How to Navigate Gender Dysphoria During Sex

In sex education curricula across the U.S., transgender youth are often missing. Because of this, transgender young people can feel as though their sexual health and pleasure is not important, and be even less prepared than their cisgender classmates for navigating sex and sexuality — especially if they're experiencing gender dysphoria.

“Trans-inclusive sex-ed is important because people have the right to learn about all gender identities and expressions. By speaking about trans experiences openly, we are able to support and validate students who may identify as non-binary, trans, or questioning,” Molly Dillon, education and outreach coordinator for Planned Parenthood Great Plains told Teen Vogue.

Maintaining sexual health without any guidance can be especially difficult if a transgender person experiences gender dysphoria. Gender dysphoria encompasses the feelings of anxiety and discomfort that transgender people can experience regarding their sex assigned at birth. Not every transgender person experiences gender dysphoria, and for those who do, it can be more or less intense depending on the day.

"Gender dysphoria, the experience of distress when your assigned gender does not match your experience of yourself, can make the complexities of navigating sex, pleasure and connection exponentially more challenging," Angie Gunn, LCSW, CST, Talkspace therapist and sex therapy expert, told Teen Vogue. "When your body is incongruent with our identity, exploring it with curiosity and desire can be really tough."

As a non-binary and genderfluid person, I know just how daunting it can be to navigate gender dysphoria during sex. Whether it’s the ongoing process of learning how to communicate my own needs despite my dysphoria, have frank discussions about sexual health while experiencing dysphoria, or navigating a partner’s dysphoria, it’s taken years for me to understand how to both protect myself and others while still making sex fun. This process can take quite a while, Gunn explained, because sex may not be your first thought when you're coping with dysphoria.

"We learn by trying, doing, and being sexual beings, but folks with dysphoria are often fighting for space to just be," Gunn said. "Pleasure is not necessarily the top priority when faced with a fight for survival, creating a gender expression that feels right, or managing the mental health challenges associated with dysphoria."

Even with clear grasp of how my dysphoria manifests, it still takes a lot of communication with my partners to ensure that sex is safe and affirming for all involved. Gunn said that dysphoria can impact sex in a number of ways, including your own image of yourself as a sexual being, your understanding of what your wants and needs are, and the ways in which others treat you.

But don't get discouraged. You can and should enjoy sex even if you're experiencing gender dysphoria. So how can trans couples navigate sex when gender dysphoria is present? In addition to Gunn, I spoke with two sex educators, Molly Dillon and Sara Raines, about best practices for keeping intimacy safe and sexy when both partners experience dysphoria.

Understand that gender dysphoria is different for everyone

One of the most important things to know about gender dysphoria is that it can vary in intensity from person to person. Some people may feel very intense dysphoria about much of their body, while others may only feel a small amount of dysphoria or none at all.

Transgender people can feel dysphoric about any part of their bodies. For me, I feel dysphoric about the size of my breasts. During sex, I usually ask my partners to avoid acknowledging or touching my chest in any way.

Just like dysphoria varies from person-to-person, what a person feels dysphoric about can change between sexual encounters, or even during a single encounter.

For instance, sometimes my chest dysphoria is so strong that it’s all I can think about during sex. Any acknowledgment of my chest when my dysphoria is severe completely kills my sex drive. Other times, I feel more comfortable with the presence of my chest and want to be touched there. I have also had partners who, during some of our sexual encounters, do not want to be touched below the waist at all. Other times, however, they may specifically ask me to touch them below the waist because they are not feeling dysphoric at the moment.

Communicate how your dysphoria manifests

For the reasons stated above and more, communication is key when navigating gender dysphoria with sexual partners, Dillon said. “Many people get nervous talking about sex, even with partners they have been with for a long time,” they said.

For people like myself with chest dysphoria, it may be more comfortable to wear a loose shirt or a chest binder during sex. Other people may want to use gender neutral or gender specific language to refer to various parts of their bodies.

