SAFERSEX FORTRANS
BODIESSAFER SEX FOR TRANS BODIES1 There is nothing wrong“
with being sexual.

We are sexual beings. Embrace yoursexuality — it’s a part of you. Embrace
yourself in it as well.”– ANGEL, 38, TRANSGENDER WOMANWHAT DIDYOU JUSTCALL ME?
A NOTE ON LANGUAGE:

This is a safer sex guide for transgender and gender expansive
people, and for our partners and lovers. When it comes to sex,
there’s a serious lack of resources available to trans people that talkabout our bodies and our needs in a relatable and respectful way. We
decided to make a guide, specifically for trans and gender expansive
people, that helps answer questions about safer sex. This guide isn’t
all about sexually transmitted infections (STIs) and condoms—inside,
you’ll find information about sex during and after transition, ways totalk to your partner(s) (romantic, casual and transactional) about sex
and suggestions for exploring your own sexuality, whether you have
many partners, one partner, or you’re going solo.
We use the word “trans” to include people who might call themselves
any of these words: transgender, transsexual, genderqueer, nonbinary, female (MTF), male (FTM), cross-dresser, agender, two-spirit
and many more. We tried to write this guide in a way that is respectfulof the huge variety of identities and bodies that are part of the transcommunity. We’re sure it’s not perfect, but we hope you see yourself
reflected somewhere in our writing.

2

SAFER SEX FOR TRANS BODIES

We, as trans people, use avariety of words to describe
our gender and our body parts,and these words can be very
unique and personal. There’s
no one right way to refer toour bodies, but to keep things
consistent in this guide, we’ve
decided to use the following
words in the following ways.

SAFER SEX FOR TRANS BODIES

3

“One of the mostaffirming things apartner has told me is,[Affirming my trans identity] is notjust about the language, it’s about… committing to recognizing me as
male and treating me as such.”

DICK: We use this word to describe external genitals. Dicks comein all shapes and sizes and can belong to people of all genders.
FRONT HOLE: We use this word to talk about internal genitals,
sometimes referred to as a vagina. A front hole may self-lubricate,depending on age and hormones.
STRAPLESS: We use this word to describe the genitals of transwomen who have not had genital reconstruction (or “bottom
surgery”), sometimes referred to as a penis.
VAGINA: We use this word to talk about the genitals of transwomen who have had bottom surgery.

– ELI, 32, TRANSGENDER/GENDERQUEERTRANS: Anyone and everyone who feels they are part of thetransgender community, including folks who identify outside of
the gender binary. Being trans does not necessarily mean that you
have had surgery, want to transition or use specific pronouns. It’s
all about how you understand yourself.
TRANSFEMININE: Anyone who was assigned male at birth andnow identifies with femininity.

Don’t assume that every
person you meet—transor otherwise—will use
or understand thesewords. In most cases,
the best thing you can
do is ask which words a
person uses to describe
their body. Remember:
Our bodies are our own
to name and use.

TRANSMASCULINE: Anyone who was assigned female at birthand now identifies with masculinity.
PARTS: We use this word when we’re talking about genitals or
sexual anatomy of any kind.

4

SAFER SEX FOR TRANS BODIESSAFER SEX FOR TRANS BODIES

5

[Communicate your needs around language and touch]“Call it my dick, and don’t
hesitate when you say it,
because that’s how I know what you
think and how you feel about what
you’re saying. Don’t say cunnilingus,
say head. Use the words you would
use for any other guy.
…My body is different. Chances are good that I

have more experience with it than you, or anyone.
I probably know what feels good. Whether that’s
what I like to be called… or how I want to be
touched.”– COLE, 29, MALE (FTM)

