Trigger warning: Genitalia mentions, I’ve tried to keep it as clean as possible
Many of us are aware that when it comes to health care while being trans, our options are limited and often inaccessible. There isn’t much information out there, and it can often be tainted by people using scare tactics to prevent us from medically transitioning or accessing the correct health care resources. Therefore, I became excited when trans health care – for both AMAB and AFAB trans humans – had an entire chapter in a book about vaginal health.
‘The Vagina Bible’ by US OB-GYN Jen Gunter has so far been an incredibly useful read and I thought it would be valuable to pass on the information about transition to those who would most benefit from it. If you are interested in reading the book for yourself, I can so far recommend it, but warning, the language throughout most of the book appears to be cisnormative. This chapter however was mostly spot on for using the correct terminology to refer to certain groups of people and gives me hope in accessing health care for myself in the future. (Not too much hope though, as it is a very binary look at transitioning, and it should go without saying that non-binary people should be able to use hormones or get surgery as part of their transition if they want to, even if this book doesn’t mention them, ☹).
I would also like to disclose that I have not sought medical transition and I do not plan to, so I cannot provide any first-hand accounts, but there are YouTube videos and online resources that can provide more information if you would like it. Additionally, as Jennifer Gunter is US based, the things I describe might not be available on the NHS / UK private, so speak to your doctor about the options you have, this is more of a general guide / advice. Finally, do not take my word above that of your doctors. I have tried to avoid giving out any medical advice as I am a biology undergraduate not a fully qualified doctor.
Trans Men and AFAB Enbys
Okay so first, the clitoris grows more than I thought it did, 4.5cm is the average length when fully grown while on T and pre surgery. I’m sorry for being so explicit so early on, but I feel like the impression I was given was that it would be much smaller, so this shocked me.
Secondly, testosterone messes up the vaginal bacteria. The bacteria in the vagina has two roles – maintain the pH of the vagina and provide protection – and T screws up both functions. The symptoms are all surrounding discomfort and changes in discharge and can arrive as early as 3 months after starting T and peak at around 2 years. As the changes can lead to increased risk of STIs and issues with cervical screenings (discussed later), there is treatment available to help manage this, mainly vaginal oestrogen. Vaginal E is NOT absorbed into the blood stream and so will NOT affect the changes made by T beyond the vagina (the internal bit). There are a few different methods available you can use to help reduce dysphoria surrounding this treatment.
Third, even if you are on T, or if you’ve had a partial hysterectomy that left the cervix (known as a supracervical hysterectomy), you still need to get cervical screenings! As I mentioned above, you are more at risk for STIs if you are on T, and therefore it is even more important to go for the regular check-ups from age 25, regardless of your sexual history and activity. (Note: some trans men may find having male gender marker causes NHS screening appointments for cervical screenings to get cancelled automatically or reminders about them to be discarded by cisnormative computer systems and/or uneducated staff, but if you speak to a competent GP, you can get around this and still access cervical screenings). The negative effects of T that can make the screenings harder to do and get useable results from occurs 6 months after starting T, so it is recommended you get a screening done before you start T if possible, as then you don’t need to get another one for another 3 years. Vaginal E can make the process more likely to be successful, and at home HPV tests are available if these aid people in feeling more comfortable. Also, get vaccinated if it is possible for you to do so. (The vaccinations are on the school vaccine programme in the UK, so most AFAB people will have been vaccinated).
Finally, testosterone does not stop periods right away, and while it does pause fertility, T does not make you infertile any more than regular hormonal contraception does. If T levels are kept consistent, within the range of a typical cis male, periods typically stop after a few months and even if they don’t, they do typically become lighter.
Trans Women and AMAB Enbys
Most of this section of the chapter was surrounding the various options for surgery to create a vagina from what the body has already, using cells from many different parts of the genital and anus region. I feel like a public blog post isn’t the place to write about this, but I will send the information to people on request if they wish, leave a comment below, DM me on Facebook / twitter / Instagram or send me an email. There is still a lot of research being done and needing to be done into how to make trans AMAB bottom surgery as successful as possible, but it is generally a very successful surgery. 75% of post-surgery trans women / AMAB non-binary people are sexually active and 70-80% can achieve orgasm. This is not to say that sex is important, nor that orgasms are always the goal of good sex, but statistics like these show that the outcomes are generally functional and hopefully give hope to people who are looking into but are worried about surgery results.
Due to the nature of the vagina made and the body parts used to create it, a trans AMAB vagina creates different discharge to an AFAB vagina, and has a different internal environment. This means it is safe and sometimes recommended to clean the vagina, please speak to your doctor if you have any concerns and how you should go about doing this, I AM NOT A DOCTOR.
AMAB bottom surgery is a big commitment and is not one that should be taken lightly. It requires hair removal with electrolysis that can take a year, no nicotine consumption for 3 months either side of surgery to maximise blood flow and a minimum of a year up to lifelong dilation is required. There are more mild surgery options available should someone prefer these. This is not to scare you out of getting full bottom surgery if that’s what you want, but to reduce stigma and fear due to lack of knowledge.
I hope you find this information useful, and/or interesting, even if you are cis or do not wish to medically transition. There is no one way to be trans and all bodies are valid regardless of gender identity. Let me know if you have any questions, either in the comments below, in dm or email.
By Taylor Adams
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