Sexual Health for Transgender and Gender Non-Conforming People

SEXUAL t&ransgender HEALTH FOR gender non-conforming people By Dr Alex Müller GLOSSARY Bisexual Gay People whose sexual orientation is towards This word colloquially refers to homosexual people of both genders, i.e. men whose people, most frequently men; thus men sexual orientation is towards men and whose sexual orientation is predominantly women. towards other men. Cisgender Gender Someone whose identity conforms to The socially constructed roles, behaviour, the gender assigned to them at birth activities and attributes that a particular and whose gender matches their sex society considers appropriate for men at birth (previously also known as non- and women. transgender). Gender-affirming treatment/ Cross-gender hormone procedure replacement therapy (Medical) treatment and procedures; One part of gender-affirming treatment such as cross-gender hormones, can be the intake of hormones in order to gender-affirming surgeries, etc., which create changes in sexual characteristics. a transgender person can choose to In the case of transgender women these undertake in order to make their bodies would be oestrogens and progesterone, more congruent with their gender which stem some hair growth and identity, thus affirming their gender. initiate breast development; in the case of transgender men, this would be Gender identity testosterone, which breaks the voice and promotes hair growth. one part of gender- One’s private sense of being male or affirming treatment can be the intake of female or another gender. It usually, but hormones in order to create changes in not always, matches the sex based on the sexual characteristics. external genitalia present at birth. In the case of transgender women these Gender markers would be oestrogens and progesterone, which stem some hair growth and The markers in identity documents, such initiate breast development; in the as passports, and other official documents case of transgender men, this would be which indicate that whether someone is testosterone, which breaks the voice and male or female. promotes hair growth. Gender non-conforming Front hole Gender non-conforming people are those Transmen who have not had surgery still who are by society’s norms not ‘recognised’ have a vagina. Since the word vagina is as male or female. usually associated with a female body, we use the more neutral word ‘front hole’. Lesbian Homosexual women; women whose Gender non-conforming sexual orientation is predominantly Gender non-conforming people towards other women. are those who are by society’s norms not been ‘recognised’ as male or female. Continued on inside back cover PREFACE This guide is for transgender and Most safer sex resources are not gender non-conforming people aimed at trans people, let alone and their partners and lovers. gender non-conforming people or gay/lesbian/bisexual/queer trans The word trans is used to include people. people who might also call themselves any of these very There is no consistent language different words: transsexual/ for our body parts or identities. transgender/genderqueer/queer/ We tried to make an information cross-dresser/drag queen/drag booklet to talk about our bodies king. When we use the term that made us feel comfortable. transwomen in this guide, we are Because there is no consistent talking about people who identify term used by everyone, we have on some level as female but were used the word “front hole” to assigned male at birth. When we describe what is medically referred use the term transmen, we mean to as a vagina and the word “pre- people who identify on some level op genitalia” to describe what is as male but were assigned female medically referred to as a penis. In at birth. certain cases, we’ve used terms like “vaginal fluids” because we We will also be talking about were unsure how to discuss these people who are not trans – that aspects of our experiences with is, people who were assigned one words that are comprehensive and gender at birth and more or less respectful. still identify with that gender. We’ll use the words cisgender and cis We have tried as best as we can to describe these people (ie, cis to be respectful and innovative women and cis men). as well as clear and concise. The glossary at the beginning of this One of the big challenges in writing booklet gives an overview of all the this safer sex booklet was the words that we use. We know that question, “How can we make a language is not static, and that it is safer sex booklet that talks about often influenced by Western ideas sex, sexually transmitted diseases, of identity. If you are offended or and HIV using language that is clear don’t see yourself in this resource, and respectful to the wide range we apologise. This resource exists of transgender and gender non- for you, so please send us your conforming people who will read suggestions so we can make it”? This wasn’t/isn’t easy. the next one better.  