6

SAFER SEX FOR TRANS BODIESGET TO KNOWYOURSELF:
MASTURBATION

There’s plenty of advice out there about how to have “the bestsex” or “the right kind of sex,” but a lot of it simply doesn’t workfor our bodies. Spoiler alert: it doesn’t work for plenty of cisgender(or non-transgender) people too. Sometimes we’re working withparts that don’t feel like they match our brains, and sometimes ourbodies are hairier or curvier than we would like. Some of us havetrouble tapping into pleasure because our bodies don’t feel likethey belong to us.
Luckily, one of the most laid-back ways to explore sexualpleasure (and incidentally, also one of the safest) is by yourself.
Masturbation allows you to experiment with how your body
responds to touch: Do your parts like vibration from a favorite toy?
Do they like soft, light touches or firm pressure? Are other areas ofyour body, like your chest, your neck or the creases of your elbows,
also sensitive to touch? Taking the time to explore your own bodycan be liberating. There is no judgment from other people, nopressure to perform a certain way and no rush. If you have ever felt
shame about the way your body looks, masturbation is one way toslowly ease into self-acceptance. Take it at your own pace. There’s
no one specific goal, only opportunities to better learn what feels
good to you.
SAFER SEX FOR TRANS BODIES

7

SCREWING,SHAGGING
OR MATTRESSDANCING:TALKING ABOUT SEX WITH OUR PARTNERS

The first step toward having safer, more enjoyable sex with yourpartner(s) is to talk about it. Many of us are told from an early age
that sex isn’t something you should discuss. However, talking to
your partner(s) about the kind of sex you want to have—and thesteps you can take to protect yourself—is an opportunity to build
trust and lessen concerns.
Sex with someone who is incapacitated by alcohol or drugs
is sexual assault and is illegal in many states. It’s also risky
to have sex with someone whose judgment is compromisedby drinking or drugs: you could hurt them physically or
emotionally. If you have any doubt that your partner is fully
engaged in what’s happening, or you think being high or
drunk might be affecting their decisions about sex, you
should wait to have sex until they are sober.

8

SAFER SEX FOR TRANS BODIES

Talking about sex really comes down to 3 big things:
1. TURN-ONS:
Talking to your partner(s) about what gets you excited can begreat foreplay! There’s such a wide menu of options in the worldof sex, and giving your partner(s) some ideas about what turns
you on will help you both have more enjoyable sex. Your partner(s)won’t know unless you tell them.
2. BOUNDARIES:Your boundaries are the things you don’t feel comfortablewith and want to establish as clear “no-go” zones. Boundaries
might be things like “No sex without a dental dam” or “Don’t
use the words ‘good girl’ or ‘baby’ to describe me” or “Don’t
pull my hair.” Practicing consent means adopting the languagethat your partner(s) use to describe themselves and respecting
the boundaries they set for their bodies. Thinking about andcommunicating boundaries might be particularly important withtransactional sex partners. Boundaries might change over timewith the same partner and might differ among partners but it’salways important to identify for yourself and others what you do
not want to do.
3. CONSENT:
Consent is the enthusiastic, mutual and voluntary agreement
to do whatever activity you’re discussing. Giving consent is an
ongoing process: You always have the right to say “yes” or “no”
to any sexual activity regardless of whether you’ve done it before,
whether you know your partner really likes it or whether you’rein the middle of doing it. We also recognize that transactionalsex complicates consent. If at any point you change your mind
about doing something, you should say so and your partner
needs to stop.

