A guide to sexual healthcare for trans+ people

We’ve partnered with The Love Tank—a community organization working to improve the sexual health and well-being of underserved communities—and Not a Phase—a charity committed to improving the lives of trans+ adults—to create a guide to safer sex for trans, non-binary, and gender-diverse people. We’re here to help you navigate safety and pleasure when it comes sex, because knowledge is power—and everyone deserves the tools to make informed choices.

Sexually transmitted infections (STIs)

Regularly testing for sexually transmitted infections (STIs) is a great way to look after our health and the health of our partners. However, clinics and guidelines are often designed for cis people, which means we may have to advocate for the tests we need. Clinics that serve the queer community are more reliable, and those with special hours for trans people, staffed by trans specialists, offer the best standard of care. 

What tests to get

A full STI screening involves a blood test—for syphilis and HIV (more on this below)—and other tests, for chlamydia and gonorrhea. These other tests are done with a throat swab if you’ve given oral sex, an anal swab if you’ve engaged in anal play (with hands, toys, or a penis), a urine sample (if you have a penis), or a vaginal/frontal swab.

If you are not living with HIV, then an HIV test will be included in the blood tests. If you are living with HIV, all the other tests will be offered and are still important to have.

If you’ve had a vaginoplasty, then it’s a good idea to do a vaginal swab and a urine test. This is because you can get vaginal STIs after surgery, but swabs alone are not always effective for detecting them. If you’ve had a vulvoplasty, then you only need to do a urine test. 

STI symptoms and gender-affirming care

If you’re on testosterone, some side effects can overlap with STI symptoms, like pain when peeing, pelvic pain, unusual bleeding, and genital itching. If you are an AFAB transmasculine person or trans man and use testosterone, you might also be more likely to develop urinary tract infections (UTIs), and these can have similar symptoms to STIs. We also know that UTIs are a common complication after phalloplasty. If you’re on estrogen and/or androgen blockers then you can experience testicular pain, which can sometimes be a symptom of an STI. 

If you have any of these symptoms, it’s a good idea to get tested and rule out STIs, as well as finding out whether you have a UTI. You can learn more in our guides to STI testing, and self-tests. Feeld members are also able to access free HIV testing in the U.S. and U.K.—find out more here.

Vaccines

There are vaccines that can help prevent many STIs. If your desires evolve, or if your transition has changed the sexual communities you’re part of, then you may become eligible for vaccines you weren’t eligible for before (depending on your location).  

The following vaccines are usually available for people born with a penis who also have sex with other people born with a penis (like, for instance, trans women who have sex with gay or bi+ cis men). They’re also available for people born with a vagina, if your partners were born with a penis and they also have sex with people born with a penis (like, for instance, trans men who have sex with gay or bi+ cis men). Vaccines to be aware of are:

• Hepatitis A
• Hepatitis B
• Gonorrhea (meningococcal B vaccine)
• Mpox (formerly called monkey pox)

These are usually available at specialized sexual health clinics, so you can ask if you think you’re eligible. In the U.K., you can get them for free on the NHS. In the U.S., there are programs for free and low-cost vaccination—contact your local public health unit to learn more. In other locations, check with your local healthcare provider or sexual health clinic.

DoxyPEP

DoxyPEP is an antibiotic taken soon after sex to reduce the risk of some bacterial STIs, especially syphilis. Taking it won’t have an impact on any hormone medications you might be using.

The research so far supporting DoxyPEP shows that it works for cis gay and bi men, and trans women, and can prevent STIs passed on through oral or anal sex. We only have a small amount of data to show that DoxyPEP works to prevent STIs in people having receptive vaginal/frontal sex (like some trans men). However, this doesn’t stop people who have vaginal/frontal sex from taking the medication—it only means we have less data about DoxyPEP and this kind of sex. 

Some healthcare providers might say you can’t take DoxyPEP if you were born with a vagina—they might assume this is the only kind of sex you need protection for—but if you have receptive anal or oral sex then it can still be effective.

Learn more about DoxyPEP via this guide from The Love Tank.

HIV

HIV prevention is a normal part of a safer sex life. But if you’re not already living with HIV and you’re trans, it can be hard to know what methods of prevention are best for you, and in what circumstances. This can also feel complicated if your preferences or partners change over time. Here’s how you can decide what options make the most sense for you…

Do I need HIV prevention?

Some HIV “risk” guidelines can be confusing, with blanket categories like “gay and bisexual men” or “trans women.” On a population level, these groups are statistically more likely to get or come into contact with HIV, but this doesn’t entirely capture how HIV works—no one is automatically “high risk” because of their identity.