Gender neutral language to refer to genitals and other body parts may include terms such as junk, bits, or chest. For trans-masculine or trans-feminine people, gender specific language can be very affirming. Sara Raines, a peer sex educator at the University of Oklahoma, says this more gender specific language will vary from person-to-person, and these preferences should be established before sex begins.

“Now might be a good time to let your partner know if you use different words for certain body parts, so they can correctly refer to them from here on out,” Raines said. “For example, people might typically use the word ‘penis’ for what some trans people instead call their clit, or people might want to use the word ‘vagina’ for what some trans people call their front hole,” she said.

Meanwhile, some trans people may not want parts of their bodies referred to or acknowledged at all. In these situations, acknowledging body parts without your partner’s consent can quickly turn a sexual encounter into a traumatic and distressing event.

Set clear boundaries on where you feel comfortable being touched

Consent and setting boundaries are the most important parts of making sure sexual encounters are safe and fun for everyone involved.

“If someone wants to have sex with you, they need to care about your boundaries and feelings,” Dillon said. “If you are nervous about telling a partner, you can even just say, ‘Hey, I really want to talk to you about sex, but it makes me feel nervous.’”

Setting clear boundaries on where everyone feels comfortable being touched also creates an environment where everyone involved can explore and discover what makes them feel good. Raines said that asserting your boundaries is the most effective way to make sure that they are not crossed during sexual contact. “Telling your partner, ‘Touching my chest is off limits,’ or ‘I don’t want to be touched from the waist down,’ lets them know exactly how you do and don’t want to be touched,” she said.

However, knowing how to assert your boundaries does not necessarily make the conversation any easier or less nerve-wracking. “Being direct with your boundaries can be challenging, especially since many trans people are taught to be ashamed of themselves, their bodies, and their needs,” Raines said. “But remember, your partner can’t read your mind, so being direct with your needs helps them understand how to help you feel safe, comfortable [and] respected.”

Practice active and ongoing consent

Active and ongoing consent means checking in regularly with all partners involved during sex to make sure that they are still comfortable with what’s happening.

“Consent should always be ongoing, freely chosen, and can be revoked at any time. Everyone needs to think about checking in on their partner during sex regardless of gender, but it can definitely help when navigating sex for people with gender dysphoria,” Dillon said.

Since gender dysphoria is not static, sexual acts that felt good at one point may not feel good later on. Dillon said that one way to effectively check in on your partner(s) is to ask “Is it okay if I ...?” Dillon also advised being understanding and respectful when your partner says they are not comfortable doing a specific sexual act or being touched somewhere that will trigger their dysphoria.

As is the case with any sexual encounter, remember that consent can only be confirmed by an enthusiastic and informed “yes!” If you are unsure if your partner is consenting to something, stop what you are doing and explicitly ask if they are comfortable continuing.

Discussions about communication and consent can sound daunting, Raines said. “But when it comes down to it, all it really means is that you care about how your partner feels, and it shows that you’re not willing to put your wants over their wellbeing and comfort.”

Figure out what feels good for you

Dysphoria can make you rethink the ways in which you experience pleasure. To figure out what feels safe and good for you, the best place to start is with yourself. That can mean engaging in what Gunn calls "fancy masturbation."

"You ... may have engaged in sex acts that didn't feel good, or people engaged with you sexually in a way that was presumptuous or harmful (ie: assuming your genitals like certain kinds of stimulation or fantasy based on gender constructs)," Gunn said. "This is an important place to get some support in healing from a therapist, as well as doing personal work to open the door to pleasure as an experience beyond your genitals or your body shape, an experience of an erotic self with endless potential for creativity and empowerment. This can look like what I call “fancy masturbation,” where you give yourself time and space to practice erotic fantasy, imagining yourself, choosing yourself, as the being you want to be, exploring all the ways you can touch and be touched, and experimenting with all the toys and accessories that support that expression."