SAFER SEX FOR TRANS BODIES

9

DATING WHILE
TRANS:PERSONAL SAFETY

Whether you’re hooking up, dating casually, having transactionalsex or looking for a lifelong partner, you will almost certainly deal
with issues of safety. While many brave and thoughtful activists aremaking important progress, dating while trans today can mean
taking some safety measures.
When you’re meeting a new person for the first time, it’s generally
safer to do so in a public place. Consider letting someone elseknow where you are and how long you expect to be out. You caneven use the buddy system, where your friend grabs a drink nearby
while you’re on a date. Other folks like to use check-ins or “safecalls,” where you call a friend at a designated time to tell them thatyou’re ok. If that friend hasn’t heard from you by the agreed upontime, they’ll implement a safety plan or notify the police to find you.
Keep in mind how drinking alcohol or using substances can affectyour judgment, boundaries and ability to consent.
Intimate partner violence, which includes sexual violence,is a serious issue for trans people and their communities.
Using force, guilt, blackmail or fear to make a partner
do something sexually are examples of intimate partner
violence. If this has happened to you, consider finding atrusted person, like a counselor, physician or advocate to talkto about it. You can also call the National Domestic Violence
Hotline at 1−800−799−7233 for someone to talk to or to finda local provider who can help.
10

SAFER SEX FOR TRANS BODIES[What is safer sex?]“To me, safe sex means abarrier between you andany fluid. That means condoms,
gloves and dental dams. Safe sex is
extremely important to me because
I am poly. I like to have sex with lotsof people and the only way to keep
doing that is to be safe.”– ELI, 32, TRANSGENDER/GENDERQUEERIS THIS RISKY?
STIs AND SAFER SEX ACTIVITIES

Sexually transmitted infections (STIs) are infections that are passed
from person to person through sexual contact, primarily throughbodily fluids (e.g., blood, breast milk, front hole or anal fluids,
semen/cum and pre-cum). While STIs are generally curable ortreatable, they can cause serious health problems if left ignoredand untreated.

SAFER SEX FOR TRANS BODIES11

ACTIVITY

STIs can and do happen, which means there’s nothing to beembarrassed about if you contract one. What’s important is thatyou get treated right away and notify your sexual partners so they
can get treated too.
Unfortunately, many people contract an STI but never know it
because they never experience symptoms. Taking precautions likeusing a barrier during sex, getting vaccinated and having STI tests
done regularly can significantly lower your chances of contractingor spreading STIs.
This is a table ofthe kinds of STIs
out there and which
activities could
expose you to them.
We’ve also included
some suggestions forprotecting yourself, likeusing condoms, gloves
and dental dams. Withany of these protection
methods, you should
also consider using
lube to prevent frictionthat could lead tosmall tears in or on
your parts during sex.
Those tears maketransmitting an STI
way easier. Tears canalso show up in yourmouth and on your gums, so avoid brushing or flossing yourteeth within 30 minutes of sex, in case you plan on using yourmouth on the part(s) of your partner(s).

12SAFER SEX FOR TRANS BODIES

Kissing

Masturbation
Sharing sex
toys, strap-ons,
and prosthetics

Humping/
Rubbing
Oral Sex (ondicks, front
holes, vaginas,
strapless oranuses)KNOWN RISKS••

HerpesOPTIONS FOR PROTECTION•

Herpes sores rarely pose serious healthrisks but if you want to reduce your risk oftransmitting them, do not kiss your partner(s)when someone is having an outbreak.

•You or your partner(s) can also takemedication daily or during an outbreak to
reduce the chances of spreading herpes
and to heal outbreaks faster.

No known risks

N/A• Chlamydia• Gonorrhea• Hepatitis A• Herpes• HPV(These risks are theoretical;
there are no documented
cases of transmission)•

Put a condom over any toy, especially ones
made of porous materials like “jelly” and PVC(polyvinyl chloride).

•

Boil or bleach sterile toys (ones that are madeof silicone, glass or metal) between each use.

HerpesHPV
Syphilis•

If you are not wearing clothes, you can put adental dam or a piece of plastic wrap between
your parts.

With exposure tosemen/fluids:• Chlamydia• Gonorrhea
• HIV

•

Use a barrier such as:o an external condom (if it fits snugly)o a finger cot
o a dental dam or plastic wrap•

If none of these options feel comfortable, split
a latex glove down the side and put the thumbhole over your parts.

•

Avoid oral sex if you or your partner(s) have any
open sores on the mouth.

