Study design, materials and methods
A sample of transgender (trans) people from the Gender Incongruence Clinic was invited to participate in this cross-sectional study. All those that accepted to participate had gender incongruence (GI). The female sexual function index (FSFI) and male sexual function index (MSFI) were used to assess Sexual Function (SF) in both female (n=38), and male (n=48) participants. The FSFI questionnaire has 19 questions grouped in six domains (desire, arousal, lubrification, orgasm, pain, and satisfaction). The score ≤ 26.55 is a risk for sexual dysfunction¹. The MSFI is an adaptation of FSFI by Kalmbach et. al (2015)², that has 16 questions grouped in five domains (desire, arousal, erection, orgasm, and satisfaction). The composite score varies between 2 to 36. In addition, participants responded to a semi-structured questionnaire to assess their feelings towards their trans condition, and about their satisfaction within their sexual life. The Hospital Anxiety and Depression Scale (HAD) questionnaire was used to assess the individual’s mood. The HAD has 14 items divided in two subscales: seven to assess anxiety, and seven to assess depression. The cutoff score for anxiety and depression is ≥ 8 and ≥ 9, respectively³. Clinical data was assessed from medical records.
Results
Forty-eight trans men and 38 trans women participated in this study. For men, the mean age was 27.55 ± 7.46 years, the mean age of sexarche was 14.67 ± 5.38 and the mean time of use of hormone therapy was 2.79 ± 0.33 years, the majority of participants were heterossexual 38 (90.48%), and 9 (77.50%) individuals had gender affirming surgery, 7 (14.89%) complained of low sexual desire, 2 (4.26%) had sexual arousal disorder, and 6 (12.77%) showed difficulty in achieving orgasm. The majority 30 (66.83%) of participants were satisfied or very satisfied with their sexual relation, and 21 (44,68%) with their body appearance. Sixteen (34,04%) of individual’s expressed feelings of discrimination in society 7 (17.95%), in their family 2 (5.13%), and 8 (20.51%) in more than one place.
For trans women (N=38) the mean age was 31.90 ± 9.70, the mean age of sexarche to be 14.68 ± 3.11, and the mean time of use of hormone therapy was 4.09 ± 0.44 years. The majority of trans women considered themselves as heterosexual 27 (87.10%), and 11 (45.85%) had undergone gender affirming surgery. When SF was examined in our cohort of transgender women, we found 9 (24.32%) complained of sexual desire disorder, 6 (16.22%) of sexual arousal, 3 (8.11%) of difficulties in achieving orgasm, and 2 (5.41%) had problems in more than one phase of sexual response. Ten (45.45%) on trans women use their penis in sexual intercourse. Regarding sexual satisfaction, the majority 18 (48.65%) of participants reported satisfaction with sexual life, and 16 (42.11%) with their body appearance. The majority of individual’s 20 (54.05%) reported feeling discrimination in society 13 (38.24%), in their family 2 (5.88%), and 9 (26.47%) in more than one place.
The Table 1 shows the Demographic and clinical characteristics of the studied population.
The Table 2 shows the total score, and the score for the domains of FSFI, and MSFI of transgender men and women. We found no significant differences between the mean scores of the HAD for either transgender cohort.
Interpretation of results
In comparison to women, trans men had better total FSFI scores (P=0.01), and for the domains of arousal (P=0.01), lubrication (P=0.01), orgasm (P=0.01) and satisfaction (P=0.01). Moreover, they had better MSFI total score (P=0.02), and for the domains of arousal (P=0.01), orgasm (P=0.01) and satisfaction (P=0.01).