“Oh yeah, that’s definitely vaginal atrophy,” my gynecologist said. She was staring at my vag under a spotlight as I sat there in a paper hospital gown that had already torn multiple times. For months, I’d been experiencing pain when I peed or tried to bottom. I thought it was just frequent UTI’s, so I’d chug water or use amounts of lube that are probably illegal in some states. That would help for a little bit, but the discomfort would return.
This whole situation felt set up to personally embarrass me, but I was happy to finally have clarity. “Yeah, it looks painful even to the touch,” my gynecologist continued.
“Well, some of that redness is the atrophy, and some of it is maybe due to me scrubbing profusely before any appointment where I know I’ll be presenting my hoo-ha,” I said, chuckling.
My gynecologist did not laugh.
When I got this diagnosis, I was thirty and had been on testosterone for five years. Until I found a medication that alleviated my pain, I was a legally mandated top. I put on my clothes and left the doctor’s office feeling cheated. Why, in my prime sexing years, can I not have the sex I want? Why have I had to give up so much (bodily, socially, politically) to transition? Why, really, am I so bothered by this news? I took my frustrations to my therapist and Google.
After forty-ish minutes of monologuing to my therapist (bless their heart), I realized my sexual life is inextricably linked to my transition. I spent fifteen years trying to be a cis straight girl and, because of my own insecurities about my gender and sexuality, I didn’t have sex at all. Then I tried being a stud for eight years, and it was expected — by my lovers and friends — that I was the top. If I even insinuated being open to getting topped or eaten out in high school, my stud bros would say “that’s gay” (yes, we were all indeed gay, but “that’s gay” meant that I was being “too gay”). Taking dick (even if it was plastic) was the biggest insult a stud could receive back then. My stud bros regurgitated what they learned from the men in their life, and I was right alongside them, letting this internalized queerphobia dictate how I performed in the bedroom. I didn’t allow myself to receive any type of pleasure that could potentially get me ridiculed, so I spent these nine years topping out of adherence to gender norms.
I didn’t start having sex that was not strictly “me = top, femme = bottom” until after college. Only then, when I realized I was nonbinary and trans, did I become more sexually free. I started sleeping with people across gender, genitalia, and sexual positions, which helped me learn what I really wanted from sex. It was possible, I learned, to have orgasms initiated by people that were not my own right hand!
After nine years of bad sex, I finally felt myself enough to bottom. To then lose that option entirely hurt me. I had to give up my sexual freedom just years after I gained it, and to add insult to injury, this news came to me during an embarrassing appointment at the gynecologist.
And sadly, I’m not alone. According to Folx Health, vaginal atrophy—which refers to the thinning and drying of the vaginal lining—is very common among trans men, trans masculine people, and other AFAB nonbinary or intersex folks on T. Despite this, most medical research about vaginal atrophy revolves around the experiences of cis women going through menopause and/or breast cancer treatment. This lack of research on trans, nonbinary, and intersex people, people who have worked hard for their gender and sexual freedom, leads to more people like me either not being told about this risk before starting T, getting bad advice from doctors, relying on their community for solutions, or accepting a lack of fulfillment in their sex lives. I’ve talked to other trans, nonbinary and intersex folks on T about vaginal atrophy, and we have all experienced one or more of these things.
I’m privileged enough these days to go to a gyno at an LGBTQ+ center, so they have some baseline understanding of trans gynecological health. Most trans, nonbinary, intersex folks in today’s America (where trans healthcare is getting defunded and stigmatized left and right) don’t have this. When I move to a new state for a job soon, there’s no guarantee that I’ll have this anymore either. For years, it was hard for me to even find a gyno who didn’t assume I was there “for my wife” when I walked in the door — let alone a gyno that was competent in LGBTQIA+ care. This is a societal failure.
Even with this new condition, my transition has been worth it. I’m more free than I’ve ever been to be shirtless, wear the clothes I want to, and interact with others and myself with more confidence. I carry my body around like it’s something to be proud of; my social circles are more reflective of my values. Gone are the days where I feel like my body is not mine to have nor share with others. Transition has brought upon a lot of loss — of friends, and rights, and labels, and sex positions — but my transition has given me so much to love about my life still.
I’m on a low dose of estrogen for my atrophy now and have found some positive results, but I know that even if I never got to bottom again, transitioning was what I needed to do. But I shouldn’t have to choose between sex and my gender; no person on HRT should. I hope that the research for vaginal atrophy begins to include people like me so that all of us with this condition can be physically, emotionally, and sexually free. People like me deserve to have our desires fulfilled — in the bedroom and beyond.
Comments
Thank you for writing about this. Vaginal pain is not talked about often enough. I have it for other reasons, didn’t even know that being on T could cause this but it makes sense.