•

Keep nails trimmed to avoid scratching theskin or causing cuts or bleeding.

•

Use latex gloves (with cotton balls in thefingers if you have long nails).

•

Use an external condom.

•

Use an internal condom – If using an internal
condom for anal sex, remove the flexible
interior ring.

•••With skin contact only:• Herpes• HPV (warts)• Syphilis
With exposure to fecal
matter:• Intestinal parasites• Hepatitis A
Fingering,fisting,manual sex

Front hole,vaginal, or
anal sex• Chlamydia• Gonorrhea• Hepatitis A• Herpes(These risks are theoretical;
there are no documented
cases of transmission)
•
•
•
•
•
•
•
•

Chlamydia
Crabs/Scabies
Gonorrhea
Hepatitis B
HerpesHIV
HPV (warts)
Syphilis

There are a lot of STIs out there—that’s why it’s so important totalk to your healthcare provider about the kind of sex you arehaving, to get tested regularly and to get treated if necessary.
Whatever you tell your provider is 100% confidential. Feel free tobring this chart with you to your appointment to help guide thatconversation with your provider.

SAFER
SEX
TOOLS

14

to change condoms in between partners and when switching
between a front hole or vagina and an anus.
Some condoms contain the spermicide Nonoxynol-9, which you
should avoid if possible. Nonoxynol-9 can irritate your parts, which
can increase the likelihood of contracting an STI. Most condoms
are made of latex, but people with a latex allergy should use otherkinds, such as polyurethane condoms. Avoid lambskin condoms
because they do not prevent the spread of HIV.
If you enjoy flavored condoms, only use them for oral sex because
the sugar that makes them taste good can also give you or yourpartner a yeast infection! For insertive sex, make sure to pair yourcondom with water-based or silicone-based lube. Oil-based lubes(e.g., olive, coconut or almond oil or body lotion) will weaken thecondom and make it more likely to break during sex. Be careful
not to use silicone-based lube with toys made of silicone as it will
degrade the surface of the toy, unless the toy is covered by an
external condom.

EXTERNAL CONDOMSINTERNAL CONDOMSAn external condom, sometimes
called a “male condom,” is rolled
down over a strapless or a dick as abarrier to prevent STI transmission
and pregnancy. External condoms
come in many shapes and sizes, so
be sure to try out different kinds
to see which ones feel best to you.
External condoms are great for oral
sex, penetrative sex of all kinds andfor putting over sex toys. Be sureInternal condoms, sometimes called“female condoms” (or FC2), arepolyurethane condoms that can beplaced inside of a front hole, vagina
or anus before sex. Internal condoms
help prevent pregnancy and the
spread of STIs by collecting semen
and preventing bodily fluids fromgetting inside of the front hole, vagina
or anus. Internal condoms are ideal for
penetrative sex, especially anal sex.

SAFER SEX FOR TRANS BODIESSAFER SEX FOR TRANS BODIES15

If you are going to use an internal condom for anal sex, make sure
to take the internal ring out before you insert the condom—it’spainful when left in and makes the condom more likely to pop
out. Remember to change condoms between partners and whenswitching between a front hole or vagina and an anus.

DENTAL DAMS
A dental dam is a stretchy, flat latex
barrier that can be placed over topof a front hole, vagina or anus for oral
sex. Plastic wrap can be used thesame way, and is cheaper and easier
to find than dental dams. Dental
dams and plastic wrap are excellent
for oral sex and rimming. Remember
to change barriers between partners
and when switching between front
holes or vaginas and anuses. Also
remember that you should only use
one side of the barrier; you shouldn’t
flip it around and use the other side!

