Sex

Discovering your female sexuality can be exciting and, for some people, overwhelming - whether or not you have had lower surgery. Your sex life and relationships might change after you transition. On the other hand, things might stay the same as they have always been for you.

You may have transitioned a long time ago and be enjoying a fulfilling sex life but just need a bit of sexual health advice.

Wherever you are in your journey, the main thing to remember is that you are entitled to have safe, enjoyable sex. You shouldn’t be pushed into anything you feel uncomfortable with.

Safer sex

Whether or not you have had lower surgery, the best way to protect yourself and your partner against sexually transmitted infections (STIs) and HIV is to:

• Use a condom or a Femidom for vaginal or anal sex. 
• Use a water-based lube with your condom or Femidom.
• Think about using a condom or dental dam for oral sex. 
• If you are sharing sex toys with someone, use a new condom each time the sex toy is used by a new person or if it is moved between a vagina and an anus (as this can transfer bacteria). 
• Similarly, always change condoms between partners or if a penis is moved between an anus and vagina during sex.

Condoms, Femidoms and dental dams are available for free at sexual health clinics. However, not all trans women can use Femidoms – it will depend upon the depth of your vagina.

Just like anyone else it's probably worth going to a sexual health clinic for regular check-ups - and there's things to consider as a trans woman.

If you have not had lower surgery

Here's some reminders if you have not had lower surgery:

• If you have a penis, you can avoid STIs and HIV by using condoms and lube if you penetrate someone vaginally, anally or orally. 
• If your partner has a penis, ask them to use condoms (or an appropriate barrier) and lube when having penetrative sex with you.

When things go wrong

It is advisable to have a sexual health screen at least once every year - but increase it to every six months or more if you have been at risk of contracting an STI or HIV.

If you think you have put yourself at risk of HIV it might be worth accessing PEP. However as a transwoman there's some considerations you should be aware of:

• If you are taking any hormones, whether prescribed or not, tell the doctor as this will affect the PEP treatment you are given. 
• Certain anti-HIV drugs cannot be used by people taking hormones and may cause dangerous interactions.

You will be able to access PEP at your nearest sexual health clinic.

Vaginal sex

• Vaginal sex may be great and really enjoyable, however for some people it can also be uncomfortable and at times cause bleeding (a way into or out of the body for sexually transmitted infections (STIs) and HIV), especially if you have recently had surgery. 
• Using dilators to stretch the vaginal skin will help as will using plenty of water-based lube during sex. 
• Dilators may sometimes cause bleeding, so if you have sex after using one make sure you use a condom or Femidom.

Anal sex

• During anal sex, the lining of the rectum can tear, providing a way for infections like HIV to get into the body. 
• If you have had lower surgery, remember that your anus, as well as your vagina, might be delicate afterwards while your genital area recovers. 
• A lot of nerve endings in the genital area are close together so it’s possible anal sex will hurt if your body hasn’t recovered properly from surgery.

Oral sex

• Oral sex is a lower risk sexual activity than anal or vaginal sex but it is still possible to pass on or get STIs or HIV this way. 
• There have been a few cases of people acquiring HIV from oral sex but it is classed a low risk activity as it is extremely rare to get HIV this way. 
• If you give someone oral sex, don’t clean your teeth or use mouthwash beforehand as your gums may bleed, providing a route into your body for an STI or HIV. 
• If you have a sore throat and a cough or if you have had recent dental work avoid giving someone oral sex for the same reasons. 
• Use a condom or a dental dam if you are giving someone oral sex. 
• If you don’t, ask your partner not to come in your mouth. 
• If someone gives you oral sex when you have recently had lower surgery, any unhealed wounds could provide a way for STIs to get into your body or theirs.

Rimming

• Rimming is licking someone’s anus.
• It’s extremely low risk for HIV but it is possible to pick up hepatitis A or bacterial infections (such as shigella or gonorrhoea) from rimming.
• These risks can be reduced slightly with good personal hygiene, or more effectively by using a dental dam to cover the anus.

Rougher sex

If you have multiple partners during one sex session or if you like rougher sex: 

• Use a different condom with each partner. 
• If you enjoy bondage, fisting or S&M be aware that any bleeding or tearing of the anus, vagina or mouth can provide routes for STIs, HIV and hepatitis into your body or your partner’s. 
• If you are fisting, use latex gloves and don’t share a pot of lube as minute traces of blood can be transferred onto your hands making it easy to pass on Hepatitis C.
  
