Trans woman

"The most frequent sexual dysfunctions experienced by trans women and trans men were difficulties initiating and seeking sexual contact (26% and 32%, respectively) and difficulties achieving an orgasm (29% and 15%, respectively). Compared with trans women after hormone treatment and non-genital surgery, trans women after vaginoplasty less often experienced arousal difficulties, sexual aversion, and low sexual desire. Compared with trans men without medical treatment, trans men after a phalloplasty experienced sexual aversion and low sexual desire less often."

"Multiple studies have compared sexual arousal levels of trans women post-operatively with sexual arousal in cisgender women. In these studies, 90–100% of trans women reported experiencing sexual arousal post-operatively, but when level of sexual arousal was assessed using the Female Sexual Function Index (FSFI), sexual arousal scores were overall lower in trans women than in their cisgender counterparts."

"In trans women who have initiated hormone therapy, but who have not undergone genital reconstruction surgery, difficulty in achieving orgasm was seen to decrease. In one study, the prevalence of orgasmic dysfunction decreased to 29.2% from 46.7% after the initiation of hormone therapy. Whether this finding can be attributed to the simultaneous decrease in gender dysphoria and body dysmorphia associated with the initiation of hormone therapy still needs to be investigated. Ability to orgasm in trans women post-vaginoplasty has also been studied. Due to the unique anatomy of trans women post-operatively, it must be noted that orgasms can occur at multiple locations including the clitoris and prostate via masturbation or vaginal penetration, for example. There is variability in the rates of orgasm post-operatively with studies citing percentages between 40–100%. These studies used the FSFI to assess orgasmic scores and demonstrated ranges of 2.82 to 4.0 out of 6 in comparison to cisgender women without sexual dysfunction who scored an average of 5.1. When analyzing the correlation between sexual activity and achieving orgasm, one study found that direct stimulation of the clitoris had a higher frequency of orgasm when compared to intercourse. In assessing frequency and quality of orgasms post-operatively, studies are inconsistent. While one study reported an increase in orgasm frequency with sexual activity post-operatively, another study of 91 trans women postoperatively found orgasms to occur less frequently in 52.6% of participants and more frequently in 20.5% of participants. Quality of orgasms, when investigated, was found to be more pleasurable postoperatively in 51% of a 218 person study and with no changes in 62.5% of a 31 person study."

"Trans women are much more likely to report sexual arousal without orgasm, and lower levels of sexual desire in general. Studies with trans women in particular find a wide variance in ability to experience orgasm post vaginoplasty surgery, ranging from 17-100% across 140 different studies. However, these studies are focused mostly on adults who transitioned in adulthood. At this time, there do not appear to be any studies which examine sexual health or orgasmic experience in trans individuals who initiated affirmative treatment prior to adulthood or the onset of puberty."

"Research exploring the lived experience of sexuality for trans women is limited, with conceptualizations focusing largely on exploring deficits or the impact of gender-affirming medical care, such as hormone therapy (HT) and/or surgeries."

"A further study highlights that as many as 26% of a sample of 307 trans women reported difficulties initiating sexual contact, 29% reported difficulties achieving orgasm, and that vaginoplasty was associated with a reduction in difficulties with sexual arousal and sexual aversion (Kerckhof et al., 2019)."

"Research into the impact of transition on sexuality reports that, following the commencement of HT, some trans women experience a temporary change in sexual desire (Defreyne et al., 2020). Research has found that trans women are less likely to engage in sexual activities before accessing gender-affirming care (Scheim & Bauer, 2019), and some experience a reduction in sexual activities after starting HT (Knezevich et al., 2012). Rosenberg et al. (2019) also found a difference in orgasm experience after commencing HT in trans women. One clinic-based study further found that as many as 32% of trans women may experience a change in sexual orientation during medical transition (Auer et al., 2014). Barcelos et al. (2022) conducted a systematic review of the available literature concerning trans women’s sexual functioning. They found that, of the 17 available studies, there was a large divergence in how sexual functioning was measured, and overall, there was limited evidence that gender-affirming surgery improved sexual functioning overall."