HIV and STIs

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 have had, your vagina may not naturally lubricate, so lube will help to prevent tearing and will make sex more comfortable.

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.

HIV

It is easier to acquire or pass on HIV if you have another sexually transmitted infection. If you have 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.

Unprescribed hormones or silicone

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

It is 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.

Antiretrovirals and hormones

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

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

Some antiretrovirals increase oestrogen levels in your body and others decrease them, so your HIV doctor will need to find the right combination for you. Most antiretrovirals are not affected by hormones apart from Amprenavir and Fosamprenavir, neither of which you should be prescribed as your hormone treatment will stop them from working.

Trans women might be prescribed a higher dose of oestrogen if they take antiretroviral treatment. If you stop taking your antiretrovirals for any reason you must tell your healthcare team, as they may need to reduce the dose of oestrogen.

If your oestrogen levels are too high, blood clots can form which could cause a stroke or heart attack. Remember, it is important to have your oestrogen levels monitored by your healthcare team.

Body fat changes

If you are taking antiretrovirals, you may be concerned about body fat changes and facial fat loss. Although this is linked to older antiretrovirals, it still happens sometimes. Facial fat loss is upsetting, especially if it leads to a more masculine appearance, and it is important to go to your HIV doctor if you notice any signs of this or any other side effects.

Support

At the time of writing there are no specific support groups for trans women who are living with HIV.

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

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 is important to get it diagnosed and treated.

You may feel awkward talking to staff about your sexual health, but you will 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 will 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 are in your consultation with the clinician to disclose.

You may feel awkward talking to staff about your sexual health, but you will 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.

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 Hosptial, 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