Sexual Inactivity Among Transfeminine Persons: A Canadian Respondent-Driven Sampling Survey

Sexual health research with transfeminine persons (individuals assigned male at birth who identify as female or feminine) has focused on HIV infection and sexual function following medical treatments. Yet, approximately half of transfeminine persons in Ontario, Canada, reported no partnered sex in the previous year. Therefore, we identified sociodemographic, social, and psychosocial factors associated with past-year sexual inactivity among transfeminine Ontarians. A multi-mode respondent-driven sampling survey of transgender people was conducted in 2009-2010 (N = 433), including 173 transfeminine individuals who had ever been sexually active. Frequencies and regression models were weighted using RDS II methods; prevalence ratios were estimated from logistic regression models using average marginal predictions. Of sexually experienced transfeminine persons, 43% (95% CI [31, 55]) reported no past-year sex partners. Sexual inactivity was independently associated with older age, childhood sexual abuse, and residing outside of the province's largest city. Transfeminine persons who had genital surgery for gender affirmation were less likely to be abstinent, as compared to those who were living in their felt gender without surgery. Transphobic harassment and higher levels of trans-related sexual body image worries were also associated with sexual inactivity, as was reduced sexual satisfaction. Implications for research and clinical practice are discussed.