Initial Psychometric Evaluation of a Brief Sexual Functioning Screening Tool for Transmasculine Adults: Transmasculine Sexual Functioning Index

Abstract

Introduction Evaluation of sexual functioning in transmasculine (TM) adults—those who identify as men, male, transmen, or non-binary yet were assigned a female sex at birth—is limited by lack of availability of brief screening measures. Aim Study aims were to (i) conduct initial psychometric evaluation of a brief screening tool to assess sexual functioning in TM adults for easy use in outpatient visits, epidemiologic studies, and assessment of treatment and surgical outcomes and (ii) assess the correlates of sexual functioning. Methods The 6-item version of the Female Sexual Function Index was adapted and piloted for use with TM adults. The resulting scale, the Transmasculine Sexual Functioning Index (TM-SFI), was administered to 150 TM adults via computer-assisted self-interview. A multivariable model was fit to assess demographic, psychosocial, and gender affirmation correlates of sexual functioning. Main Outcome Measure The main outcomes of this study were the calculated reliability and validity of the TM-SFI and fit cumulative logit models to estimate associations of medical gender affirmation (chest surgery) and body image self-consciousness with level of sexual functioning. Results Internal consistency reliability was good (Cronbach's alpha = 0.80). Item correlations ranged from 0.21 to 0.80 ( P < .05). All scale items loaded onto a single factor (eigenvalue = 11.13; factor loadings > 0.50), evidence of good construct validity. After controlling for potential confounders, participants who had chest surgery exhibited significantly higher odds of being in the highest sexual functioning tertile relative to those without chest surgery (adjusted odds ratio = 2.46; 95% confidence interval = 1.08–5.64; P = .033). Moderate-to-high body image self-consciousness was associated with lower odds of sexual functioning (adjusted odds ratio = 0.42; 95% confidence interval = 0.18–0.94; P = .035). Conclusion Initial evaluation of the TM-SFI warrants formal psychometric validation against clinical diagnoses of sexual functioning concerns in TM patients. The brief screener can be used to assess sexual functioning in TM adults and may identify TM who could benefit from clinical interventions to improve sexual functioning. Reisner SL, Pletta DR, Potter J, et-al. Initial Psychometric Evaluation of a Brief Sexual Functioning Screening Tool for Transmasculine Adults: Transmasculine Sexual Functioning Index. J Sex Med 2020;8:350–360.

Testosterone use and sexual function among transgender men and gender diverse people assigned female at birth

“…For example, other studies have found that access to gender-affirming chest reconstruction surgery is associated with higher sexual function scores, while experiencing barriers to accessing gender-affirming care is associated with lower sexual function scores. 25 Although prior studies have not observed an association between testosterone use and orgasm, 6 testosterone use was associated with a higher ability to orgasm in our study. Notably, we observed that a majority of transgender and gender diverse people AFAB using testosterone (67%) experienced vulvovaginal pain during sexual activity.…”

“…We conducted secondary analyses with a robustly adjusted model that included all covariates that are associated with sexual function and dyspareunia in prior literature, but were not associated with testosterone use in our sample, including history of sexual assault, prior pregnancy, inflammatory bowel disease, irritable bowel syndrome, uterine fibroids, pelvic inflammatory disease, polycystic ovary syndrome, and intrauterine devices. [17][18][19][20][21][22][23][24][25][26][27][28][29][30] Our primary analysis considers current versus never testosterone users. Results comparing former to current users are provided in the Supplementary Materials.…”

“…We broadly considered five categories of covariates that have been previously associated with sexual function among cisgender women and transgender men: structural changes to the pelvis, inflammatory conditions in the pelvis, hormonal influences, mental health, and substance use. [17][18][19][20][21][22][23][24][25][26][27][28][29][30] Structural changes to the pelvis included prior pregnancies, hysterectomy, and uterine fibroids. Inflammatory conditions in the pelvis included pelvic inflammatory disease, inflammatory bowel disease (including Crohn's disease and ulcerative colitis), irritable bowel syndrome, and bacterial sexually transmitted infections (STI; defined as chlamydia, gonorrhea, or syphilis diagnosis in the past year).…”

“Existimos”: Health and social needs of transgender men in Lima, Peru

“…Medical gender affirmation emerged as a high-priority area of unmet need for trans men in this study. Prior research has demonstrated the positive health impacts of medical gender PLOS ONE affirmation, including improved mental health and psychosocial functioning [27][28][29]. Participants reported that lack of publicly funded services for hormone treatments and surgery in Peru was a barrier to their self-actualization.…”

Avaliação da função sexual de pessoas com incongruência de gênero: um estudo transversal

“…O tempo de TCH da amostra foi de dois anos e meio para os homens e cinco anos para as mulheres, sendo que os homens fizeram uso de Cipionato de testosterona intramuscular 200mg/2ml diário a cada 21 dias, e as mulheres Valerato de estradiol via oral associada à Ciproterona 25 mg/ dia. Functioning Index (TM-SFI) para homens trans, operados ou não (32). A maioria dos participantes do nosso estudo não realizou a cirurgia de afirmação de gênero, o que motivou a aplicação de um questionário semiestruturado em associação ao FSFI e MSFI, uma vez que ambos não foram validados para a língua portuguesa.…”