Abstract
Introduction Sexual dysfunctions (SD) are a common issue for transgender-identified individuals and may persist despite access to gender-affirming care. Healthcare disparities experienced by transgender and gender-diverse people (TGDP) are often overlooked. Data on the prevalence of SD in TGDP from representative samples are rare, and little is known about the help-seeking behavior and healthcare needs regarding sexual problems in this subgroup compared to the needs of cisgender women (CW) and men (CM). Patient and Public Involvement can improve the quality and impact of research on under-researched topics.
Objective This study aims to investigate the prevalence of SD in TGDP in the German population and to compare sexual health and healthcare needs between TGDP and the groups of CW and CM.
Methods This cross-sectional study used data from an online survey with a sample representative of the German population in terms of gender, age, and federal state. ICD-11 criteria and FSDS-DAO were used to assess sexual health outcomes. Questionnaire items on gender, risk factors for SD, and healthcare needs were developed in collaboration with a culturally and gender-diverse group of eight external co-researchers and advisors following the patient and public involvement methodology. Outcomes were examined by gender group. Participants who reported identification with a gender different from their gender assigned at birth, a non-binary gender, a diagnosis related to gender incongruence, and/or variations of sex development were assigned to the TGDP group.
Results Data from N=4,023 participants (CW: n=1,985, CM: n=1,815, TGDP: n=223) were collected with a mean age of 49.0 years (SD = 16.5). The 6-month prevalence of sexual dysfunction (SD) according to ICD-11 criteria was considerably higher among TGDP (34.4%) compared to CW (16.3%) and CM (16.6%), as reflected in the FSDS-DAO scores of the TGDP subgroup (M = 21.1, SD = 15.3), CW (M = 11.1, SD = 12.4), and CM (M = 12.3, SD = 12.7). The demand for information regarding sexual problems among those experiencing SD was more frequently reported by TGDP (67.5%) than by CW (44.0%) and CM (47.3%), with an odds ratio of 4.3 for TGDP vs. cisgender. Across all gender groups, the most preferred source for information was online research, followed by peer networks (29.0%) and friends (26.5%) in the TGDP group, in contrast to healthcare providers and partners for CW and CM. The most desired dialogue partners among healthcare providers (HCP) were urologists and general practitioners in TGDP (26.4% and 23.9%) and CM (37.3% and 25.4%), and gynecologists (36.0%) and psychotherapists (11.5%) for CW. Among TGDP with SD, 49.9% had undergone therapy for sexual dysfunctions (in CW 10.2%, in CM 15.2%), with psychotherapy (36.0%) being the most frequently reported treatment. The TGDP group showed higher needs for information and help, identifying the lack of services considering individual needs related to culture, gender identity, physical illness, and mental health conditions as the primary barriers to care. Diversity sensitivity training for HCPs, drug developments, improved resources, and 'blended care' solutions that encompass both digital and physical procedures were identified as the most urgent developments to improve care for sexual dysfunctions.
Conclusions The results indicate the alarming extent of the burden of SD for TGDP. Furthermore, the findings emphasize the importance of tailored interventions that acknowledge and address the diverse needs of TGDP.
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Who knew that screwing around with your natural hormones, physiology and sex characteristics would have downstream consequences for your sexual function?
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