Safe sex for transgender people

Reviewed by our clinical team

Whether you’re trans, non-binary or cis, safe sex is essentially down to using a condom to avoid getting an STI or getting yourself or your partner pregnant. However, trans people have some additional factors to bear in mind.

For a guide to the basics of staying safe, read on.

How STIs spread

The first thing to know is that sexually transmitted infections can be spread in a number of different ways – not just through penetrative sex. Bacteria and viruses are carried in semen and "pre-cum" (pre-ejaculatory fluid), vaginal fluid, anal fluid and blood. Some infections can also spread through skin-to-skin contact.  

With this in mind, you can catch STIs from any of the following:

• Vaginal sex (also known as frontal sex) 
• Anal sex 
• Oral sex and rimming 
• Fingering 
• Sharing sex toys 
• Intimate touching

Using condoms

The best and easiest way to protect yourself from STIs is to use condoms. There are two types of condoms, usually known as “male” and “female” – although it’s easier to think of them as “external” and “internal”.

External (or “male”) condoms are designed to go over the penis or to cover a sex toy. Internal (or “female”) condoms are designed to go inside the vagina/front hole or anus.

In addition to keeping you safe from a number of STIs, including HIV, chlamydia and gonorrhoea, condoms can also protect against pregnancy.

However, it’s worth noting that condoms alone can’t protect you from all STIs. Infections like genital warts and genital herpes are spread via skin-to-skin contact, which means you might be exposed even if you’re using condoms.

Are trans people more at risk of STIs?

It is thought that worldwide trans people are 49% more likely to be living with HIV than the general population. In some parts of the world this might be due to more overt discrimination leading to a reluctance to get tested, fear of recrimination and being cast out by their communities. Difficulties with condom use might also be a contributing factor.

If you are a trans person who's recently had gender affirming surgery (also known as "lower" or " bottom" surgery), your risk of catching an STI is also higher. This is because the newly created or (removed tissues) are delicate and more prone to bleeding. You might also be engaging in different or perhaps riskier sex. 

How to protect yourself if you’re a trans woman

If you’re a trans woman who hasn’t had lower surgery, it’s a good idea to use external condoms during sex with a new or casual partner – i.e. anyone who might have an STI that you don’t know about. You can also use external condoms to cover sex toys. 

If you have had lower surgery, you might be able to use internal condoms, although it depends on the depth of your vagina. You can also use internal condoms for anal sex.

In addition, trans women can benefit from the following: 

• Water-based or silicon-based lube, which helps prevent discomfort, pain and tearing during sex, as well condom breakage 
• Dental dams, thin squares of flexible latex which can be placed over the genitals or anus during oral sex or rimming 
• Latex gloves to be worn when you’re fingering your partner 

How to protect yourself if you’re a trans man

As with trans women, condoms are the best option for trans men who want to stay safe in the bedroom, and how you use them will depend on your personal situation.

External condoms can be worn over a surgically-constructed penis or a sex toy. Internal condoms can be worn inside the vagina/front hole or inside the anus. In addition, you can use dental dams and latex gloves to offer further protection from STIs.

What to do if you’ve recently had gender-affirming surgery

For trans women and trans men who have recently had lower surgery, there are some extra precautions to bear in mind. 

Unhealed skin can make it easier for you to acquire HIV and other infections during sex. Trans women might have some bleeding as a result of using vaginal dilators, while trans men might be more susceptible to tearing and bleeding as a result of hormone therapy.

While healing or when experiencing any bleeding, you should be extra careful to use condoms – especially if you aren’t sure about your partner’s HIV status (2). 

More tips for safe sex 

Other than using condoms, lube and dental dams, remember the following: 

• Avoid sharing sex toys unless you’re cleaning them between uses or covering them with a fresh condom 
• Avoid sex if you spot any new symptoms like sores, blisters, rashes or unusual discharge in yourself or your partner 
• Avoid fingering if you have cuts or sores on your fingers 
• Avoid oral sex if you have sores in your mouth or bleeding gums

It’s also a good idea to get tested for STIs regularly if you’re having sex with new or casual partners. Easy home test kits are available from Online Doctor. 

If you think you might be particularly high-risk for HIV you can speak to a healthcare provider about using a preventative medication called PrEP (pre-exposure prophylaxis). Learn more from the Terrence Higgins Trust website.

Where to get more support

If you’d like to get more advice about sexual health, you can visit your nearest NHS sexual health or GUM clinic. The Terrence Higgins Trust also has centres around the UK where you can get advice and STI testing.

If you need advice, information or support about a range of issues that affect trans people it's worth checking out the resource page of Terrence Higgins Trust website - they have a list of up-to-date charities and resources.

References

https://www.tht.org.uk/hiv-and-sexual-health/sexual-health/trans-people/trans-feminine/safer-sex
https://www.nhs.uk/live-well/sexual-health/sex-activities-and-risk/
https://www.tht.org.uk/hiv-and-sexual-health/sexual-health/trans-people/trans-masculine/safer-sex
https://www.avert.org/professionals/hiv-social-issues/key-affected-populations/transgender