Medical and psychological treatment practices regarding trans women's sexual health: A review of the international literature

Objectives.-To understand the place of, and the evolutions in, medical and psychological treatment for trans women's sexual health, within the framework of gender transition/affirmation processes. Method. - A narrative review of the medical, psychiatric, and psychological literature. After selection, 19 articles were analyzed inductively using grounded theory and classical methods of thematic content analysis. Results. - Most of the articles reviewed establish a relative lack of research on the topic of sexual health and well-being. Sex reassignment surgical treatments significantly increase the quality of sex life for trans women, except when a "neovagina" is constructed. Changes in sexual orientation are not always linked to elements of treatment, but appear to be linked to other psychosocial factors. Discussion. - Categories of sexual orientation are as fluid as sexual practices and gender and change over the course of a subject's lifetime. The discursive construction of gender and sexual orientation is located within the singular discourse of a particular individual at a given moment of her evolution. Conclusions. - After having long been considered a central element in the diagnosis of "transsexualism", the issues of sexuality and, in particular, of sexual orientation currently appear to be little taken into account by those professionals who accompany trans people on their medical pathway. This absence is strongly criticized by the authors of the main literature reviews that have already been published. They suggest a more serious clinical consideration of trans women's singular sex lives. It is also observed that the practice of genital reassignment surgery no longer occupies the central place it did until recently, and that the question of sexuality is posed independently of anatomical modifications of the genitals. (C) 2021 Published by Elsevier Masson SAS.