Becker, Inga

Elaut, Els

Heylens, Gunter

Kerckhof, Mauro

Kreukels, Baudewijntje

Nieder, Timo

van de Grift, Tim

Ghent University Academic Bibliography

Results from the European Network for the Investigation of Gender Incongruence (ENIGI)Mauro Kerckhof1, Baudewijntje Kreukels², Timo Nieder³, Inga Becker³,4, Tim van de Grift5, Gunter Heylens1 & Els Elaut1.1 Department of Sexology and Gender, Ghent University Hospital, Belgium .2 Department of Medical Psychology, Center of Expertise on Gender Dysphoria, Amsterdam UMC, location VU University Medical Center Amsterdam, The Netherlands.3 Interdisciplinary Transgender Health Care Center Hamburg, Institute for Sex Research and Forensic Psychiatry, University Medical Center Hamburg-Eppendorf, Germany 4Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, University Medical Center Hamburg-Eppendorf, Germany5Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC, location VU University Medical Center Amsterdam, The Netherlands Contact: mauro.kerckhof@ugent.beINTRODUCTION: Research shows higher prevalence rates of sexual dysfunction (including the experience of distress) in transgender persons after Gender Confirming Interventions (GCI), compared to the general population. Less is known on the relation of different sexual dysfunctions and sexual pleasure. Possibly, this relationship differs between individuals in different treatment trajectories and also between individuals with or without a current relationship.METHODS: This study is part of the ENIGI (European Network for the Investigation of Gender Incongruence) follow-up study. An online survey was presented to transgender persons four to six years after first clinical contact in the gender clinics of Amsterdam, Ghent or Hamburg. The participants filled out the Amsterdam Sexual Pleasure Index (ASPI) (Werner, Gaasterland, van Lunsen & Laan, in press), a recently developed questionnaire to measure sexual pleasure (total score range 1-6), and answered a broad range of questions about sexual problems (including distress criteria). A sexual dysfunction (problem with distress) was differentiated from a function disturbance (problem without distress). 324 individuals filled out data on sexual pleasure, 254 individuals (126 trans women, 128 trans men) indicated to be sexually active in the last 6 months.RESULTS: Multiple regression analyses predicting sexual pleasure, with a separate model for each sexual dysfunction, did not find significant interactions between treatment group and sexual dysfunction, or between relationship status and sexual dysfunction, except for vaginal cramp. As a result, interaction terms were left out of the subsequent regression models, except for vaginal cramp. A stepwise multiple regression analysis was used to calculate R² changed after adding the different sexual dysfunctions in the model. The models in which the sexual dysfunction significantly contributed to explain variance in sexual pleasure are shown in table 1.The relation between sexual dysfunction and sexual pleasure in transgender individualsTable 1. Multiple regression resultsSexually active trans women: Sexually active trans men: Model (block 1)Sexual aversion Arousal difficultiesPain aftersexualintercourseVaginal cramp³Model (block 1)Sexual aversionArousal difficultiesOrgasmdifficultiesBleeding during or after intercourse³Vaginalcramp³Beta Beta Beta Beta Beta Beta Beta Beta Beta Beta BetaConstantNo relationship vs. relationship 0,108 0,021 0,081 0,064 0,198 0,351*** 0,320** 0,352*** 0,313** 0,314** 0,386**Treatment group² 0,066 0,024 0,008 0,102 0,175° 0,137 0,147 0,203*No problem vs. Dysfunction -0,355*** -0,319** -0,337** 0,023 -0,170° -0,187* -0,210* -0,377** -0,312**No problem vs. Function disturbance -0,245** -0,141 -0,101 -0,209* -0,139 -0,185* 0,139Dysfunction*No relationship -0,314*R Square Change 0,155 0,102 0,114 0,089 0,063 0,049 0,068 0,166 0,094R-squared 0,017 0,168 0,109 0,121 0,115 0,160 0,218 0,221 0,232 0,255 0,200Adjusted R-squared 0,000 0,132 0,075 0,084 0,08 0,144 0,184 0,189 0,202 0,217 0,176No. Observation 117 97 109 100 79 110 97 104 106 62 68Final model (stepwise regression): block 1 + block 2 (no problem vs. dysfunction; no problems vs. function disturbance)*, **, *** indicates significance at the 95%, 99% and 99,9% level, respectively. ° indicates marginally significant effect 0,05<p<0,06²: Trans women: HT-group vs. VA-group [HT-group: hormonal treatment; VA-group: hormonal treatment and vaginoplasty]; trans men:  MA-group vs. PH-group. [MA-group: hormonal treatment and mastectomy; PH-group: hormonal treatment, mastectomy and phalloplasty]³:Model for trans men in MA-group. Model for trans women in the VA-group. Function disturbances are not presented.CONCLUSIONS: The association between dysfunction and sexual pleasure was not different across treatment groups or relationship status, except for vaginal cramp in trans women. Trans women experiencing sexual aversion, arousal difficulties and pain after sexual intercourse, reported less sexual pleasure. Trans women experiencing vaginal cramp after genital surgery, also reported less sexual pleasure, but only when in a relationship. Orgasm difficulties in trans women were not associated with sexual pleasure. Trans men experiencing sexual aversion, arousal difficulties and orgasm difficulties, reported less sexual pleasure. For trans men who did not have genital surgery, the experiences of bleeding during or after intercourse and vaginal cramp were negatively associated with sexual pleasure. Trans men and trans women experiencing sexual aversion without self-report of distress, also reported less sexual pleasure. Vaginal cramp and bleeding were the two dysfunctions that were most strongly associated with lower sexual pleasure.

The relation between sexual dysfunction and sexual pleasure in transgender individuals

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The relation between sexual dysfunction and sexual pleasure in transgender individuals

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