It can be helpful to think about the risk of getting HIV in terms of the body parts you and your partners have, along with the kind of sex you have. Condomless anal sex is highest risk, followed by condomless vaginal/frontal sex. Condomless oral sex is extremely low risk, and requires specific circumstances—like an open wound or recent dental work—to lead to transmission. 

HIV exposure is more likely if you don’t always use condoms and if any of your sex partners were born with a penis (and still have one) and they also have sex with people born with a penis (who still have one). This would include gay and bi trans men, bi trans women, and so on. 

You can also have a higher chance of exposure if your sex partners are from countries or communities with higher HIV rates, if you engage in sex work, or if you share equipment to inject drugs.

HIV PrEP

HIV PrEP is a medication that prevents you from getting HIV. When taken as prescribed, it is almost 100% effective at preventing HIV transmission during sex. There are oral and long-acting injectable versions of PrEP available. Taking it won’t have an impact on any hormone medications you might be using.

Injectable PrEP works for everyone. Oral PrEP does too, but there are some differences in the ways it can be taken based on body type. Healthcare providers can make assumptions about the sex we have based on our bodies, and prescribing guidance can differ in different parts of the world.

You can visit PrEPster to learn more. For help talking to healthcare providers about PrEP, check out this guide from The Love Tank.

For more information, read our guide to HIV and the treatment options available.

Contraception

On top of thinking about STIs, reproductive health is another important consideration when it comes to your overall sexual health and wellbeing.

Some people in the trans+ community may have undergone procedures which can impact their fertility—such as an orchiectomy, hysterectomy, vaginoplasty, vulvoplasty, or vaginectomy (usually performed as part of other gender-affirming surgeries, though not always). If you or your partner has had one of these, then you won’t need to use contraception (but remember that condoms can still be necessary for preventing STIs).

Hormone therapy can lower fertility, but it isn’t a contraceptive. This applies whether you’re on estrogen, androgen blockers, or testosterone (even if your periods have stopped). For any sex that could result in pregnancy—where someone who produces sperm has vaginal/frontal sex with someone with ovaries—it’s a good idea to think about contraception. 

The copper IUD doesn’t contain hormones and won’t interact negatively with any hormones you are using. Condoms are also a hormone-free barrier method of contraception. 

For emergency contraception, the morning-after pill (also known as Plan B) is safe to take when you’re on testosterone. The copper IUD can also be effective when inserted up to 7 days after sex.

Hormones and sexual experience

Hormone therapy can have some side effects regarding sexual function. Whether these effects concern you may depend on the kinds of sex you like to have. 

Estrogen and androgen blockers can make it harder to get and maintain an erection. If this is important to you for having sex, then you can use erectile dysfunction medications like Viagra or Cialis to help. These won’t interact with your hormones but they can interact with other medications, so ask your healthcare provider first. Using some recreational drugs while taking erectile medications can cause a dangerous drop in blood pressure—it’s generally advised not to combine them, especially if you know you have a pre-existing heart condition or are already using blood pressure medications.

Testosterone can affect the vagina by reducing lubrication and making the vaginal/frontal tissue thinner. This is referred to as “vaginal atrophy” and it can make sex painful or uncomfortable along with raising the risk of UTIs. Using lube during sex will help, along with applying special vaginal moisturizers. You can also use creams or insertable tablets that contain estrogen. Because these release estrogen solely into the genital tissue, the risk of them affecting hormone therapy is very low and lots of people find them beneficial.

*

As a minority group, trans+ people can often feel isolated. At the same time, navigating topics around intimacy and dating—while prioritizing wellbeing, pleasure, and accessibility—requires community support. We are deserving of spaces where we can share and celebrate our wins, as well as navigate the pitfalls of the dating world and learn from our shared hurdles. This is why at Not A Phase our online Trans+Connect series includes a monthly Intimacy Edition, where you can share and explore topics around dating, sex, and intimacy in an online peer-led support group setting. To join our next session, sign up here for free.

For more on Not A Phase and the multitude of ways we strive to uplift the lives of trans+ adults across the U.K., visit notaphase.org or follow @notaphaseorg.

For more information on sexual health and access to HIV PrEP, head to prepster.info and www.queerhealth.info or follow @thelovetankcic.

*We use certain terms to describe body parts and acts for clarity, but encourage members to choose whichever terms feel comfortable, or resonate for them.