ANOVA, Karolinska University Hospital, Norra Stationsgatan 69, Stockholm, Sweden.
Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden.
Nat Rev Urol. 2019 Feb;16(2):121-139. doi: 10.1038/s41585-018-0108-8.
Sexuality is important for most cisgender as well as transgender persons and is an essential aspect of quality of life. For both the patient and their clinicians, managing gender dysphoria includes establishing a comfortable relationship with sexual health issues, which can evolve throughout the course of gender-affirming treatment. Gender-affirming endocrine treatment of transgender men and women has considerable effects on sex drive and sexual function. Gender-affirming surgery (GAS) can improve body satisfaction and ease gender dysphoria, but surgery itself can be associated with sexual sequelae associated with physical constraints of the new genitals or postsurgical pain, psychological difficulties with accepting the new body, or social aspects of having changed gender. In general, a positive body image is associated with better sexual function and satisfaction, but satisfaction with sexual function after GAS can be present despite dissatisfaction with the surgery and vice versa. Factors involved in the integrated experience of gender-affirming treatment and the way in which sexuality is perceived are complex, and supporting sexuality and improving sexual function in transgender patients is, correspondingly, multifaceted. As the transgender patient moves through their life before, during, and after gender-affirming treatment, sexuality and sexual function should be considered and maximized at all stages in order to improve quality of life.
性对于大多数顺性别者和跨性别者来说都是重要的，是生活质量的重要组成部分。对于患者及其临床医生来说，管理性别焦虑症包括与性健康问题建立舒适的关系，这在性别肯定治疗过程中可能会不断发展。跨性别男性和女性的性别肯定内分泌治疗对性欲和性功能有很大影响。性别肯定手术（GAS）可以改善身体满意度，缓解性别焦虑，但手术本身可能会导致与新生殖器的身体限制或术后疼痛、接受新身体的心理困难或改变性别的社会方面相关的性后遗症。一般来说，积极的身体形象与更好的性功能和满意度相关，但即使对手术不满意，也可能存在对性功能的满意度，反之亦然。参与性别肯定治疗的综合体验的因素以及对性的感知方式非常复杂，支持跨性别患者的性和改善其性功能是多方面的。随着跨性别患者在性别肯定治疗之前、期间和之后的生活中移动，应该在所有阶段考虑并最大化性功能，以提高生活质量。
