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Transgender, Intersex, and Gender Nonconforming Sexual Health & Anatomy (Weekly Top 5 August 1 - 7)

Hey, ya'll. So I purposely got started on this week's blog entry early because, well, last week's took way too long. I think it needed to be lengthy to say what I wanted, and honestly, I probably could have come up with a lot more to write about, but I had to rein myself in a little bit. I got to have fun with friends and also do some self-care time this weekend, and I hope everyone else got to have the weekend they wanted as well. So, in the last two weeks, we have looked at male and female sexual health and anatomy. This week I wanted to talk about transgender, intersex, and other gender-nonconforming folks' sexual health and anatomy. This is an area that I know many people are still not educated on, or perhaps just really confused about. That's ok, but I hope I can shed some light on these groups.

#1 What Does it Mean to be Transgender or Intersex?

While the websites listed above go into more detail, I want to give you all the basics. A transgender person's gender identity does not match up with their biological sex markers. We need to understand that our gender expresses who we are, the same as our personality. Your sex is what your biological markers, such as genitalia and chromosomes, distinguish you as. So a transgender man would be someone who at birth had the biological markers of a female. Still, their gender identity does not match what society or themselves see as female, and instead, that person is most comfortable and authentic as a man.

Realizing that gender roles, expectations, and stereotypes are societal constructs makes it easier to understand transgender, nonbinary, or any other gender non-conforming individual under the umbrella. If someone is an introvert, we don't question that about them. If someone has a loud and boisterous personality, we don't deny them being who they are. (Well, let's be brutally honest, we've all actually been the ones to push an introvert or silence boisterous people at times because someone is too much, so let's all work on being better.) But, why should we say that someone expressing who they are differently than us or that doesn't look exactly the way we think it should, is wrong? As long as they are safe to themselves and those around them, each person should be allowed to be themselves. And that is precisely what a gender non-conforming person is trying to be, themselves.

Switching gears, let's look at what intersex means. If someone is intersex, it means that they were born with reproductive or sexual anatomy that does not specifically fit into the binary of male or female. There are a lot of different ways someone can be intersex. Some people will know the instant they are born if they are intersex. Others may not find out until puberty or adulthood, or perhaps when they start trying to have children. Intersex people could be born with genitalia that is compromised of both male and female bits. They could be born with ovaries and testes or have an extra or different pair of chromosomes, such as XXY. The questions with intersex individuals are often whether or not the parents should choose their sex for them and if surgeries should be performed on children. While every family will make their own call on this and what they feel is best for them, in my opinion, surgery is often not necessary. The intersex child should decide who they are when they are old enough to make that decision.

I want to note that most intersex individuals are sterile due to the reproductive systems or extra chromosomes. Also, some forms of intersex can signal underlying metabolic concerns. If you are worried or have reason to believe you may be intersex, please seek a medical professional to help assess and address your concerns.

#2 Anatomy, Medical Intervention Options Available

***I want to be ever so careful here because the last thing I want to do is stigmatize, ostracize, or trigger anyone. I know for my transgender and non-binary friends out there that gender dysphoria can be crushing, so the last thing I want is to make anyone here feel judged, objectified, or less than. So, while I will be going over the possible medical transition options for those folks who may wish to utilize these medical interventions, in no way is medical intervention necessary for someone to live out their gender identity. Each person and their journey and body are unique, so do not make assumptions about a potential partner, but have open and honest communication about what to expect, wants, and needs when it comes to your body and your sexuality. ***

Some of the medical options available for transition are:

  • Hormone Replacement Therapy (HRT) gives either testosterone or estrogen to someone to create more masculine or feminine features on them. Such as giving a transgender man testosterone to help them grow facial hair and perhaps put on more muscle mass. Taking estrogen can help with a more rounded body shape and with forming breasts.

  • Top Surgery: This could be a mastectomy (the removal of breast tissue or creation of a more masculine-looking chest) or a breast augmentation (getting breast implants to create a more feminine looking chest)

  • Hysterectomy or Orchiectomy: In a hysterectomy, the internal female reproductive organs are removed, such as the uterus, fallopian tubes, and ovaries. An orchiectomy is a surgery to remove the testes.

  • Bottom surgery: This could be a vaginoplasty (creation of a vagina by inverting penile skin), phalloplasty (construction of a penis using skin from other parts of your body), or a metoidioplasty (surgery that causes your clitoris to work more like a penis, along with hormone treatment to make your clitoris grow larger).