This guide is about the sexual health of transgender and gender non-conforming people. It aims to tell you about: • your body and what you can do with it • how to have safe and enjoyable sex Sexual • the risks of sex and how to health for negotiate them transgender and gender non- GENDER EXPRESSION, conforming OUTING AND PERSONAL people SAFETY Transgender people often try to ensure that their gender expres- sion conforms to expectations by Sexual health means: society regarding this gender. Presenting clearly as female or • overall well-being with male is sometimes called ‘passing’. your sexuality However, whether you pass or not • a positive and respectful does not define whether you are approach to sexuality a man or a woman. and sexual relationships For transmen this means being seen • enjoyable and safe sexual as male, for transwomen being seen experiences without coercion, as female. Your gender expression is a matter of perception, the way that discrimination or violence people perceive and treat your gender Although transgender and in day-to-day life. gender non-conforming people You can feel very male or female and have many sexual health needs identify as a man or a woman and not pass by society’s dominant definitions, that are similar to cisgender or only pass some of the time. people, we also have very There are a lot of ways that transgen- specific needs that are not der people express their masculinity usually discussed. or femininity; from binding their chests to changing the way they talk This guide will give you the to taking hormones and changing most important information their bodies. about your sexual health, and Gender non-conforming people do not help you to make decisions match society’s perception of what is that lead to enjoyable male or female. Sometimes they are 1 and safer sex. trying to challenge the idea that there are only two genders (the gender binary), or they just don’t care.  For many transgenders it is important • Do you have a place to go, or can that their gender expression matches you leave the situation safely? society’s norms, because they feel • Do you have support from your more accepted or often because it is friends or family? safer. However, what society thinks • Can you deal with possible about your gender expression does emotional/sexual rejection? not make you more of a man or a woman. BEFORE YOU HAVE SEX Whether or not your gender expression conforms to society’s You usually don’t just walk up to norms, you will need to decide if and somebody and have sex. when to tell somebody you have met that you are transgender. There are Having sex should be a negotiated pro’s and cons to both disclosing and decision that you and your partner or not disclosing. Every person needs to lover make together. make their decision based on where There are many ways to have sex, but they are, if they feel comfortable and/ you should always feel comfortable or safe, and many other reasons. about the person you are having sex You need to think about this not at with, about the place where you have the time of having sex, but much sex and about the circumstances earlier. When you want to tell under which you have sex. someone you are trans, consider the For transgender and gender non- following points: conforming people, there are a few • Are you in a space that is physically things to consider before having sex and emotionally safe? That you feel with somebody. comfortable in? • Can you leave the situation? Meeting people TIP S • Are you prepared to educate Bar/Nightclub someone who might Bars and nightclubs TALKING TO there is a risk not know a lot about are common places for STRANGERS that the person transgender people? meeting people. Some If you are leaving might become There is always a gay clubs are transfriendly with someone, angry, violent risk that the person and others are not. If tell a friend or or abusive you are disclosing to you can, talk to other introduce the does not take it well. transgender and gender person to your friends before They might become angry, violent non-conforming people you leave with or abusive. This can be not only about their experiences the person. an emotional risk for you, but also at different bars. threaten you physically. Meeting Online Think about the following in case your The internet is a great place to find disclosure goes badly: 2  people to hook up with. Online dating Keep in mind that it is the person sites can, potentially, give transgender you’re connecting with – not the and gender non-conforming people website. Just because the site is safe, the opportunity to meet people for doesn’t mean the person is. friendship, a relationship or to find casual sex. S TIP MYTHS ABOUT TRANS- GENDER AND GENDER DISCLOSING NON-CONFORMING PEOPLE • Decide ahead of time if you’re going to disclose your gender identity. You can do it in your online profile, in e-mails or in person. TRANSMEN • If you disclose, be prepared to answer Aren’t at risk for HIV questions about your gender and your body. For some people this can be an opportunity to This is a really common myth. If you let people know what you want sexually and have unprotected sex you are at risk. what your expectations are. This is because it is easy for cum, blood, • If you decide to meet up with the person, or