james lumsden

A guide to safer sex for trans men: how to manage risks and maintain good sexual health.

Trans men, for the purposes of this guide, means anyone who was labelled female when they were born, but who identifies as male, trans male, trans masculine or non-binary.

Safe sex for trans men means recognising that trans men 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/frontal sex.

Use a barrier

If you’ve had lower surgery or not, the basic information about safer sex for trans men is the same: use a barrier such as a condom (external or internal condom) along with water-based lube.

If you’ve recently had lower surgery and have unhealed skin, this could make it easier for you to acquire or pass on HIV, as bleeding can provide a route into or out of your body.

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.

It’s easier to acquire or pass on HIV if you have another STI.

Trans men and condoms

Whether a penis has always been there, is surgically-constructed or bought in a shop, the safest option is to always use a condom:

  • – condoms come in different sizes, shapes and materials (including latex-allergy free)
  • – always change condoms between partners
  • – never use the same condom from anus to vagina/front hole, even with the same partner, as bacteria in the rectum can cause vaginal/front hole infection
  • – change the condom if you’re having sex for more than half an hour to prevent it breaking.

Find out more about using condoms.

PEP

If a condom breaks, you can consider taking post-exposure prophylaxis (PEP) to reduce the risk of HIV infection.

PrEP

PrEP (pre-exposure prophylaxis) is a drug taken by HIV-negative people before sex that reduces the risk of getting HIV.

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.

PrEP offers trans men protection during both frontal and anal sex. You’ll need to take PrEP every day for 7 days to reach maximum protection.

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

Internal condoms
  • – An internal condom is a condom worn inside the body of the partner being penetrated (internal condoms are sometimes called ‘female’ condoms or Femidoms).
  • – It can be used in the vagina/front hole, or anus (if the top ring of the condom is removed).
  • – It is the safest option for those with a metoidioplasty (a type of genital surgery that creates a small penis) or enough testosterone-enhanced clitoral growth for penetration.
Dental dams
  • – A dental dam is a sheet of latex which can be used for vaginal, anal and oral sex.
  • – It is used to cover the genital area and provides a barrier which can prevent the transmission of STIs.
Lubricants
  • – Water or a silicone-based lubricant reduces risk of damage to the skin during sex and the chance of the condom breaking.
  • – Avoid oil-based lubricants (such as Vaseline, baby oil or moisturisers) with latex condoms as these can cause condoms to split.
  • – Avoid silicone-based lubricant with silicone dildos and sex toys as it can degrade the surface.

The NHS Freedoms website sells a wide selection of condoms and lube at low prices.

Safer sex and testosterone

Testosterone (or T) can change vaginal/frontal lubrication, so some trans men find they don’t produce enough. It may be because the natural acidity in the lubrication has changed, making you more vulnerable to infections like thrush and cystitis. This seems to be more of an issue during the first few years on testosterone. Make sure you always have enough lube.

Reduced levels of oestrogen affect the thickness of the walls of the vagina/front hole, which may result in tiny unnoticed tears happening more easily during sex. The walls of the rectum can be affected in the same way, making it even more important to use condoms and lube.

Types of (safer) sex

Discovering your male 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.

Anal and vaginal/frontal sex:

  • – Highest risk for getting an STI or HIV.
  • – Use an external or internal condom.
  • – Use water-based or silicone-based lube.
  • – Some infections such as herpes, genital warts and syphilis, can be transmitted through regular skin-to-skin contact. A barrier such as a condom, dental dam, or a latex glove reduces risk but only protects the covered area.

Oral sex:

  • – Lower risk but still possible to get or pass on STIs such as herpes, syphilis or gonorrhoea.
  • – Much less risky 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.
  • – If someone gives you oral sex when you have recently had lower surgery, any unhealed wounds could provide a way for STIs or other infections to get into your body or theirs.
  • – 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 directly before giving someone oral sex as your gums may bleed, providing a route into your body for an STI or HIV.

Using sex toys:

  • – Clean them thoroughly using warm soapy water before using them with different people as infectious fluids can transfer.
  • – Use a new condom for each new person, or avoid sharing sex toys.
  • – Sex toys can cause tiny unnoticed tears to the skin lining the vagina/front hole or the anus, so use condoms and lubricant.

Fingering:

  • – Make sure you don’t have any cuts on your hands or fingers.
  • – Keep your nails short and use plenty of lube
  • – Clean your hands thoroughly using warm soapy water before fingering a different partner, as infectious fluids can transfer on the surface of fingers.
  • – Use a condom to cover the finger, or avoid fingering more than one person.

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 can reduce risks slightly, or more effectively by using 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 could 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 is moved between vagina/front hole and anus.
  • – Bondage, fisting or S&M can result in bleeding or tearing of the anus, vagina/front hole or mouth, providing a route for STIs, HIV and hepatitis.
  • – Use latex gloves when fisting 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.
Negotiating sex

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 men like women, that all trans men want to receive or give anal sex, or that no trans men are comfortable using their vagina/front hole, 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 LGBT+ anti-violence charity Galop.

Trans and positive

If you’re living with HIV, your antiretroviral treatment will be tailored so that it can be taken safely alongside your hormone treatment. It’s important to have your hormones levels monitored.

Most antiretrovirals appear not to be affected by hormones, however there’s no research looking at drug interactions in trans men. 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.

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

Trans clinics and GUM clinics

If you’re sexually active, you should go to a sexual health clinic for regular check-ups. The clinics provide a free, confidential service:

  • – testing for infections
  • – providing treatment
  • – free condoms and lube
  • – advice and information

At the clinic you’ll be given a registration form to complete. You may be asked if you have any symptoms. You don’t have to tell the receptionist that you’re trans – you can wait to tell this to the clinician in private.

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

Examinations

Some clinics have gender-specific waiting and treatment rooms and they might not have the equipment needed to do all the necessary tests in a ‘male’ treatment room. If you’re concerned, call the clinic beforehand to discuss their facilities and your requirements. You can also have someone come with you, and ask to see a male or female clinician.

When you see the clinician treating you, it’s a good idea to discuss any genital surgeries and the sex you’ve been having, as this will affect what samples are taken. It’s best to be completely honest so that they can give you the best care.

During your examination, the clinician may want to take some swabs from your throat, rectum and genitals, including the inside of the vagina if you have one. Vaginal swabs are usually done using a speculum. Some clinics allow you to take some swabs yourself. You may be offered blood tests to check for infections such as HIV, hepatitis or syphilis. You’ll be told how to get all the results and how long it will take to receive them (from straight away to a few weeks).

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.

Resources for trans men

Original Source: https://www.tht.org.uk