Avoiding Assumptions: Sexual Function in Transgender and Non-Binary Individuals

As the field of gender-affirming care continues its advancement, a clinical gap in the definition and evaluation of sexual function in transgender and non-binary (TGNB) individuals is becoming increasingly apparent. Recent speculations propose the modification of cis-gender heteronormative sexual function measurement tools as a useful way to close this knowledge gap. Although the use of previously validated tools creates an easier platform for modification, the assumption of cis-gender sexual function as baseline will further disrupt patient-provider relationships, leading to inaccurate scientific conclusions, and increase the healthcare barriers faced by this community. As the definition of health has grown to include sexual function, the responsibility of the physician has evolved to include the treatment of sexual dysfunction as well. Without the imminent establishment of a scientific definition of sexual function with an accompanying measurement tool, this lack of understanding continues a precedent that may further stigmatize and distance this population from healthcare. Although this challenge may seem daunting, it should be noted that this has been accomplished for both cis-gender heterosexual men and women. This failure to scrupulously address the needs of the TGNB community directly contradicts the medical profession's revered values of equity and compassion. This branch of sexual medicine and gender-affirming care is critical for maximizing the quality of life as well as equity of the TGNB community to their cis-gender, heteronormative counterparts. A careful, kinder, and more inclusive approach is necessary, and the TGNB community deserves optimized care which requires a uniquely developed definition of sexual function and the required measurement tools.