vaginal fluids that have HIV in them make sure someone knows where you’re to be absorbed into your body during going and that you have some way of unprotected sex. Think about the sex contacting them if the situation is not what you have or want to have. Educate you were expecting. yourself about the risks associated with • If you’re meeting somebody for the first time, those sexual activities and learn about meet in a public space. Don’t meet people for ways to reduce your risk while still the first time in your or their apartment. enjoying the sex you want. • Be clear that you want safer sex and be prepared to assert that when you get Don’t have sex with other men together with somebody. Some people will Like all men, transmen identify as say they are into safer sex and then when straight, bisexual, gay, queer, pansexual, they get together will try to have unsafe sex. This may be particularly true if the person asexual, etc. There is a misconception you’re with believes that transpeople are that if you are a transman, you will much less likely to have HIV. automatically only want to sleep with • Know that people who are HIV positive women. Some transmen do. However, will not necessarily disclose their HIV some transmen like sleeping with other status. HIV carries a great deal of stigma men - trans and cisgender. and discrimination. The fact that a person is willing to have unsafe sex with you does not Are Bottoms mean anything about their HIV status. They This myth stems from the fact that may have HIV and think that you do too or people assume that transmen don’t that it is your responsibility to insist on safer have penises. However, some transmen sex if you want that. They may not have HIV have had surgeries that allow them to and think that you don’t either. And they may have HIV and not know it. penetrate their partners with their 3  TRANSWOMEN Don’t have sex with other women Like all women, transwomen identify genitals. There are also other options as straight, bisexual, lesbian queer, like strap-ons, dildos and hands that pansexual, asexual, etc. There is transmen use to have sex with. a misconception that if you are a The way their genitals look doesn’t transwoman, automatically you will determine whether somebody will be only want to sleep with men. Some a top or a bottom. transwomen do. However, some There are a lot of transmen who like transwomen like sleeping with other being bottoms, while others like being women - trans and cisgender. tops. Some will switch, giving and receiving, depending on the time and Transwomen who sleep with person(s) they have sex with. Still women aren’t at risk for HIV others like to have sex without any kind This is a really common myth. If you of penetration. Besides, being top or have unprotected sex you are at risk. bottom is not only about penetration The risk for HIV is lower between two and position. women, but lesbian women can also Can’t get pregnant get HIV. Think about the sex you have or want to have. There is a section This is a common and dangerous on safer sex in this booklet, and it misunderstanding. Even if transmen are describes the HIV risk for every taking testosterone, they can still get sexual activity. Look it up to learn pregnant if they have penetrative sex what activities place you at risk for with somebody who has a penis. If you HIV – regardless of who you are have sex with a person who has a penis, sleeping with. make sure they use condoms. This also protects you against HIV and other STIs. Can only be bottoms Do not like their partners to touch/ Some transwomen have had surgeries stimulate their genitals that allow them to be penetrated by their partner. However, being This is the most common assumption top or bottom is not only about about transmen. Like with any other penetration and position. The way people sex and intimacy is negotiated. that their genitals look doesn’t Especially in the case of longer term determine whether somebody will be relationships, and growing trust, many a top or a bottom. There are a lot of transmen have various levels of comfort transwomen who like being bottoms, with their partners actually touching, while others like being tops. Some will stimulating and seeing their genitals. switch, giving and receiving depending on the time and person(s) they have sex with. Still others like to have sex without any kind of penetration. 