Supporting sexuality and improving sexual function in transgender persons

ABSTRACT Sexuality is important for most cisgender as well as transgender persons and is an essential aspect of quality of life. For both the patient and their clinicians, managing gender

dysphoria includes establishing a comfortable relationship with sexual health issues, which can evolve throughout the course of gender-affirming treatment. Gender-affirming endocrine

treatment of transgender men and women has considerable effects on sex drive and sexual function. Gender-affirming surgery (GAS) can improve body satisfaction and ease gender dysphoria, but

surgery itself can be associated with sexual sequelae associated with physical constraints of the new genitals or postsurgical pain, psychological difficulties with accepting the new body,

or social aspects of having changed gender. In general, a positive body image is associated with better sexual function and satisfaction, but satisfaction with sexual function after GAS can

be present despite dissatisfaction with the surgery and vice versa. Factors involved in the integrated experience of gender-affirming treatment and the way in which sexuality is perceived

are complex, and supporting sexuality and improving sexual function in transgender patients is, correspondingly, multifaceted. As the transgender patient moves through their life before,

during, and after gender-affirming treatment, sexuality and sexual function should be considered and maximized at all stages in order to improve quality of life. KEY POINTS * Evaluation of

sexual dysfunction in transgender persons is multidimensional. * Hormonal treatment is likely to increase sexual desire in transgender men and decrease desire in transgender women. * A

reduction in sexual drive is not necessarily a concern, but can, in fact, be appreciated or even desirable for some patients. * Before initiating hormonal or surgical treatment, wishes and

hopes about future sexual function should be explored. * Sexual problems in transgender persons can be trans specific or not. General principles in sexual medicine apply to both cisgender

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SIMILAR CONTENT BEING VIEWED BY OTHERS INVESTIGATING THE ASSOCIATION BETWEEN GENDER-AFFIRMING TREATMENT INTENTIONS AND CHOICES ON MENTAL HEALTH AMONG TRANSGENDER INDIVIDUALS Article 29 May

2025 SEXUAL FUNCTION OF TRANSGENDER ASSIGNED FEMALE AT BIRTH SEEKING GENDER AFFIRMING CARE: A NARRATIVE REVIEW Article 05 May 2023 SEXUAL ORIENTATION IN TRANSGENDER INDIVIDUALS: RESULTS FROM

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H. Sigurjonsson for important feedback regarding the illustrations. REVIEWER INFORMATION _Natural Reviews Urology_ thanks S. Morrison, T. v. d. Grift and the other anonymous reviewer(s) for

the peer review of this manuscript. AUTHOR INFORMATION AUTHORS AND AFFILIATIONS * ANOVA, Karolinska University Hospital, Norra Stationsgatan 69, Stockholm, Sweden Mats Holmberg, Stefan Arver

 & Cecilia Dhejne * Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden Mats Holmberg * Department of Medicine, Huddinge, Karolinska Institutet,

Stockholm, Sweden Stefan Arver & Cecilia Dhejne Authors * Mats Holmberg View author publications You can also search for this author inPubMed Google Scholar * Stefan Arver View author

publications You can also search for this author inPubMed Google Scholar * Cecilia Dhejne View author publications You can also search for this author inPubMed Google Scholar CONTRIBUTIONS

All authors researched data for article, made substantial contributions to discussions of content, and wrote and edited the manuscript before submission. CORRESPONDING AUTHOR Correspondence

to Mats Holmberg. ETHICS DECLARATIONS COMPETING INTERESTS The authors declare no competing interests. ADDITIONAL INFORMATION PUBLISHER’S NOTE Springer Nature remains neutral with regard to

jurisdictional claims in published maps and institutional affiliations. RIGHTS AND PERMISSIONS Reprints and permissions ABOUT THIS ARTICLE CITE THIS ARTICLE Holmberg, M., Arver, S. &

Dhejne, C. Supporting sexuality and improving sexual function in transgender persons. _Nat Rev Urol_ 16, 121–139 (2019). https://doi.org/10.1038/s41585-018-0108-8 Download citation *

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