ABSTRACT
Objective: This descriptive study aimed to assess the
prevalence and characteristics of pelvic pain and explore predictive
factors for pelvic pain in transgender (trans) individuals using
testosterone therapy.
Design: Cross-sectional survey.
Setting: Online.
Sample: Trans people presumed female at birth, using
testosterone for gender-affirmation, living in Australia, and aged
> 16 years.
Methods: Logistic regression was applied to estimate the effect
size of the possible factors contributing to pain after starting
testosterone.
Main Outcome Measures: Prevalence and characteristics of pelvic
pain following initiation of testosterone therapy, type and length of
testosterone therapy, menstruation history, and relevant sexual health,
gynaecological and mental health experiences.
Results: Among 486 participants (median age 27 years), 351
(72.4%) reported experiencing pelvic pain following initiation of
testosterone therapy, described most commonly as in the suprapubic
region and as “cramping”. Median duration of testosterone therapy was
32 months. Persistent menstruation, current or previous history of
post-traumatic stress disorder, and experiences of pain with orgasm were
associated with higher odds of pelvic pain after testosterone therapy.
No associations were observed with genital dryness, intrauterine device
use, previous pregnancy, penetrative sexual activities, touching
external genitalia, or known diagnoses of endometriosis, vulvodynia,
vaginismus, depression, anxiety, or obesity.
Conclusions: Pelvic pain is common in trans people following
initiation of testosterone therapy. Given the association with
persistent menstruation and orgasm, as well as the known
androgen-sensitivity of the pelvic floor musculature, further research
into pelvic floor muscle dysfunction as a contributor is warranted.
Tweetable Abstract: Pelvic pain is common in transgender people
using testosterone
Funding: ASC is supported by a NHMRC Investigator Grant
(#2008956). LMA is supported by the Research Training Program
Scholarship from the Australian Commonwealth Government.
Keywords (MeSH): Transgender persons; pelvic pain;
testosterone; androgens; menstruation disturbances; sexual activity;
sexual function