4  THESE HELP TO KEEP dams are generally YOU SAFE DURING SEX difficult to find. If you don’t have a dental Male Condoms dam, you can use a make sure condom, cut it open the non- Male condoms are available and then spread it microwaveable free of charge at every cling wrap out. You can also use government health does not non-microwaveable facility. They are often have small cling wrap (make sure available free of charge holes in it! it does not have small in schools or other public holes in it). Use dental buildings. dams if you have You can also buy male a t-penis or a vagina and receive condoms in supermarkets and oral sex, or use them for licking and pharmacies. Use male condoms if you sucking of the anus. have a penis and have penetrative sex (vagina, front hole or anus), or Gloves if someone gives you oral sex. Male condoms should also be used when Gloves using strap-ons or dildos, especially are made of if you sometimes share these. latex or silicone and Female Condoms are available at pharmacies Female condoms in different are inserted into sizes. Use gloves if you the vagina or front are fingering or fisting your partner. hole before having You can also cut off the thumb of a sex. You can get glove and use it for your t-penis them at your local clinic, instead of a dental dam. but you will often have to ask for them. Use female Lube condoms if you have a vagina or front hole and have penetrative sex Lube helps to keep your genitals (vagina or front hole) with somebody. wet during sex. This reduces Female condoms can also be the risk of injuries and used anally. tears, and makes sex more enjoyable and safer. You can Dental dams get lube in pharmacies and sex shops. Not all Dental dams are lubes are good for square pieces condoms, sex toys or of silicone that you packers. Read more put over genitals about lubes in the 5 when you lick or next section of suck them. Dental this guide. HAVING SEX best, especially if you’re using latex condoms. This helps prevent tears Body fluids can transmit HIV in the anal and vaginal lining, which and STIs (sexually transmitted will help prevent you and your infections). partner from getting HIV or an STI. You can find more info on different Body fluids are cum/semen, blood, kinds of lube in the section on pre-cum, vaginal fluids including sex toys. menstrual blood, and breast milk. • Barebacking (not using condoms) Some things, like herpes, can be is popular in gay porn, but this is transferred just by skin-on-skin the most high risk way to have contact, so always make sure to look sex. Respect your body and your carefully at your partners’ or clients’ partner’s body by using condoms genitals and mouths. You cannot and lube! eliminate the risk by one hundred per • As a transwoman, if you have cent, but you can reduce it. Similarly, sex with a cisgender woman or male and female condoms, dental a transman with your pre-op dams and gloves do not reduce your genitalia, remember that you could risk of getting HIV or an STI to zero – still get them pregnant. Use a but they reduce it a lot. condom if you aren’t planning on Having penetrative sex (in the getting your partner pregnant. anus, vagina or front hole) Oral sex Having sex and being penetrated in or Sucking, licking, eating out – it’s all penetrating the anus, vagina or front the same thing. Oral sex (using your hole with a penis, a pre-op genital, a mouth and tongue on someone’s strap-on or a toy can be enjoyable. crotch) can be very enjoyable for Just remember, that, especially with many people. Oral sex is low risk penises and pre-op genitalia, this can for HIV transmission, but you could be one of the most high risk sex acts. still be at risk for other STIs: herpes, It is high risk for HIV and every other gonorrhoea, Chlamydia, and Hepatitis STI. The following tips will help you to B. Some people enjoy having oral sex have safer, yet enjoyable sex: when they have their period, others • Use a condom. For transwomen, don’t. You can have sex when you or use a condom on your pre-op your partner is menstruating, as long genital, too. as you stick to the tips for safer sex. • Change condoms between holes Here are tips for you to have safe and between partners. This helps oral sex: prevent the spread of bacteria and • Use a condom for penis and pre-op STIs between different body parts genitalia. Put some lube on the and partners. inside of the condom for extra • Use lube! Water-based lubes are sensation. Transmen who have had 6  surgery and have a penis should • Use a dental dam. Or, cut the ends also use condoms. of a condom off, and then cut down • Make sure to try and avoid one side of it to create a large swallowing cum and precum, if you square that will work just like a decide to go without a condom. dental dam. Or you can use non- microwaveable cling wrap. • Use a dental dam for vaginas, front holes and t-penis. Some transmen • Some people like to douche find that dental dams don’t before getting rimmed. This is not work well after they have taken recommended, because it can testosterone for a long time, so increase your risks of contracting one solution is to cut a glove on an STI. the thumb-side from the wrist to where the thumb starts. This can Scissoring cover their t-penis, while the rest When two people with vulvas rub can hang down and be used as a their genitals together, we usually dental dam. You can also use non- call this scissoring, or tribbing. microwaveable cling wrap if you Transwomen who have sex with don’t have a glove or a dental dam. cisgender women and transmen who have not had surgery often enjoy this. This is a low risk for HIV, but can be Don’t floss or brush your teeth for a risk for syphilis, gonorrhoea, and at least 30 minutes before having or herpes. These are the ways to reduce giving oral sex. Flossing and brushing your risk: can make tiny cuts inside your mouth • Check your partner’s