GLOVES
Latex or nitrile (latex-free) gloves can be used when putting fingers
or fists inside a front hole, vagina or anus. Wearing gloves reduces
the chance of contracting or transmitting STIs through tiny cutson your hands or fingers, and it also prevents you from scratching
your partner(s) and exposing them to nasty bacteria under yourfingernails. If you have long or sharp nails, you may want to put
small cotton balls in the fingertips of your gloves to prevent themfrom ripping the latex.
A glove can also be turned into a barrier that accommodates a
dick exposed to hormones or a smaller strapless. You can makethis combo dental dam/condom (a condam!) from a glove by
cutting a line up the pinky-finger side, removing the fingers (butbe sure not to cut the thumb) of the glove, and placing the thumbhole over the dick or strapless. This way you can lick, suck or
stimulate all the sensitive parts in that area.

There is a very popular myth that you can’t use microwavesafe plastic wrap for oral sex because it has tiny holes tolet steam out; this is not true. Microwave-safe plastic wrap
simply melts at a higher temperature—so that you can put itover food that gets really hot—but poses no issues as a safer
sex barrier.

16

SAFER SEX FOR TRANS BODIESSAFER SEX FOR TRANS BODIES17

SAFERSEXWITHOUTBARRIERS?
Physical barriers like condoms and dental
dams aren’t the only way to reduce yourchances of contracting an STI and to keep
yourself safe during sex.

In some cases, people starting a new
relationship get tested first in order tolimit the likelihood of STI exposure. Somepeople in a relationship may commit tousing protection with partners outside therelationship or not having partners outside
the relationship at all. Some polyamorous
people only sleep within an exclusive
group of partners who do not have sexual
relationships outside of the group, whichis called closed-group polyamoryor polyfidelity.

18

SAFER SEX FOR TRANS BODIES“Emotionally safer sex
is achieved throughcommunication andgentleness. This is the kind of sex

that can be incredibly healing to sexualassault or domestic abuse survivors. It canremove the association between sex and emotionalor physical violence over time. It’s proven incredibly
valuable to me.”– ASH, 25, GENDERQUEER WOMAN

In any long-term relationship, you can negotiate the use of
barriers in a way that makes sense for you and your partner(s).
Maybe you don’t use barriers together, but with people outsideof your relationship you do. Maybe everyone uses barriers for
insertive sex, but you are less worried about the risks from oral
sex. Those decisions are up to you. The most important thing isthat you feel comfortable with the decisions you are making about
your own body.
For this reason, having emotionally safer sex is just as importantas having physical sex that is low in risk. Sex can be vulnerable,
whether it’s part of a long-term relationship or a hook-up.
When you or your partner(s) are feeling vulnerable, there’s anopportunity for everyone to show respect by honoring boundaries
and decisions without judgment or guilt-tripping. No one isperfect, and good communication is a skill to be practiced.

SAFER SEX FOR TRANS BODIES19

We recognize that communication can be complicated withtransactional sex partners. In some cases, the recognition of thesex transaction can actually help frame sexual negotiation, but
power and control dynamics can also make this more challenging.
Hopefully, ongoing communication can help us have sexual
experiences where we all feel safe and respected.
Staying Healthy with HIV
Research shows that it is virtually impossible for a person livingwith HIV who consistently takes their antiretroviral medication(ARVs) to pass the virus onto a partner. Therefore, having sex withpeople living with HIV who consistently take their medication andmaintain an undetectable viral load is a highly effective way toprevent the spread of HIV. Sometimes this method is referred to as“treatment as prevention.” Seeing a doctor regularly and havingvery low levels of HIV in the body (even though the virus is still
there) are keys to staying healthy if you or someone you know is aperson living with HIV.
Pre-Exposure Prophylaxis (PrEP)
PrEP is an HIV prevention strategy that currently involves taking a
once-daily pill to reduce the chance of acquiring HIV. Right now,
Truvada® is the only FDA-approved pill for PrEP. When taken asprescribed by a knowledgeable healthcare provider, PrEP is highly
effective at preventing the spread of HIV. PrEP only works if you
take it regularly, so it can be helpful to take your medication aspart of your morning routine, such as right after brushing yourteeth. It takes at least 7 days for PrEP to offer HIV protection in
anal/rectal tissue. For vaginal or front hole tissue, it takes at least
21 days. However, PrEP does not protect against other STIs or
pregnancy. Just like with other prescription medications, you
should continue to see your doctor and get routine STI screenings
and other tests to make sure the regimen is still appropriate.

