Let’s Talk About Trans Sex


To date, the sexuality models and interventions utilized in therapeutic fields are often constructed based on binary, heterosexual, cisgender coitus (Iantaffi & Benson, 2018)—leaving those in same sex relationships, those with different abilities, those with multiple partners, and those with various gender and sexual identities, excluded from the conversation. Specifically, trans people are often neglected, as they are not afforded the same sexual privilege as cisgender clients, a topic that is often dismissed in sexuality research.

Overall, expanding sexology research and discussions to include trans sexuality can expand clinical awareness and offer affirmation to all clients. There are many positive outcomes for therapists that are clinically knowledgeable and affirmative when working with trans clients and their partners’ diverse sexual scripts.

Historically, literature focusing on transgender sexuality was rare, yet rich, such as Harry Benjamin’s (1966) autobiographical accounts from trans patients. There has been a recent shift in literature, in which trans identities are described as resilient and normal, yet sexuality discussion remains minimal beyond postoperative sexual outcomes.

Even medical language, although subjective, represents a misunderstanding, as gender dysphoria is used to label the trans experience, however it is not the gender that is dysphoric, rather the body.

Misunderstandings are also represented in the media by over sexualizing trans people through pornography that is not trans produced and trans positive. Additionally, the media has created a streamlined understanding of physical transition with hormonal and surgical interventions; this inaccurate linear process discounts variations in transition and non-binary gender identities. Additionally, by focusing on physical transition, we ignore the distressing psychological experiences. Trans people may experience the incongruence of the mind and body, creating complex layers of body dysphoria (Martin, 2020). Congruence obtained through hormones and/or surgery may lessen body dysphoria, yet these layers may still create distress during sex and with sexual partners.

Sexology needs to go beyond cisheteronormativity. There is a greater need for positive trans sexual inclusivity from both the clinical and research world.

Layers of dysphoria

As a researcher, I explored the intersections of body dysphoria and sexuality for trans people. Through accounts from thousands of participants (Martin, 2020), I have noticed the process in which trans people negotiate their body dysphoria during sexual experiences. The three common themes that continuously arise include: 1) mental, 2) physical, and 3) relational. Traditional sexuality research and interventions often provide techniques geared towards cisgender clients. However, for trans clients who may not have the body that aligns with their internal identity, it is important that therapists are equipped with the knowledge around sexuality for trans clients.

It is important that therapists understand the impact of body dysphoria on mental health, which may often lead to depression or anxiety. Unpacking it begins with the mental experience of negotiating body dysphoria. During sex, an added piece for trans people is learning how to mentally navigate body dysphoria. This powerful, yet debilitating experience is often driven by connections of mental representations, which include the correct genitals and/or renaming body parts that affirm gender identity (Iantaffi & Benson, 2018; Martin & Coolhart, 2019). This negotiation during sexual interactions is a process to create unity between the body and mind. For those who experience body dysphoria, sexual language is created that represents the mental experience. It is recommended that therapists are aware of this mental experience and should educate themselves on language and learn from their clients which language fits best for their body parts and sexual interactions.


For trans clients who experience body dysphoria, the physical negotiation often begins with extreme discomfort around primary and secondary sex characteristics. In order to alleviate this discomfort, trans people may take testosterone, have gender confirmation surgery (e.g., chest masculinization, phalloplasty, etc.), or use items (e.g., prosthetics, toys, clothing, etc.) that affirm and become a part of their sexual reality. Clients may express interest in learning how to improve their sex life, which can be explored in therapy through ideas of coping mechanisms. A therapist’s knowledge around sexual practices and body dysphoria may help clients feel normalized. With the partner(s), physical negotiation could include setting physical boundaries around a partner’s physical touch or touching the body in ways that affirm gender (Martin & Coolhart, 2019). As a therapist, it is important to be knowledgeable around these physical negotiations. This could include gaining awareness of items that can assist in relieving body dysphoria for clients, as well as ongoing education around hormone and gender confirmation surgery procedures and outcomes, with resources to provide to clients. 

