Study design, materials and methods
Trans individuals who were outpatients at our gender incongruence (GI) center for follow-up of gender affirming hormone therapy with age ranging 27 to 30 years old were invited to participate in this cross-sectional study. Clinical data were collected from the medical records. The scale female sexual function index (FSFI) was administered to all trans-females (n=50) and all trans-males (n=58). The FSFI questionnaire has 19 questions grouped in six domains (desire, arousal, lubrification, orgasm, pain, and satisfaction). The score ≤ 26.55 is a risk for sexual dysfunction². Also, each participant also responded to a semi-structured questionnaire that assessed feelings regarding being transgender in Brazil and satisfaction with sexual life. The Hospital Anxiety and Depression Scale (HAD) questionnaire was used to assess the individual’s mood. The HAD has 14 items divided in two subscales: seven to assess anxiety, and seven to assess depression. The cutoff score for anxiety and depression is ≥ 8 and ≥ 9, respectively³. A logistic regression model was constructed to estimate the relationships of different variables with FSFI scores, and the results were reported as odds ratios (ORs).
Results
There were 108 participants, 58 (53.70%) trans men, and 50 (46.30%) trans women. These two groups were similar in most characteristics, but differed in comorbidities, body mass index (BMI), duration of relationship, number of sexual partners, and frequency of sexual intercourse.
Analysis of the FSFI scores showed that 32 trans men (55.2%) and 41 trans women (82.0%) had total FSFI scores of 26.55 or less. Relative to trans women, the trans men had a significantly better total FSFI score and in the domains of arousal, lubrication, orgasm, and satisfaction (all P < 0.01).
The semi-structured analysis of sexual satisfaction showed that 17 (28.80%) trans men were very dissatisfied or dissatisfied, and 21 (30%) were very dissatisfied or dissatisfied
Interpretation of results
The Table 1 shows the results of the estimate of the logistic regression model with univariate analysis for being risk of SDF and evidences that age, BMI, years of study, ethnicity, marital status, sexual orientation, GAS, satisfaction with gender affirming hormone therapy, and feeling discriminated do not predispose SDF. While the gender, therefore being women, dissatisfaction with body appearance, having risk for anxiety and depression are factors of risk of sexual dysfunction.
A multivariate analysis of these data showed that being a trans woman (OR: 0.242, 95% CI: 0.095, 0.615) and having score of risk for depression in the HADS (OR: 0.22, 95% CI: 0.055, 0.88) were significant risk factors for SDF (Table 2).