Sexual health is part of being human. Like anyone else, transgender and nonbinary people deserve sex that feels good, safe and affirming. Everyone’s body is different—you may or may not take hormones, have surgery or be sexually active—and that’s all normal. Understanding your body and sexual health needs can help you make informed choices about pleasure, protection and care.
Caring for Your Body
People with Vaginas
Testosterone can thin the vaginal walls, which may increase the risk of cuts, tears or bleeding and raise the chance of HIV or other STIs. Some people also use topical estradiol (applied internally) to help the vaginal walls stay healthy, increase natural lubrication and reduce discomfort from thinning or atrophy. Using estradiol this way does not affect testosterone levels. Talk with your provider to see if this option is right for you.
Testosterone is not effective as birth control, so people whose periods have stopped can still become pregnant. People with a cervix, uterus or ovaries are also at risk for certain cancers caused by HPV.
Talk with your provider about Pap tests and the HPV vaccine. A Pap test looks at cells from the cervix to check for early signs of cancer. Your provider will also examine your uterus and ovaries for anything unusual. Let them know what makes you most comfortable during exams.
Like anyone else, transgender and nonbinary people deserve sex that feels good, safe and affirming.
People with Penises
Some people tuck to hide their genitals beneath clothing. This involves gently positioning the testicles and penis and securing them with tight underwear or surgical tape. Tucking can be safe if done carefully, but improper technique can cause health issues. Tips for safe tucking:
- Use only surgical tape to avoid skin damage.
- Keep hair trimmed in the groin to make tape removal easier.
- Take breaks from tucking daily.
- Avoid tucking for too long, as it can cause chafing, sores or lower sperm count.
People taking estrogen and PrEP should follow dosing instructions carefully—doubling doses does not increase protection. Even on estrogen or other feminizing hormones, some people can still produce enough sperm to cause pregnancy.
Body modifications and injections
Some people have silicone or other substances injected, sometimes called “pumping,” to achieve a curvier or more sculpted body shape. These procedures can cause serious health risks. Injected products may harden, move to other parts of the body, or cause infections and permanent changes.
For your safety:
- Talk with a trained healthcare provider about safe options for body modification.
- Only consider procedures performed by licensed medical professionals using approved materials.
- Avoid DIY injections, as they can lead to permanent harm, infection or death.
Practices and Safety Tips
Like anyone else who has sex, transgender and nonbinary people are at risk for sexually transmitted infections (STIs). STIs can be transmitted through oral, vaginal or anal sex. Getting tested regularly for STIs, including HIV, is an important part of sexual health. Having an STI can increase your risk for HIV, so staying on top of testing helps protect your health. Strategies to reduce risk:
- Use condoms, dental dams or internal condoms during oral, vaginal or anal sex.
- Change condoms for each sexual act and clean toys before sharing or switching between body parts.
- Use lube, especially for anal sex, to prevent microtears that increase risk of HIV and other STIs.
- Avoid sharing needles if you use injectable drugs, including hormones.
- Talk with a provider about PrEP, a medication highly effective for preventing HIV.
- If you have an STI, get treated right away and make sure your partners do too.
Comfort, Pleasure and Communication
Sexual health isn’t just about avoiding infections—it’s also about pleasure, consent and comfort. Talk openly with partners about what feels good, what doesn’t and what protection you want to use. Explore what works for your body, especially if hormones or surgeries have changed sensations.
If sex is painful or you notice bleeding, discharge or sores, see a provider who understands trans and nonbinary bodies. Taking care of your sexual health includes both physical safety and emotional comfort, and protecting yourself also helps reduce the risk of HIV and other STIs.
Taking care of your sexual health includes both physical safety and emotional comfort, and protecting yourself also helps reduce the risk of HIV and other STIs.
Getting Care
Everyone deserves health care that respects their body and identity. Be open with your provider about your body and the sexual activities you engage in so they can provide care that meets your needs. Regular checkups and STI/HIV testing are important parts of good self-care.
If you test positive for an STI or HIV, treatment is effective, and support is available. You can also ask for a provider experienced in trans and nonbinary care, bring questions to your appointments and access services like Caracole for HIV testing, PrEP and other sexual health support.
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