genitals for which increase your risk of spreading any sores, open cuts, or abrasions. or getting HIV or STIs. • Try wearing underwear and/or pants while tribbing to reduce contact with fluids. • Use non-microwaveable cling wrap Rimming with lube. Rimming (licking and sucking your partner’s anus) can be very enjoyable. Fisting It is low risk for spreading or getting Fisting is when you insert your HIV, but a high risk for spreading entire hand (or most of it) into your gonorrhoea, herpes, syphilis, Hepatitis partner’s vagina, front hole or anus. A and Hepatitis B. If you follow this Transwomen who have had bottom advice you can lower your risk surgery often cannot be fisted while rimming: because the skin is not stretchy • Wash the area. Simply use soap and enough, if it is forced this can lead to water. Be careful not to get the tears and other issues. For the person soap up your butt, because this receiving, fisting can increase your irritates and can burn. risks for spreading or getting 7 HIV or STIs during other sex acts for BDSM up to two weeks after being fisted Some people really like BDSM. due to small tears (often invisible at BDSM stands for Bondage & first glance). For the person doing the Discipline (BD), Domination & fisting, this is a very low risk for HIV Submission (DS) and Sadism and transmission, as long as you have no Masochism (SM). cuts or sores on your hand. • Use gloves. BDSM are not only direct sexual activities, but can also • Use lube, lots! This will decrease be power and role play. small injuries or tears in the vagina, BDSM should be based front hole or anus that make it on informed consent, and easier to catch or spread HIV and needs to be safe and consensual. other STIs. Use water-based lubes, especially if you are using A lot of BDSM activities have no HIV a latex glove. risk or a low HIV risk, for example use • Make sure to use condoms during of leather, whips, chains, floggers, sex for at least two weeks after paddles, clamps, masks, gags, and being fisted. anything else that do not include the exchange of body fluids from one Fingering and handjobs person to another. Always clean these tools before using them on another Penetrate your partner with your person (see the section on sex toys finger, or wrap your hand around your for cleaning tips). partner’s penis, t-penis or pre-op genitalia. No matter the shapes of Other BDSM activities can be cutting, the genitals involved, this is usually play piercing and suspension. These low risk for transmitting HIV, but you activities are higher risk for HIV if could still be at risk for getting or one person’s blood enters another spreading warts and herpes. person’s bloodstream. Some people • Wash your hands before having sex. also enjoy scat play (involving human Simply use soap and water. excrement), which can put you at risk for Hepatitis A and parasites. • Check to make sure you don’t have any open cuts or abrasions Water play (involving human urine, on your hands. Rubbing your hands also known as ‘golden shower’) has with hand sanitizer, lemon juice, or no risk for HIV, but can transmit other alcohol should make it obvious if STIs to open sores on the skin. If you you’ve got any little cuts. are having any other kind of sex while • Wear gloves. Especially if you’re doing BDSM, your risks are the same penetrating their vagina, front as described above. Here are a few hole, or anus. Make sure to switch tips for safe BDSM play: gloves between each hole and each • Avoid direct contact with blood, partner so that you don’t pass shit or other bodily fluids. Avoid 8 any bacteria or viruses between pee on open skin sores, mucous genitals and partners. membranes and eyes.  • Use clean, sterilized equipment (like needles, knives, blades,) and don’t re-use it on other people. SEX IF YOU HAVE • For piercing, branding, or shaving, any drops of blood should be HAD GENDER wiped away with sterile cotton REASSIGNMENT balls. Soak the cotton ball in SURGERY medicinal alcohol. Many transgender people like • Use condom and dental dams the genitals they were born with for all other sexual activities. and don’t want to change them, and many cannot afford to have the surgeries they would like to change their bodies. Still, a few LUBE trans people both want and are For penetrative sex and fisting, lube able to have genital surgeries. can be an essential part of having a good time. This is especially important If you have had surgery, or are sleeping for transwomen who have vaginas, with somebody who has had surgery, because their vaginas will hardly here are a few tips: become wet by themselves. Using lubricants can reduce small injuries of Orchidectomy the vagina, front hole and anus. Small An orchi removes the testicles, which tears increase your risk of contracting or spreading HIV and other STIs. produce most of the testosterone in Water-based lubes are the best – use the body. They also create semen. So, K-Y Jelly, which you can get at Clicks if you’ve had an orchi, you might find or any pharmacy. Vaseline, aqueous that this changes sex a bit. First off, cream, water, spit, cooking oils, and you might still