Community health centre

A Checkpoint is a health centre for gay and other men who have sex with men (MSM). The Checkpoints Vaud and Zürich also counsel transgender people and their partners.

Sexual Health

Safer Sex

 

Find out our new guide "safer sex pour les personnes trans*" (only in french): guide pdf (paper version on demand).

The Safer Sex Rules

• With penetrative intercourse (anal, vaginal) always use a condom

• No needle sharing (drugs, hormones, silicone)

• No sperm or blood in the mouth

In relation to the transmission risk of HIV or other transmissable diseases (STI) certain things must be taken into account with transgender people, especially if they are undergoing hormone therapy and/or have had sex reassignment surgery. Each individual situation has to be taken into consideration according to the assessment of risk.

It is unfortunately not possible, to find definitions for the bodies of transgender people, which do justice to the diversity of transgender bodies and identities, which all transgender people may deem applicable. Even myCheckpoint.ch doesn’t have the patent solution The terms used are elementary, generally understood terms for parts of the body and are to be dissociated with identities.The fact that these definitions are used here, does not mean that all transgender people accept these definitions with regard to themselves.

Transgender women
A hormonal therapy and/or a resulting genital operation does not preclude the risk for transgender women to transmit HIV or other STI’s or to infect themselves.

Penetrative sex

If you are receiving hormonal therapy and you use your original sexual organs for sex; a fluid and clear sperm does not mean that you cannot transmit HIV or other STI’s, or that you are no longer potent. Therefore use a condom when having sex.

The same goes for you if you have a vaginoplasty: ask your partner to use a condom or you use a Femidom© (an internally worn condom). Do not hold back on the lubricant; the skin of a vaginoplasty is very receptive to HIV and STI infections.

Because of hormones and testosterone blockers the libido often decreases. An erection that makes it possible to penetrate a partner can prove to be problematic. In this case a cock-ring can help. Cunnilingus, fellatio and anilingus.

If you allow your vagina to be licked as a transgender woman: there is no danger of an HIV infection, and if you lick your partners vagina – other than when menstruational blood is present. In any case other STI’s can be transmitted through vaginal licking. The risks in connection with a vaginoplasty compared to that of a non-transgender vagina are barely known. To be on the safe side, it is recommended to protect oneself, with a «Dental Dam», a latex cloth or cling film.

Preventative materials

With cunnilingus and anilingus the risks do not differentiate from those for non-transgender people.

Kissing and licking

Scissor Position

With the «Scissor Position» (vagina on vagina) the risk of an HIV transmission is slight (except during the menstruational cycle of your partner). However there is a real risk of transmitting another STI or to infect oneself; because in this position it is difficult to use a «Dental Dam» or a latex cloth.

Finger games

There is no risk of HIV transmission through anal or vaginal finger practices. However bacteria, parasites or viruses can be present on the fingers and can be transmitted this way. This should especially be taken into account when switching from the anus to the vagina.

Masturbation

Hard practices

If you have a vaginoplasty and you like to be vaginally fisted; pay attention to the resistance of your vagina (whose elasticity is less than that of a non-trans vagina). Increased caution is especially called for if you have recently had surgery. Always wear a glove while fisting and assure yourself, that the person, who is fisting you anally or vaginally, is also wearing a glove which is used for one and the same person only. For other hard practices, there are no distinctions to non-transgender people.

Hard

Transgender man
Transgender men can transmit HIV and other STI viruses or infect themselves; regardless of whether they are undergoing hormone treatment and/or have had sex reassignment surgery.

Penetration and Fellatio

If you haven’t had your womb/ovaries removed, testosterone does not protect you from becoming pregnant. The possibility of a pregnancy is in fact very slight – especially if you don’t have your periods any more – but cannot be ruled out. Make sure you use adequate contraception if you don’t want to become pregnant.

Reproduction and contraception

For transgender men with a neopenis (phalloplasty or metaidoioplasty) there is to date no reliable data about the HIV/STI risk of infection through penetration or fellatio. To be on the safe side you should use a condom. In the case of a metaidoioplasty you can use a finger cot, if a normal condom doesn’t fit. (Prepare the finger cot yourself).

If you have a phalloplasty, without an erection pump and you want to penetrate a partner, you can use a hollow penis prosthesis. If you have an erection pump; the erection can be strengthened with the help of a cock-ring.

Preventative materials

Cunnilingus and Anulingus 

Licking the vagina does not pose a threat to an HIV transmission, as long as this sexual practice is avoided during a menstruational period. However, other STI infections can be transmitted this way. A «dental dam», a latex cloth or cling film can serve as protection.

The same risks exist with anilingus, just as for non-transgender people.

Kissing and Licking

Scissor Position

The «Scissor Position» (vulva on vulva) is linked to a very low HIV transmission risk, if it is not carried out during the menstruational cycle. However there is a real risk of transmitting another STI or to infect oneself; as in this position it is difficult to use a «Dental Dam», a latex cloth or cling film.

