Trans and gender diverse folx may want or need to navigate masturbation, sexual pleasure, and sexual intimacy differently than their cis peers. As a clinician, sexual health and wellness is in our wheelhouse- it is part of whole being wellness. We should be a go to source for our patients no matter their gender identity or genitals for resource, education, and information of sexual pleasure and sexual health. So many clinicians and patients think of sex as only PIV- bio penis in bio vagina. As a very sexually active queer, gender diverse person, I am here to tell you it is so much more! Sex should be defined by the participants- not clinicians, not the media, not stereotypes, not patriarchal/colonial/misogynistic attitudes. So sometimes I have sex with myself, sometimes I have sex with another person or persons. Sex for me almost NEVER involves a bio penis in my vagina. It often involves fingers, hands, fists, toys, and dildos in my vagina in combination with clitoral stimulation- usually a vibrator. It often involves me topping or taking actions on someone else where nothing happens to my genitals (well except arousal). It can involve me penetrating a partner's mouth with my toes, their skin with a needle, their mind with dominance.

Sex is as limitless as the imagination of the people having it!

If you are a clinician who has less personal exposure to a more expansive definition of sex consider reading some LGBTQ+ focused erotica written by queer authors to get some ideas. I will post some suggestions on the blog in a few weeks when I recommend resources for patients. I am also planning a discussion panel where you can attend free live or join QueerCME as a premium member to have access to the recording. Follow QueerCME on instagram or tiktok to find out when you can register.

Okay back to supporting patients!

I start by GETTING CONSENT:

• Is it okay if we talk about your genitals?
• What words do you want me to use for them?
• Is it okay if we talk about masturbation and sex- pleasure and health?
• Great! Don’t forget, you can always tell me you don’t want to answer a question and we can move on.

After consent has been provided, we can dive in:

• Are you having any genital pain?
• Are you having any genital discharge?
• Do you masterbate?
• How is masturbation for you?
• How are orgasms for you with masturbation?
• Do you have any pain or discomfort with masturbation?
• What questions do you have about masturbation?
• What resources do you want or need around masterbaton?
• How would you describe your sexual orientation?
• Are you currently having sex with anyone? And for the purpose of this conversation sex is all the intimate things- kissing, groping, oral sex, anal sex, genital sex, kink, fetish, all the things.
• How are you navigating coming out to potential sexual or romantic partners? 
• This is important to help reduce risk of violence
• For STI testing purposes, I need to know what goes where when you have sex. Does your mouth go on anyone’s genitals, do your genitals go in anyone’s mouth, etc
• How is sex for you?
• How are orgasms for you with sex?
• Do you have any pain or discomfort with sex?
• What questions do you have about sex?
• What resources do you want or need around sex?

Not all trans or gender diverse folx have bottom dysphoria, dysphoria around their genitals. I don’t. Before starting any hormonal or medical interventions for gender it is important to know a patient’s goals for their genitals- do they want to maintain erectile function, are they a front hole size queen (meaning they want to maintain high elasticity of the vaginal tissues)?

Informed consent counseling on how medical interventions may affect sexual health is super important:

•  Hormones and blockers may affect:
• how often you think about sex
• What you find sexually attractive or appealing- what turns you on
• Your genital function
• How you experience orgasm
• What techniques get you off

Follow me on social this month on IG @queercme or TikTok @queercme to hear how I talk through some of these things with my patients. Read the blog each Monday to get more clinical guidance and resources. And don’t miss the free live lecture where you can ask me questions: REGISTER HERE