pre-cum, but might not other oils are NOT recommended! be able to cum anymore. This does Vaseline is made from petroleum, will not mean that you cannot have an degrade the anal or vaginal lining and orgasm though. And it also doesn’t weakens condoms, increasing your mean that you are no longer at risk risks. Water, spit, and oils tend to be for HIV and STIs. You might find that absorbed quickly by the body, meaning you’ll get dry fast, which also increases you are unable to maintain an erection your risks. And remember: lube does after having an orchi. If you can, use not protect you from HIV and STIs. a condom when having sex with your You will still need to use a condom. pre-op genital. If you find that you can’t get a condom to stay on, try using cling wrap. 9 Vaginoplasty Your new vagina was probably created it could cause a vaginal prolapse – with skin from your penis, testicles, that means that your vagina could thighs, and maybe even your colon. fall out. You could also cause a There are a few things to keep in fistula – a hole between the anus mind: and the vagina, which can be very • You are still at risk for getting or hard to repair and dangerous to spreading HIV and STDs. Depending your health. So be careful - when on the kind of surgery, you might you are having anal sex, take it slow even be at a higher risk than you and easy at first, and stop if you were before (such as when a feel irregular pain. surgeon uses parts of your colon). • Don’t forget to dilate. Follow your So make sure that your partners surgeon’s guidelines, but dilate use condoms, dental dams, and/or at least once a week. Some gloves. transwomen stop dilating after a • Trans vaginas don’t usually self- few years – but be careful, this can lubricate. While some transwomen lead to a shrinking of your vagina, self-lubricate a bit (this usually which is usually irreversible. happens only after surgeries that • If you experience pain or tightness used the colon method), most while having sex, try dilating an hour don’t get any self-lubrication and or two before you have sex. those of us who do don’t lubricate • If you are being penetrated, try as well as ciswomen or transmen. different positions to find ones that So make sure to use lube. work best for your body. Some • Transwomen’s vaginas are less positions work better than others stretchy and more delicate than for trans vaginas, but it varies from ciswomen’s and transmen’s woman to woman. vaginas, so there are some things • Your vagina can also get yeast that you might not ever be able to infections, so make certain that do. The number one among them is anything going into your vagina is vaginal fisting. You also should not clean. You will also need to douche/ have anal sex and anal fisting for clean your vagina regularly. a while (up to 2 years) after your surgery. Check with your surgeon. One of the reasons for this is that 10  • Wear a thin undershirt under your Changing binder to help absorb sweat and prevent skin irritation. your body Taking hormones We all produce the sex hormones oestrogen and testosterone but people who were labelled female at birth have more oestrogen and people who were labelled male at TRANSMEN birth have more testosterone. Binding Transmen can take testosterone (often called ‘T’) to make their body Binding is the process of flattening look more masculine. When you your breast to create a flatter take T, your facial and bodily hair will and less noticeable chest. Some increase, your muscles will grow and transmen bind all the time; others you will lose fat on your hips and only do it when they go out in public breasts. When you take T, your clitoris or for special occasions. also grows. It will become longer and Binding can have health consequenc- wider. Initially, this growth can also es. Many of the synthetic materials cause your clitoris to be very sensitive used for binding don’t allow your skin and irritable. It can become erect, but to breathe. This can lead to skin you cannot penetrate your partner rashes and skin infections. When you with it. T can also affect your mood, bind too tightly it can cause pain and and either make you depressive, or restrict your breathing. Tight binding is aggressive. If you want to take hor- especially dangerous for young mones to change your body, you can transmen whose bodies are still inject T, or get a skin plaster or gel. growing, because it can disturb the At the moment, it is difficult to growing of your ribs and lungs. To get hormones in South Africa. reduce the potential risks of binding: Gender DynamiX has a list of health • Loosen your binder if it hurts, cuts care providers who will prescribe your skin, makes it difficult to hormones. It is important to know move, or makes it difficult to take a that taking hormones has side deep breath. effects. For this reason, you should • Give your skin a chance to breathe. get your hormones from a health Take breaks from binding. care worker. 