20

SAFER SEX FOR TRANS BODIES

Post-Exposure Prophylaxis (PEP)
PEP is an HIV prevention strategy that currently involves taking
HIV medications immediately after a single high-risk event,such as condomless sex with a person whose HIV status you do
not know. These medications stop HIV from making copies ofitself and spreading throughout your body. PEP involves taking
medication for 28 consecutive days, and it’s best to start PEP assoon as possible after a potential exposure to HIV, since it only
works if you start it within 72 hours of the exposure. PEP does notprovide protection against any other STIs, however. If you everneed to take PEP, you might also want to consider talking to yourprovider about PrEP.
Vaccinations (Sexual Health)
Vaccines signal your body to make antibodies,exactly like it would if you were exposed to adisease. After getting vaccinated, you develop
immunity to that disease, without having to
get the disease first. You can be vaccinatedfor Hepatitis A, Hepatitis B, and against
many of the disease-causing HPV (Human
Papillomavirus) strains, all of which can be
spread through sexual contact.

“I was unaware of how fluidsex could be pre-transition. I

thought it was me, the girl (bottom), andhe, the guy (top), and that was the gist ofit. By showing me how comfortable they were with mybody, showing me even though I was uncomfortable
in my body, it can be appreciated by someone else
involved, regardless. Passion, kissing, playing up what I
felt was feminine—my breasts, my lips.”– ANGEL, 38, TRANSGENDER WOMANOTHER SEXYOPTIONSBDSM and Kink
BDSM is short for Bondage, Discipline, Domination, Submission,
Sadism and Masochism, and encompasses a huge array ofactivities that some of us do for fun, sometimes in a sexual way.
And of course, because many of these activities don’t involve ourparts, they’re generally very low risk for transmitting STIs!
However, there are some higher-risk BDSM activities that
may expose you and your partner(s) to bodily fluids, including
blood. All of these activities require a high level of skill andcommunication, and should not be attempted without mentorshipor supervision by a more experienced person in the BDSM
community. And since blood can transmit STIs, including HIV and
Hepatitis C, these activities also require safety precautions toprevent transmission. Always use sterile needles, knives or blades;
wipe up excess blood with a single-use cotton ball dipped inrubbing alcohol; and avoid cutting or touching any open sores on
the skin.
Because BDSM activities can involve very intense physicalsensations as well as scenarios where people are reacting insituation-specific ways, most people use a safeword to indicate
when a boundary has been crossed or when play should stop.
Accordingly, a safeword is usually a word that you would not
ordinarily say during play, such as “red,” “pineapple” or even“safeword.” You should always discuss your safeword with yourpartner(s) BEFORE beginning any kind of BDSM activity.

While plenty of us feel comfortable using our parts during sex, it’salso ok if you don’t feel comfortable doing that. Luckily, sexuality
is broad, and there are lots of ways to be sexual without using yourparts at all.

22

SAFER SEX FOR TRANS BODIESSAFER SEX FOR TRANS BODIES23

HORMONESAND SURGERY:SEX DURING TRANSITIONCOMMON HORMONE-RELATED CHANGESTESTOSTERONE:

•
•
•
•
•
•
•
•
•

Increased hair growth
Front hole dryness
Dick growth (1-5 cm)
Oilier skin/acne
Increased muscle mass
Increased sex drive
Growth of hair on abdomen,chest and backMenstrual cycle
becomes irregular
Voice deepens

ANDROGEN-BLOCKERS/ESTROGEN:

•
•
•
•
•
•
•

Decreased ability to get andmaintain erection
Lower sperm count andejaculate production
Balls (testes) shrink
Sex drive decreases
Breast tissue grows
Decrease in muscle tone
Redistribution offat deposits*Always check with your physician or pharmacist about potential drug interactions among hormone therapies and other drugs.

