We encourage you to discuss any concerns you may have related to sexual pleasure or function with a clinician.
Testosterone can increase libido, genital sensitivity, and can change lubrication; some people with uteruses also experience uterine cramps intermittently or with orgasm for reasons that are not well understood. Depending on one’s symptoms and goals, additional lubrication, dilator use, pelvic floor physical therapy, ibuprofen use for cramping, an exam, and/or resources for sex therapy may be recommended. Some people have a hysterectomy if symptoms of uterine cramping persist and cannot be well controlled and if having the uterus removed aligns with their needs and goals.
Estrogen-based therapy can cause spontaneous erections to stop or decrease significantly and may decrease or change libido; erections may be less firm and orgasms may take longer to achieve on estrogen-based therapy. Of note, orgasms can occur without erections. Some people using estrogen-based therapy who desire assistance with erections may use medications marketed for erectile dysfunction; PPMI does not prescribe erectile dysfunction medications but encourages folks who are interested to speak with their primary care doctor. Sex therapy may also be helpful; we are happy to provide resources!