From Avoidance to Engagement: Trans Masculine and Nonbinary Strategies to Cope with Gender Dysphoria During Sex

The current study takes a resilience-based approach to the sexual well-being of transmasculine and nonbinary individuals through asking them directly what coping strategies they utilize to manage gender dysphoria during sexual activities.

Participants (N = 360) included trans masculine (n = 177, 49.2%), nonbinary (n = 148, 41.1%), and agender (n = 35, 9.7%), individuals who were assigned female at birth. An online study was completed by participants and thematic analysis was conducted to understand participants' descriptions of their strategies for coping with gender dysphoria during sex.

Based on participant responses, we developed five core themes that correspond to strategies used to navigate gender dysphoria during sex: 1) Communication; 2) Cognitive Strategies; 3) Physical Strategies; 4) Queering Gender; and 5) Physical Transition. Chi-square tests for independence were then conducted exploring differences across gender (transmasculine, nonbinary, agender) in the proportion of participants expressing each theme. Importantly, not all participants reported experiencing gender dysphoria in sexual contexts.

Based on these findings, we developed a conceptual model that organizes coping strategies along a continuum from avoidant to engaging, with an intermediate category we refer to as positive avoidance. Our work offers not only a descriptive account of coping but a foundation for developing affirmative, flexible, and client-centered interventions that honor both resilience and vulnerability in trans people's sexual lives. Understanding the spectrum of coping strategies that transmasculine and nonbinary partners use when navigating gender dysphoria during sex can help clinicians avoid normative assumptions about what constitutes "healthy" sexual functioning.