiling at camera

What does a trans woman need to know?

  1. Trans risks
  2. STIs
  3. Trans and positive
  4. Clinics

Trans risks

Whether or not you’ve had lower surgery, the basic information about safer sex is pretty much the same: use a barrier such as a condom or a Femidom along with water-based lube. Lube is especially important as, depending on the type of surgery you've had, your vagina may not naturally lubricate, so lube will help to prevent tearing and will make sex more comfortable.

More about lowering your risk.

Some sexually transmitted infections (STIs) such as genital warts and herpes are passed on through close skin contact, so a condom won’t necessarily protect you against these infections.


The type of surgery you have had

If your vagina was made using skin from your colon (known as an intestinal implant or colovaginoplasty) it may be easier to get some STIs. This is because intestinal skin is a mucus membrane and some STIs can easily penetrate it.

A vagina created from penile and testicular skin is less vulnerable to STIs as it isn’t made from a mucus membrane. However, if the skin tears this could be a way for STIs and HIV to enter your body. If you have any warts on your penis have them treated before surgery otherwise they can continue to grow inside your vagina.

More information about STIs.


The risk of HIV

It's easier to acquire or pass on HIV if you have another sexually transmitted infection. If you've recently had lower surgery and have unhealed skin, this could also make it easier for you to acquire or pass on HIV, as bleeding can provide a route into or out of your body.


The risk of unprescribed hormones or silicone

If you inject yourself with unprescribed hormones or silicone, don't share needles as HIV and hepatitis C can be passed on through blood.

It's dangerous to carry out these procedures on your own as they can go wrong. Injecting yourself with silicone is potentially life-threatening.

More information about HIV.

STIs

Sexually transmitted infections (STIs) are passed on during unprotected vaginal, anal and oral sex - although some, like genital warts, can be passed on through close skin contact.

Most STIs are easily treated and can be cured (apart from HIV) although they can cause serious health problems if you ignore them.

Hepatitis C is a blood borne virus which can lead to serious liver problems. Doctors think it can be transmitted through sex if blood is present.

Not all STIs have symptoms but you should go to a sexual health clinic for a check-up if you notice:

  • Discharge from your genitals.
  • A rash on or around your genitals.
  • Itching or sores on or around your genitals.

Trans and positive

Antiretrovirals and hormones

If you're living with HIV, the antiretroviral treatment you receive will be tailored so that it can be taken safely alongside your hormone treatment.

Antiretrovirals may alter the hormone levels in your body, so it's important that your HIV healthcare team knows about any hormones you're taking (including any that are unprescribed) as well as the quantities.

Existing research on drug interactions in women taking both the contraceptive pill and antiretrovirals has helped medics advise trans women on the likely interactions between oestrogen therapy and antiretrovirals. There has not, however, been equivalent research carried out to look at drug interactions in trans men who are taking testosterone and antiretrovirals.

Currently it seems that most antiretrovirals appear not to be affected by hormones.


Should I stop taking my HIV treatment?

If you stop taking your antiretrovirals or change the amount of testosterone you take you must tell your healthcare team. Remember, it's important to have your testosterone levels monitored.


Will my body change from HIV treatment?

If you're taking antiretrovirals, you may be concerned about body fat changes. Although this is linked to older antiretrovirals, it still happens sometimes - it's important to go to your HIV doctor if you notice any signs of this or any other side effects.


What if I take unprescribed hormones?

If you're taking any hormones which have not been prescribed by a doctor, be sure to tell your HIV doctor. It’s very important that they know about this as it may affect the antiretroviral treatment you take.


Monitoring your hormone levels

Make sure you go to have your hormones levels monitored. This is important for all transwomen but if you're taking antiretrovirals it's especially important.


Support for HIV positive trans women:

At the time of writing there are no specific support groups for trans women who are living with HIV. See the Help tab of our wellbeing page for trans women’s support.

You can access support, counselling, community forums and all manner of other services if you're HIV positive in myHIV.

i-base has a useful Q and A page for trans people who are living with HIV.

