Continuing Medical Education: Sexual Functioning in Transsexuals Following Hormone Therapy and Genital Surgery: A Review (CME)

Abstract

Introduction Sexual function following genital sexual reassignment surgery (SRS) is an important outcome for many transsexuals, affecting the choice of surgical technique, satisfaction with surgery, and quality of life. However, compared to other outcome measures, little clinical and research attention has been given to sexual functioning following SRS. Aim To discuss the potential impact of cross-sex hormone therapy and SRS on sexual function and to summarize the published empirical research on postsurgical sexual functioning in male-to-female (MtF) and female-to-male (FtM) transsexuals. Methods Cross-sex hormone therapy and SRS techniques are outlined, the potential roles of cross-sex hormone therapy and SRS on sexual function are discussed, and peer-reviewed literature published in English on postoperative sexual functioning in MtF and FtM transsexuals is reviewed. Main Outcome Measures Sexual desire, sexual arousal, and ability to achieve orgasm following SRS. Results Contrary to early views, transsexualism does not appear to be associated with a hyposexual condition. In MtF transsexuals, rates of hypoactive sexual desire disorder (HSDD) are similar to those found in the general female population. In FtM transsexuals, sexual desire appears unequivocally to increase following SRS. Studies with MtF transsexuals have revealed not only vasocongestion, but also the secretion of fluid during sexual arousal. Research on sexual arousal in FtM transsexuals is sorely lacking, but at least one study indicates increased arousal following SRS. The most substantial literature on sexual functioning in postoperative transsexuals pertains to orgasm, with most reports indicating moderate to high rates of orgasmic functioning in both MtF and FtM transsexuals. Conclusions Based on the available literature, transsexuals appear to have adequate sexual functioning and/or high rates of sexual satisfaction following SRS. Further research is required to understand fully the effects of varying types and dosages of cross-sex hormone therapies and particular SRS techniques on sexual functioning.

Sexual desire in female-to-male transsexual persons: exploration of the role of testosterone administration

“…After sex reassignment surgery (SRS), which often includes gonadectomy, cross-sex hormone treatment is continued as in other hypogonadal subjects. In view of a possible impact of testosterone on sexual desire, it has been suggested that the effect of continuous testosterone administration in female-to-male transsexual persons might lead to an increase in sexual desire (4). Also, care givers working in treatment centers for gender dysphoria sometimes encounter complaints of low sexual desire in maleto-female transsexual persons while this is hardly the case in female-to-male transsexual persons.…”

“…Our knowledge of sexual desire in female-to-male transsexual persons is even more limited since data from validated questionnaires on sexual desire in female-to-male transsexual persons are nonexistent (4). The available data can only be interpreted as an indication of sexual desire through measurement of the frequency of sexual activity or frequency of masturbation before and after SRS.…”

Psychopathological profiles in transsexuals and the challenge of their special status among the sexes

“…In further studies it would therefore be interesting to see which mechanisms have an effect on mood in MtF compared to hypogonadal men. However, such features as estrogen substitution in MtF, and an especially low testosterone level, often being lower than that usually seen in premenopausal biological females [33], may interfere with result interpretation.…”

Yes and yes again: are standards of care which require two referrals for genital reconstructive surgery ethical?

“…One argument often made is that the two-signature system limits reversion to the birth assigned gender role after gender-related surgeries as reversion can have catastrophic psychological sequelae. Indeed, around 2%À3% of trans people who have undergone genital surgery regret it 5 and revert to their assigned gender role (Land en, Wa linder, Hambert, & Lundstr€ om, 1998;Lawrence, 2003;Michel, Ansseau, Legros, Pitchot, & Mormont, 2002;Nieder et al, 2013), although this is lower in areas which have stringent requirements before surgery. Whether this is an acceptable margin for such a complex procedure, what causes those reversions, and whether two signatures from within a multidisciplinary/interdisciplinary team avert more reversions are the pertinent points here.…”

“…Furthermore, as part of the ongoing support of the trans person at a gender clinic, the matter will have been brought up on several occasions by supporting professionals in the multidisciplinary/interdisciplinary team prior to the final evaluation. There is also a significant body of academic evidence suggesting that such genital surgeries improve the overall quality of life of carefully evaluated trans-sexual people who have had a consistent desire for such surgeries and who are not sexually motivated (De Cuypere et al, 2005;Gijs & Brewaeys, 2007;Gooren, 2011;Klein & Gorzalka, 2009;Murad et al, 2010;NHS Audit, Information & Analysis Unit, 2008;Smith, Van Goozen, Kuiper, & Cohen-Kettenis, 2005). …”