Some of us want to take hormones such as testosterone or estrogento change our appearance so that it better reflects our sense of self.
Others choose to have surgeries to remove or construct different
body parts like breasts, dicks, balls and vaginas. These changes cansometimes relieve gender dysphoria or a lackof confidence in the way our bodies look.
They can also help align our external
appearance with how we feel internally.
Surgeries and hormones can change
how our bodies respond to sexual
touch and what feels pleasurable.
HORMONE CHANGESAll of the effects of hormones
are totally normal, but they may
take some getting used to.
Masturbation is a great way tolearn how to please yourself as
your body changes. It may
be helpful to refer back to
our suggestions aroundmasturbation.
24

SAFER SEX FOR TRANS BODIESTRANSFEMININE
HORMONES
Many transfeminine people on androgen-blockers or estrogennotice a decrease in libido. You may also have fewer instances of
waking up with an erection or, in some cases, may have difficulty
getting or maintaining an erection even when you are sexually
aroused. The longer you take these hormones, the less sperm

SAFER SEX FOR TRANS BODIES

25

and ejaculatory fluid your body usually makes, so even if you do
get an erection, orgasm may look and feel quite different while
taking hormones. These changes mean that over time, you becomeless able to get someone pregnant. However, being on these
medications does not serve as effective contraception (pregnancy
prevention). If you’re having sex with someone with an intact uterus,
open fallopian tubes, and ovaries that still are releasing eggs thatyour sperm can reach and fertilize (your partner has not had their
fallopian tubes tied) and effective contraception is not being
used, they can still get pregnant unless your sperm can not accessyour partner (you have had a vasectomy or you no longer makesperm because your balls have been removed). Feel free to ask
your healthcare provider if you are concerned about causing an
unwanted pregnancy.

TRANSMASCULINEHORMONES

once you start taking testosterone, so it’s especially important touse lube to prevent tearing during sex. Tearing in your front holecan make you particularly susceptible to contracting STIs.
Testosterone also causes your dick to grow (up to a couple ofcentimeters) and after a while, you will stop getting a regularperiod. If you are taking testosterone and having sex withsomeone who produces sperm and has not had their tubes tied(a vasectomy), even if you’re not getting your period regularly,
you can still get pregnant. The only exception is if you’ve had
your uterus and/or ovaries removed, your fallopian tubes tied or
blocked, or effective contraception is being used. Again, feel free
to ask your healthcare provider if you are concerned
about causing an unwanted pregnancy.   

It’s important to rememberthat needles and other injection
equipment can transmit STIs, so
it’s crucial that you use a sterile
needle and equipment each time you
give yourself a dose of hormones,
steroids or drugs. Don’t shareneedles or other injection equipmentwith your friends, because doing
so will increase the chances of STI
transmission, including Hepatitis
C. If you need sterile needles, you
can get them through local needle
exchanges or buy them in bulk
online. Neither of these
options requires aprescription.

Many transmasculine people taking testosterone will notice anincreased sex drive, and your orgasms may feel stronger and more
intense. It may, however, be harder for your front hole to get wet

26

SAFER SEX FOR TRANS BODIESSAFER SEX FOR TRANS BODIES27

SURGICALCHANGES
There are a number of genital reconstruction surgeries available
to trans people, each with unique effects on the body. Some of
the major surgeries are:After vaginoplasty, your surgeon may advise you to wait a while (upto two years) before engaging in certain activities, like anal sex andanal fisting, in order to prevent tearing and other complications.
Your doctor may also give you a set of dilators, which you insert
regularly to prevent the tissue from contracting and your vagina
from shrinking. You can also dilate an hour or two before sex tohelp prevent pain or tightness. Inserting dilators may be difficult or
painful at first; try using a body-safe lube and experimenting to findthe most comfortable angle to insert the dilator. Over time, it will
get easier and less painful.