  

Discussing healthy, safe sex for trans women means recognising that trans women can have partners of every gender and a variety of body types. Your sexual preferences, if you are sexual, may include being a receptive partner in anal, oral or vaginal sex. Equally, you may enjoy being a penetrative partner in those situations.

You may be submissive or dominant, or be able to switch between the two. Your ideal may be a heavy bondage session or simply affectionate cuddling. The key thing is that the sex is healthy, safe and what you want and are comfortable with.

You may encounter some preconceptions when negotiating the sex you want – for example, that all trans women like men, that all trans women want to receive or give anal sex or that all trans women are comfortable using their penis if they have one.

Whether or not any of these are true for you, aiming to practise good consent (keeping sexual activity consensual and respectful of your limits and preferences) means that your sex will be safer and more likely to meet your expectations. All of this means that you are more likely to enjoy it.

Being aware of the preconceptions mentioned, discuss things with your partner beforehand to ensure that you both understand what you’d like to do and what is off-limits. This doesn’t have to be overly formal but it can be fun, eg: ‘What I really enjoy is…’, ‘I don’t like to... but I do want to…’, ‘I don’t want to try that now but would you like to try…’ etc.

It’s absolutely fine to call a halt to things if you stop enjoying them. Anyone who doesn’t respect your request is not respecting you and may be committing a sexual offence. You might use a ‘safe word’ – a word or phrase that instantly calls a halt to things, commonly used in the bondage (BDSM) community.

Gender dysphoria can make intimacy difficult, particularly if you find getting erections upsetting or triggering (causing you to re-experience emotional distress). So making sure your partner will be sensitive to your needs is essential.

If your partner does not respect your wishes or practise good consent, this may be abusive. Even if you do not feel that ‘abusive’ is the correct term, if the way they interact with you sexually makes you upset or uncomfortable, you can access support and advice from LGBT charity Broken Rainbow.

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.

Sexually transmitted infections and 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.

Vaginal or anal sex

If your partner penetrates your vagina or anus during sex, they should use a condom or you can use a Femidom, if appropriate, to protect you both from STIs and HIV. Vaginal sex may be uncomfortable and cause bleeding (a way for STIs and HIV to get into or out of the body) especially if you have recently had surgery.

Using dilators to stretch the vaginal skin will help, as will using plenty of water-based lube during sex. Dilators may sometimes cause bleeding, so if you have sex after using one make sure you use a condom or Femidom.

If you have had lower surgery, remember that your anus - as well as your vagina - might be delicate afterwards while your genital area recovers. A lot of nerve endings in the genital area are close together so it is possible that anal sex will hurt if your body hasn’t recovered properly from surgery.

Although everyone has a different healing process, it can be around two to three months after surgery before you will feel like having sex. Note that some doctors recommend waiting two to three months before having penetrative vaginal sex to allow the area to heal.

If your partner is a trans man, he may not be able to use regular-sized condoms but he can seek advice about other appropriate barriers. Our booklet Trans Health Matters: Sexual Health, HIV and Wellbeing for Trans Women has further information.

Oral Sex

Oral sex is a lower risk sexual activity than anal or vaginal sex but it is still possible to get or pass on STIs or HIV this way. There have been a few cases of people acquiring HIV from oral sex.

If someone gives you oral sex when you have recently had lower surgery, any unhealed wounds could provide a way for STIs to get into your body or theirs.

Ideally use a condom or dental dam if you are giving someone oral sex. If you don’t, ask your partner not to come in your mouth.

Sex Toys

If you share sex toys with someone, put a condom over the sex toy every time a new person uses it or if it is moved between your vagina and anus, as this can transfer bacteria.

Rougher sex

If you have multiple partners during one sex session or if you like rougher sex:

• Use a different condom with each partner.
• If you enjoy bondage, fisting or S&M be aware that any bleeding or tearing of the anus, vagina or mouth can provide routes for STIs, HIV and hepatitis into your body or your partner’s. 
• If you are fisting, use latex gloves and don’t share a pot of lube as minute traces of blood can be transferred onto your hands making it easy to pass on hepatitis C.