Content
Text

Trans women, for the purposes of this guide, means anyone who was labelled male when they were born, but who identifies as female some or all of the time, or non-binary.

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 may include being a receptive and/or penetrative partner in anal, oral or vaginal sex.

Safer sex

Text

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

  • use a condom or a Femidom (internal condom) for vaginal or anal sex
  • use a water-based lube with your condom or Femidom
  • use a condom or dental dam (a latex square placed over the genitals or anus) for oral sex.

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

You should have a sexual health screen at least once every year. Increase this to every six months or more if you've been at risk of contracting an STI or HIV.

PrEP (pre-exposure prophylaxis)

Text

PrEP is a drug taken by HIV-negative people before sex that reduces the risk of getting HIV. PrEP offers all women protection during both vaginal and anal sex.

Taking PrEP before being exposed to HIV means there's enough drug inside you to block HIV if it gets into your body - before it has the chance to infect you. Women need to take PrEP every day for 7 days to be protected against HIV.

Depending on where you live, you might be able to access PrEP on the NHS or through a trial.

You can also get it online.

Is the risk of STIs different depending on the type of surgery I had?

Text

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. Intestinal skin is a mucus membrane and some STIs can easily penetrate it. Always use a condom or Femidom.

A vagina created from penile and testicular skin is less vulnerable to STIs. However, if the skin tears this could be a way for STIs and HIV to enter your body.

Before surgery, treat any warts on your penis or they can continue to grow inside your vagina.

Post-exposure prophylaxis (PEP)

Text

If you think you've put yourself at risk of HIV it might be worth accessing post-exposure prophylaxis (PEP).

  • Tell the doctor if you're taking any hormones (prescribed or not) as this will affect your PEP treatment.
  • Some anti-HIV drugs can’t be used by people taking hormones and may cause dangerous interactions.

You can access PEP at your nearest sexual health clinic.

Types of (safer) sex

Text

Discovering your female sexuality can be really exciting. Wherever you are in your transition, and whether you have decided to have surgery or not, you're entitled to have sex that is safe and enjoyable.

Vaginal sex

  • Use a condom or Femidom as vaginal sex can be uncomfortable and cause bleeding (especially if you’ve recently had surgery), providing a way for STIs and HIV to spread.
  • Use lots of lube. Depending on the type of surgery you've had, your vagina may not naturally lubricate, so plenty of water-based lube helps prevent tearing and makes sex more comfortable.
  • Dilators helps stretch vaginal skin post-surgery but can cause bleeding, so use a condom or Femidom if you have sex after.

Anal sex

  • Use a condom or femidom as anal sex can tear the lining of the rectum, providing a way for infections like HIV to get into the body.
  • After lower surgery, your anus, as well as your vagina, might be delicate while your genital area recovers.
  • Use lots of water-based or silicone-based lube.
  • Always change condoms between partners or if a penis or sex toy is moved between an anus and vagina (this can transfer bacteria).

Oral sex

  • Low risk but still possible to get or pass on STIs such as herpes, syphilis or gonorrhoea
  • Very low risk but still possible to get or pass on HIV.
  • Avoid oral sex if you have bleeding gums, ulcers, a sore throat or recent dental work.
  • Avoid receiving oral sex until you are fully healed from surgery.
  • Avoid letting a partner ejaculate in your mouth. You can also use flavoured condoms or dental dams.
  • Don’t clean your teeth or use mouthwash before giving oral sex as your gums may bleed, providing a route for an STI or HIV.
  • Use a condom or dental dam to prevent STIs spreading.

Rimming

  • Rimming is licking someone’s anus.
  • Extremely low risk for HIV but possible to pick up hepatitis A or bacterial infections (such as shigella or gonorrhoea).
  • Good personal hygiene lowers risks slightly.
  • Use a barrier like a dental dam to cover the anus.

Frottage

  • Frottage involves rubbing genitals together without any penetrative sex.
  • Low risk but a chance that skin-contact bacteria or viruses can be transferred (such as herpes, syphilis or genital warts).
  • Parasites (such as scabies or crabs) can be passed via skin contact.

Rougher sex

  • Use a different condom with each partner, and when a penis or sex toy is moved between vagina and anus.
  • Bondage, fisting or S&M can result in bleeding or tearing of the anus, vagina or mouth, providing a route for STIs, HIV and hepatitis.
  • Use latex gloves when fisting.
  • 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.

Negotiating sex

Text

Sex should be 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.

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.

If your partner doesn't respect your wishes or practise good consent, this may be abusive. Even if you don't 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 the LGBT+ anti-violence charity Galop.

Trans and HIV positive

Text

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

Currently, it seems that most antiretrovirals appear not to be affected by hormones. However, there are a few drugs that don’t work well together. It’s important to have your hormones levels monitored, and that your HIV healthcare team knows about any hormones you're taking (including unprescribed ones).

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

Trans clinics

Text

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

If you live in London or Brighton there are sexual health clinics just for trans people, their partners, friends, and family:

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

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

GUM Clinics

Text

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 an STI it's important to get it diagnosed and treated.

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. You'll have to speak to the receptionist and fill in some details – you could mention your history on the form or, if you prefer, you can wait until you're in your consultation.

When you see the clinician treating you, it's a good idea to discuss any genital surgeries and the sex you've been having. It’s best to be completely honest so that they can give you the best care.

Being treated with respect

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.