TRANSFEMININE SURGERIES

TRANSMASCULINE SURGERIES•

Breast augmentation: Implant silicone or saline shells toincrease the size and augment the shape of the chest•

Mastectomy/Chest Reconstruction: Remove excess tissue
from the chest and masculinize its shape•

Facial feminization surgeries (including tracheal shave):Feminize the shape of the face and throat, and reduce theappearance of the Adam’s apple•

Hysterectomy: Remove the uterus and sometimes the cervix•

Bilateral salpingo-oophorectomy: Remove the ovaries andfallopian tubes•

Vaginectomy: Remove the front hole•

Metoidioplasty: Free a dick exposed to hormones from theligaments in the labia to let it hang lower•

Phalloplasty: Form a larger dick (with implant for creating anerection) using skin grafted from the arm, back, or thigh•

Body contouring surgeries: Relocate fat from the torso andarms to the butt and hips to increase curviness•

Orchiectomy: Remove the balls (testes)•

Penectomy: Remove a strapless•

Vaginoplasty: Form all vaginal structures

Many transfeminine people note that it becomes harder tomaintain an erection once their testosterone levels become
lower either by their hormones or having an orchiectomy. In turn,the way you have sex with your partner(s) may need to adapt.
Surgically-created vaginas don’t usually self-lubricate, so you may

28

need to use a body-safe water or silicone-based lube whenever you
insert dicks, fingers or fists. Surgically-created vaginas are also not
as stretchy as front holes and often take more time to “warm up.”

SAFER SEX FOR TRANS BODIES

After metoidioplasty or phalloplasty, you may sometimes pee ateaspoon’s worth of fluid during sex. When you wear an external
condom, make sure to pinch the tip to make space for the fluid. If acondom doesn’t fit snugly, but a finger cot is too small for your dick,you can use a cock ring to keep a condom in place.

SAFER SEX FOR TRANS BODIES

29

RESOURCES:
We can’t possibly cover everything in this guide, but there are
great resources out there with additional information. We’ve
included a few below. You should also consult a trans-competentdoctor for any additional questions you have about transition,
STIs or safer sex. You can use this guide as a tool to start a
conversation with your healthcare provider. This is also a greattime to get support from a peer group. Our trans community isa huge source of knowledge, strength and encouragement as
you experience changes in your body and your life. Good luck,
wherever you are in your journey!

30•

Choosing a body-safe lube:
dangerouslilly.com/lube-guide•Contraception and birth control options:bedsider.org•

Find a testing location:gettested.cdc.gov•

Find safer sex supplies near you:condomfinder.org/find.php•

HIV/AIDS and Safer Sex:
aids.gov/hiv-aids-basics•

Hormones: A guide for FTMs by TransCare•

Hormones: A guide for MTFs by TransCare•

Intimate Partner Violence:
tnlr.org/English•

Safer Sex in BDSM:
actoronto.org/bdsm•

STI information:
thestdproject.com/std-list•

Trans-competent doctors and mental health providers:radremedy.org (this is the only one with listings for DC rightnow): mytranshealth.com; transrecord.com

SAFER SEX FOR TRANS BODIESTRANS PRIDE
FLAG“The stripes at the top andbottom are light blue, thetraditional color for baby boys.
The stripes next to them are pink,
the traditional color for baby
girls. The stripe in the middle iswhite, for those who are intersex,
transitioning or consider
themselves having a neutral or
undefined gender. The patternis such that no matter which way
you fly it, it is always correct,
signifying us finding correctness
in our lives." -Monica Helms,
transgender activist, author,
veteran of the United States
Navy, and creator of the Trans
Pride Flag.

The content of this guide was developed by Bianca Palmisano of Intimate Health Consulting.