Considering that sex is often a partnered activity, a sexual partner can aid in reducing body dysphoria. This relational negotiation begins with the mental experience of body dysphoria and processing the impact of sex with partners. For some, sexual identity of a partner, sexual acts, and language greatly influence and affirm gender identity (Martin & Coolhart, 2019). The co-construction of their sexuality may be discussed openly or need a push from a therapist.

A therapist can provide a model of affirming conversation around sexuality. Sexual communication for trans people helps identity needs, language, and boundaries to maximize sexual satisfaction. Sexual partners have a powerful impact on trans people’s perceptions of themselves sexually, by providing affirmation through safety, connection, attraction, support, validating their partner’s gender identity, communication, increasing intimacy and sexual satisfaction (Martin & Coolhart, 2019; Martin, 2020). It is recommended that therapists help clients co-construct their sexuality through communication and behavior. Therapists can also work with clients to affirm their partner’s trans identity during sex in ways that the trans person feels affirmed. Also, therapists can help highlight gender euphoric moments that have occurred sexually between partners.

Therapists can also work with clients to affirm their partner’s trans identity during sex in ways that the trans person feels affirmed. Also, therapists can help highlight gender euphoric moments that have occurred sexually between partners.

AD Gender Identity And Inclusivity In MFT Practice

Providing a safe space

Discussing sexuality with any client creates a vulnerable, yet possible healing experience. For those who do not receive sexual education or sexual knowledge from the media that caters to their gender and/or sexuality, this opens a deeper layer of vulnerability. First and foremost, therapists should be comfortable and educated in working with clients of various sexual and gender identities. By creating a safe environment to discuss sexuality, trans clients may be open to discussing experiences or thoughts they have internalized for years. Since body dysphoria directly influences sex, unpacking sexual scripts and understanding the process can help create a better joining process. A trans client may attend therapy for a variety of reasons; specifically, if a client expresses needing a letter for medical transition, reducing gate keeping is a way to decrease the distress trans clients may have in working with providers.

Expanding on the mental, physical, and relational negotiations of body dysphoria needed during sex helps paint a picture of the layers within working with sexual issues for trans-including relationships. It is important to take into consideration these layers, which are not included in most sex interventions and techniques. Gender is often expressed through sexual activity for trans people, and it is crucial that therapists understand the layers of body dysphoria. In a therapeutic context, processing ways to combat body dysphoria can strengthen the sexual relationship and aide in increasing sexual satisfaction.

When working with marginalized populations, it is important to take the necessary steps in order to be an effective ally. Being an affirmative therapist needs to go beyond acceptance, but also include continued advocacy outside of the therapy office. For example, therapists should work to support their trans clients by providing a list of affirming providers in the area. Additionally, since most graduate programs only touch on the basics around trans identities, therapists should commit to seeking out additional training and education. If a therapist is cisgender, a good idea would be to connect with trans colleagues and explore research, learning firsthand effective coping mechanisms for managing body dysphoria, facts on medical/legal transition, resources, and best training practices. Body dysphoria that accompanies a trans identity can greatly impact sexuality, but with the help of a sex positive and affirming therapist, clients can reach resiliency and gender euphoria.

Tristan K. Martin

Tristan K. Martin, PhD, LMFT, CST, is an AAMFT Clinical Fellow with a private practice in Manlius, New York. As an affirmative and sex-positive therapist, his clinical and academic work focuses on sexuality and overall support of trans youth, adults, and families.


Benjamin, H. (1966). The transsexual phenomenon. Ann Arbor, Michigan: Human Outreach & Achievement Institute.

Iantaffi, A. & Benson, K. (2018). Sex is for every body: Trans-affirming sex therapy. In D. Flemons & S. Green (Eds.), Quickies: The handbook of brief sex therapy (pp. 196-215). New York, NY: WW Norton & Company.

Martin, T. K. (2020). Transgender congruence and sexual satisfaction in trans masculine adults: The role of affirmative sexual partners [Doctoral dissertation, Syracuse University].

Martin, T. K., & Coolhart, D. (2019). “Because your dysphoria gets in the way of you…it affects everything.” The mental, physical, and relational aspects of navigating body dysphoria and sex for trans masculine people. Journal of Sexual and Relationship Therapy. doi: 10.1080/14681994.2019.169645

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