  • Tracheal Shave: This would be for someone born male; you can make your Adam’s apple smaller

  • Facial Feminization Surgery: This surgery creates smaller, more feminine facial features.

  • Laser Hair Removal: For those who may want to get rid of unwanted or undesirable body hair.

  • Fertility Preservation: If you want to have biological children someday but are starting HRT or doing any bottom-related surgery, it may well be a good idea to freeze some sperm or eggs for the future.

#3 Social Transition Options Available

As stated above, no medical interventions are necessary for someone to live out their gender and who they are. In the same way, it is not required for anyone to go through social transitions, but social transitions are often the first step for many folks. So here are some common social transition options:

  • Coming out to your friends and family as transgender, nonbinary, or gender nonconforming.

  • Asking people to use pronouns (she/her, he/him, they/them) that match your gender identity.

  • Choosing and going by a new name that fits your gender identity.

  • Dressing/grooming in ways that match your gender identity. For many people, this means buying clothes from a different section of the store than normal or learning how to do makeup.

  • Presenting in public part- or full-time in your identified gender, may include:

    • Packing (using a penile prosthesis to give a masculine genital contour).

    • Tucking (placing the testes into the inguinal canal, held in place with tight underwear or a garment called a gaff, to give a feminine genital contour).

    • Binding (using a tight chest garment to flatten breasts and give a masculine chest contour).

    • Breast, hip, or buttock prostheses (inserts into clothing or bra to augment breast, hip, or buttock size).

  • Changing your legal documents to reflect your chosen name, gender identity, and pronoun used. This can be a timely, costly, and weary process for many people, especially since the rules for changing these documents change from state to state.

#4 Intimacy and Sexual Relations

Ok, there are so many resources and tips and amazing information in all of these articles, and this video is amazing, so please check it all out. I do want to sum up a few concepts and information for you, though. First off, if you are a trangender, intersex, or other gender-nonconforming person, you need to do the ethical thing and discuss that with your partner before getting into the bedroom, especially if you want to have a good experience with this partner in the bedroom. Also, for your safety, make sure you are not alone with a cisgender person when you have this discussion with them because you never know how someone might react to finding out information about you that maybe they weren't expecting.

For all of my cisgender folks, here are some things to know. Just because someone is transgender, intersex, or nonbinary, it does not mean that you can't still have an exciting, pleasurable, and intimate sexual encounter with them. Sex may look a little different, but it can still be a great experience for all involved if you go into it with an open mind and genuine care for each other's pleasure. Due to the effects of HRT, surgeries, and gender dysphoria, many gender non-conforming folks can have trouble reaching their climax and have many parts of their body or genitalia that they may not want to be touched or played with at all, or not in traditional sorts of ways. This is why communication is so critical. Make sure you understand what your gender-nonconforming, transgender, or intersex partner wants you to call their genitalia and where and how they like to be touched. Also, don't be afraid to get toys involved. Even in relationships where both folks are cis-gendered, toys are always great allies in the bedroom, not competition.

How our society talks about and thinks about sex stigmatizes so much of it and honestly limits what is and isn't sex or sexual. Intimacy with a partner is not limited to a penis going into a vagina. It is so much broader than that, and no matter where a gender-nonconforming or transgender partner is on their journey of transition (or not transitioning), respect that they are a human being deserving of love, intimacy, and pleasure, just like everyone else. If you are unsure of what to do or say or how to touch or not to touch, ask them. If everyone in our world were more open and honest about their desires and expectations in the bedroom, about how they want their bodies treated in and out of the bedroom, and how they like to experience pleasure in and out of the bedroom, we would see a much more inclusive and understanding world. At the end of the day, sex and intimacy are not about the destination of getting to climax with your partner. It's about the journey and experience of getting to share something vulnerable, sexy, and hopefully fun with someone that you care about, regardless of their gender.

#5 Resources

To end, I wanted to share a bunch of resources. Whether you are looking for mental, physical, emotional, or sexual help on this gender-nonconforming journey you are on, or perhaps are the friend, relative, or partner of a genre non-conforming person. I wanted to provide some great tools and websites available to you. So if you are in search of help or support, PLEASE go check out these websites and all the options available to you.

Also, shout out to my amazing friend and fellow sexologist, William Lynch, who helped me proof-read and make sure I was using the proper language in this article.

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