Clinics

Going to a sexual health clinic can be unnerving for anyone and it may be particularly difficult for trans people. But if you think you have a sexually transmitted infection (STI) it's important to get it diagnosed and treated.

You may feel awkward talking to staff about your sexual health, but you'll need to let them know your history so that they can diagnose you correctly, especially if you need an examination. It may be helpful to let the doctors and nurses looking after you know how you would like to be addressed.

When you arrive at the clinic, you may find there is a male and female waiting room. It’s important that you feel comfortable sitting in the female area. When you arrive you'll have to speak to the receptionist and fill in some details – you could mention your history on the form so that the doctor is able to treat you correctly. However, if you prefer, you can wait until you're in your consultation with the clinician to disclose.

Find your nearest GUM (genito-urinary medicine) clinic.


Examinations

It might be necessary for the nurse or doctor to examine your genital area to diagnose you, or they may need to take swabs. This may be a distressing prospect for you. If this is the case try to discuss your feelings with the person treating you. It might be possible for you to take the swabs yourself, or the doctor might decide an examination isn’t necessary. It could be that they will need to examine you - this may be the only way to get the correct treatment for your symptoms.

It’s important that all the staff in the clinic treat you with dignity and respect. If you feel at any time that this hasn’t happened, it may be worth making a complaint or talking to the Patient Advice and Liaison Service (PALS) at the hospital.


Trans clinics

Some areas have sexual health clinics for trans people. Contact THT Direct to find out what’s available where you live.

There is a sexual health clinic in London called cliniQ which is just for trans people, their partners, friends, and family:

cliniQ
Chelsea & Westminster Hospital, 56 Dean Street, Soho, London W1D 6AQ

Brighton has a trans clinic too. It's called Clinic T:

Clinic T
Royal Sussex County Hospital, Eastern Road, Brighton, East Sussex BN2 5BE

 

Rate:

Empty Star Empty Star Empty Star Empty Star Empty Star (No votes cast) Please log in or register to vote. What's this?

Save:

Please log in or register to add this article to My favourites. What's this? Adding an article to My favourites will allow you to easily come back to it later or print it.


Your comments

You will need to be logged in before you can leave a comment.

Please log in using the form on the top right of the page or register.

The Information Standard: Certified member

This article was last reviewed on 23/3/2015 by Anna Peters

Date due for the next review: 23/3/2018

Content Author:

Current Owner:

More information:

 
Nam, Aidsmap.How the immune system works. 2012

Nam, Aidsmap. Overview of HIV and the immune system. 2012

Nam, Aidsmap. The basics. HIV and the immune system. 2012 

Nam, Aidsmap. How transmission occurs. 2012

Nam, Aidsmap. Body fluids. 2012

Nam, Aidsmap. Many patients diagnosed with HIV today will have normal life expectancies, European studies find. 22/2/10

Nam, Aidsmap. HIV treatment. 17/2/12

Nam, Aidsmap. Safer drug use. 2012 

NHS Choices. Death shows risk of illegal sillicone jabs. 10/2/11 

Nam, Aidsmap. HIV and sex booklet

Transgender people, hormonal therapy, and HIV treatment interaction. Darby Hickey. Published in GMHC Treatment Issues, December 2008. 

The Body. Transgender Health and HIV. Kimberly Keller, M.Sc. From San Francisco AIDS Foundation. Summer/Fall 2009

The Body. Transgender Therapy and HIV. Two complicated conditions rolled into one. Enid Vazquez
From Test Positively Aware Network 
July/August 2008

The Body. An Interview With Walter Bockting, Ph.D. A Leading Expert on HIV in the Transgender Community Explains Why There's More Work to Be Done. By Jeff Berry from Test Positive Aware Network. July/August 2008.

Nam, Aidsmap. HIV and sex booklet. 2011  

Can't pass it on

People on effective treatment can't pass on HIV

If everyone knew this, we could bring an end to stigma and stop HIV transmissions.

map with pin

Service finder

Find GU clinics and services near you.

condoms

Condoms

The easiest and most effective precaution to take against most STIs is using a condom.