Scientific Society Symposium
Transgender persons suffer infinitely from the discrepancy between gender identity and physical status. The social, emotional and physical transition process is supported psychologically, with cross-sex hormones and gender-affirmative surgery but despite all efforts physical limitations remain. Prior to and while transitioning imagining of sexual activities and feelings of the desired gender are common. Sexual phantasies and expectations are often characterized by stereotypes. It is part of preparatory work-up with sexuologists to establish realistic views on sexuality in order to avoid confusion and disappointment. Transgender persons are prepared to do almost everything to become a ´real´ man or woman. Appearance of genital organs and functionality are of utmost importance for transgender persons but these organs also are visible proof of succesful transition. Dysfunctional genitals cause extreme feelings of frustration as these constructs mirror the gender identity. In transwomen to date´s standard surgical procedures ( penile inversion technique) show extremely satisfying results in terms of appearance and functionality. Sexuality can be affected negatively by the narrow anatomy of the male determined pelvis or by the on-going shrinkage process of the neovagina. Orgasm is almost always possible. More problematic is the fact that transwomen post sex reassignment surgery miss circulating androgens causing libido loss. To overcome this problem androgen add-back in ultra low dosages are offered but acceptance is poor. For most transmen the ability to penetrate is regarded as the ultimate goal. As a matter of fact it is the exemption rather than the rule. For the creation of a neophallus major surgery is required with very high rates of complications. Thereafter a erection prothesis is needed. To maintain sexual feelings and potentially orgasm some transmen content oneself with the creation of a metadoioplasty, a small penis constructed from the enlarged clitoris and labia. Appearance is male and the ability of orgasm is intact but peeing while standing and penetrative intercourse are not possible. Other transmen use the intact vagina for sexual activities while for others the vagina is a no-go area. Sexuality of transpersons is extremely heterogeneous, partly characterized by the inherent limitations of the transitional process, partly influenced by gender stereotypes , and often neglected by both transpersons themselves and professionals.