The issues of sex and relationships have often cropped up when I have met transgender people through my work. How their chosen gender will be received by a potential partner can be a constant cause for concern, with many grappling with one key question: When (and if) should I raise my transgender status?

Dr Helen Webberley by Jenny Potter

Dr Helen Webberley by Jenny Potter

Sex is a watershed moment for all of us. Removing our clothes leaves us vulnerable, shining a spotlight on our physical insecurities. Too big, too small, too fat, too thin, too many lines. The wrong colour, too dry, too wet, too quick, too slow. When should we summon the courage to discuss issues such as infection, contraception, past history and what works for us. Now imagine taking all of the above insecurities and adding another layer: that of your genitals being different to what your partner is expecting.

In reality, as with same sex partnerships, there is no reason why a transgender person cannot go on to have perfectly fulfilling sexual relationships - once they are comfortable with themselves. This may be achieved over a number of years and with the support of their families and loved ones, as well as through the safe prescribing of hormones. For some maybe surgery will give them the final gender affirmation they need.

Cross sex hormones for transgender women (oestrogen) allow the development of female characteristics: breasts, curves and skin softness. For transgender men, the use of testosterone results in the development of male musculature and hair - on both the body and face. These hormones do affect the genitals, the penis will shrink and the clitoris enlarge, and this is enough for many trans people. For those looking for more dramatic change, surgery is the preferred route.

So what exactly is involved, in terms of the mechanics? Well, for the male to female (MTF) patient, a clitoris is formed from the tip of the penis to allow the delicate and intense nerve fibres to remain in tact and enabling orgasm to be achieved. The shaft of the penis is opened up and its contents removed. This leaves the skin, which is sewn back up and pushed inside the cavity within the pelvis, creating the passage for the vagina. The scrotum is opened and the testicles removed and the skin fashioned to make the labia or lips.

In the transgender man, surgery uses the muscle from the forearm, taken with its nerve and blood supply, to form a penis. Erection can be achieved with the use of surgical inflatable implants. The labia majora (outer lips) are stitched together to form a scrotum, and artificial testicles are inserted.

For some, who have surgically transitioned, there may be no discernable evidence that the existing genitals were once those associated with the opposite sex. With effective surgery, orgasm is achievable and both people in the relationship can go on to have a perfectly happy sex life.

As society continues to become more accepting of sex - same sex relationships, different ways to enhance your sexual experience and even polygamy; perhaps the fear of having the ‘wrong’ genitals may subside. If a cisgender man is attracted to a transgender woman because of her looks, persona and personality, then surely the path is paved for them to find the same sexual satisfaction with each other?


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