Finger games

There is no risk of HIV transmission through anal or vaginal finger practices. But be careful of skin lesions in the vagina or the anus! These could open the gates for other STI’s to cultivate. However bacteria, parasites or viruses can be present on the fingers and can be transmitted this way. This should especially be taken into account when switching from the anus to the vagina.

Masturbation

Hard practices

Transmissable infection risks and protection with hard practices do not differentiate from those of non-transgender people. Continuative information about hard sexual practices can be found under:

Hard

 

What I want and what I don't want

Reproduction and contraception

Urology and Andrology

Urologie und Andrologie

Resources

What I want and what I don't want

Only you know your wishes and aversions in relation to sexuality and sexual practices and only you can communicate these. Your body, your privacy and health are your personal property and you decide how you want to treat yourself and how you want to be treated.

Your body and your privacy

Your privacy belongs to you and you decide what you want to reveal about yourself, your body and/or your identity. When you go out to have sex, try to make it clear to yourself beforehand what you want to say about yourself and what not; even when such things are, more often than not, hard to predict!

Your health

It can occur that certain sexual partners ask you to do things that you don’t want to do, e.g. not to use a condom. Don’t let yourself be persuaded: It is certainly not a good thing when a person is prepared to gamble with both your and their health! A person can have HIV or another STI, without you being aware of anything and perhaps he or she themselves don’t even know.

If you want to have sex on a night out, take condoms and lubricants with you and try to have a clear idea what sort of sexual practices come into question for you and which not.

Preventative materials

Reproduction and contraception

Preventive methods, other than a condom, do not protect you from an HIV/STI transmission or infection.

Besides the conventional methods of contraception (condoms, the coil, anti-baby pill, etc.) a long-term hormonal therapy can prevent reproduction. After the initial intake of hormones, it takes however, according to one’s personal disposition and type of hormone therapy (product, dosage, etc.) a certain amount of time until the reproductional capability is theoretically at zero. Talk this over with your endocrinologist or gynaecologist.

Emergency contraception for transgender men

If as a transgender man you have a womb and ovaries, you can use emergency contraception after unprotected or badly protected vaginal sex (with or without ejaculation).

What is emergency contraception?

These are tablets – also known as « the morning-after pill » which reduces the risk of pregnancy after unprotected vaginal sex.

When should the pill be taken?

At the latest; 72 hours after unprotected sex. The earlier the pill is taken the more effective the outcome.

Where is the pill available?

  • At family-planning and sexual-health centres
  • Over-the-counter at the chemist (25 to 40 Francs)
  • At hospital emergency departments

Emergency contraception does not protect against HIV or other sexually transmitted infections. Get the information from Checkpoint about the possibilities of a PEP, a vaccination against Hepatitis A and B and a STI-Test.

Gynaecology

A regular gynaecological check-up is recommended (yearly or every 2 years) for transgender women with a vaginoplasty and for transgender men with their original sexual organs. Even if this is not very pleasant; the preventive medical check-up is there to detect, early on, possble STI and other infections or diseases, such as cancer.

If you don’t have a doctor, the counselling for transgender people, at the Checkpoint Zürich or Lausanne can help you with addresses of transgender friendly gynaecologists.

Transgender women

Besides the vaginoplasty check-up (for infections, fungal infections, etc.) regular breast palpations are recommended; in order to detect abnormal changes which could be the indication of a tumour. A mammogram can also be worthwhile. The same recommendations apply here as for non-transgender women.

The Pap smear test (cervical cancer smear test) is not essential for transgender women with a vaginoplasty, unless a part of the glans was used in the construction of the neo cervix; which is normally not the case.

Transgender men

For transgender men with their original sexual organs a gynaecological preventive check-up (infections, fungal infections, etc.), in particular a cervical smear test, is recommended so as to detect cancer cells or pre-stage cancer cells.

A HPV-Vaccination is also recommended in this case. The vaccination costs are covered by the health insurance, for those who at birth were registered as being of the female sex, up until (and to the end of) the age of 26. The cervix is not always removed with every hysterectomy (removal of the womb). If you have had your womb removed but still retain the cervix; then a preventive check-up is advisable.

If you are taking testosterone and you haven’t had an ovariectomy (removal of the ovaries) or a hysterectomy, it is additionally recommended, to have the size of the womb and the ovaries checked up on. Hormones can sometimes facilitate the accumulation of cysts on the ovaries. In certain cases testosterone can cause an atrophy of the ovaries. If you want to retain your fertility, remember to have the size of your ovaries checked regularly.

Urology and Andrology

Transgender women

A regular andrological preventive medical check-up is recommended for all transgender women, in order to check the prostata. If testicles are still existent, it is also advisable to have an examination for possible carcinosis.

Transgender men

There is currently no scientific research concerning specific health risks in relation to phalloplasty. A regular preventive medical check-up of the neopenis and possible implants (testicles, penile prosthesis) is recommended; to be on the safe side.

Resources