• Sexual Health Shanghai

Transgender

Transgender Men and Women
Persons who are transgender identify as a gender that is not congruent with the sex they were assigned at birth. Transgender women (“trans-women” or “transgender male to female”) identify as women but were born with male anatomy. Similarly, transgender men (also referred to as “trans-men” or “transgender female to male”) identify as men but were born with female anatomy. However, transgender persons might use different and often fluid terminology to refer to themselves through their life course. Gender identity is independent from sexual orientation. Persons who are transgender might have sex with men, women, or both and consider themselves to be heterosexual, gay, lesbian, or bisexual. Prevalence studies of transgender persons in the overall population have been limited and often based on small convenience samples.

Transgender Women

A systematic review of studies of HIV among transgender women suggests that the prevalence of HIV in the United States is 27.7% among all transgender women and 56.3% among black transgender women (214). Data also suggests high rates of HIV among transgender women globally (215). Bacterial STD prevalence varies among transgender women, but is based largely on convenience samples. Providers caring for transgender women should have knowledge of their patients’ current anatomy and patterns of sexual behavior before counseling them about STD and HIV prevention (216). Most transgender women have not undergone genital affirmation surgery and may retain a functional penis (217-219); in this instance, they might engage in insertive oral, vaginal, or anal sex with men and women.

Transgender Men

The few studies of HIV prevalence and incidence in transgender men suggest that although some transgender men engage in risky behaviors, they have a lower prevalence of HIV than transgender women (220). Providers should consider the anatomic diversity among transgender men, because many still have a vagina and cervix and are at risk for bacterial STDs, cervical HPV, and cervical cancer (221).

Recommendations

Clinicians should assess STD- and HIV-related risks for their transgender patients based on current anatomy and sexual behaviors. Because of the diversity of transgender persons regarding surgical affirming procedures, hormone use, and their patterns of sexual behavior, providers must remain aware of symptoms consistent with common STDs and screen for asymptomatic STDs on the basis of behavioral history and sexual practices.

Useful Resource

  • Shanghai Public Health Clinical Center | shaphc.org
  • Shanghai Municipal Center For Disease Control & Prevention | scdc.sh.cn
  • Shanghai Skin Disease and STD Hospital | shskin.com

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