11 If you inject T, your healthcare worker • To change your genitals there should show you how to do it. You are generally two methods: can also ask your partner or a friend – Metoidioplasty is when the to help you inject it. It is important clitoris is ‘released’ from skin/ hood that you clean the injection site and it gives an effect of a larger before you inject, and that you use clitoris. – Phalloplasty is when a new, clean needle every time muscle, you inject. nerves, veins and skin from a donor site of the person’s body Breast cancer and cervical cancer is used to form a phallus. As a transman, you are still at • Many times, in addition to risk for breast cancer and cervical metoidioplasty or phalloplasty, cancer. You should continue to have testicles are formed by implanting breast cancer exams. silicon to the previous labia. Unless you have had surgery and If you are thinking about having your uterus removed, you should also surgery, contact Gender DynamiX have regular Pap smears to checkfor for details of surgeons overseas. You cervical cancer. You can get those at should calculate that you will need your clinic or GP. Find trans-friendly a few weeks near the place where health care workers through Gender you had surgery to monitor that your DynamiX, S.H.E. or TIA. body heals well. Gender reassignment surgery/ Gender affirming surgery TIP Some transmen have surgery to S change their bodies. There are many options: You should • Remove your breasts and create calculate that a male-looking chest (this is called you will need mastectomy/ chest reconstruction) a few weeks near the place • Remove your womb and ovaries where you had (this is called hysterectomy and surgery oophorectomy). Sometimes to monitor surgeons also remove the vagina that your body (this is called vaginectomy). heals well. 12  TRANSWOMEN Tucking Tucking is the process of hiding your bodies look more feminine. When you pre-op genitalia and testicles so that take oestrogen, your facial and bodily you don’t have a ‘bulk’ in your groin. hair will become less, your muscles Often the testicles get pushed back will become weaker and you will gain into the body in the inguinal canal, weight on your hips and breasts. and the pre-op genitalia get tucked Oestrogen also makes your penis and back towards the anus. You can testicles shrink, and you will no longer either strap it with tape, or use tight be able to have an erection. If you underwear. want to take hormones to change If you’re intending to father a child your body, you will need to take two any time soon, then forget tucking hormones: oestrogen and another and wear looser fitting dresses or hormone that stops your male pants. Tucking lowers your sperm hormone, testosterone, from working. count, since body heat affects sperm This is called an anti-androgen. production. At the moment, it is difficult to get • Don’t tuck and/ or strap for too hormones in South Africa. People get many hours. Chafing or sores them either from a private GP or from can occur. the specialised transgender service at • Sitting down must be practiced, Groote Schuur Hospital in Cape Town. because sitting too hard is like It is important to know that taking being kicked in the groin. hormones has side effects. For this • If you are using tape, make sure it reason, you should get your hormones is surgical tape. Using other tape from a health care worker. You also like duct tape can take your skin off need have regular blood tests if you when you remove it. take hormones. • Cut the hair in your groin really Prostate cancer short if you are using surgical tape. As a transwoman, even if you have Taking hormones had surgery, you are still at risk for We all produce the sex hormones prostate cancer. You should have oestrogen and testosterone but regular checks at your local clinic people who were labelled female or GP. To check for prostate cancer, at birth have more oestrogen your health care worker has to do an and people who were labelled exam of your anus. Find trans friendly male at birth have more health care workers through Gender testosterone. Transwomen can DynamiX, S.H.E. or TIA. take oestrogen to make their 13 Gender reassignment surgery/ HIV Gender affirming surgery Some transwomen have surgery to change their bodies. There are many options: • Enlarge your breast (this is called mammoplasty) • Change your genitals (if you remove your penis it is called penectomy, HOW DOES A PERSON removing your testicles is called GET INFECTED WITH HIV? orchidectomy, and building a new HIV (Human Immunodeficiency vagina is called vaginoplasty) Virus) is the virus that causes AIDS. Surgery is expensive and can have HIV slowly damages the body’s many side effects. It is also not defence system. very accessible in South Africa. It is This means the body starts losing available at some state hospitals, but its power to fight infection and the waiting period can be very long. heal itself. This might take years to Some transwomen who can happen. When the virus has broken afford it have surgery overseas. down most of the body’s defence If you are system the infected person will start thinking TIP S becoming ill. about having This person would then have AIDS. A surgery, You should person with AIDS can get sick from contact calculate that many different diseases because the Gender you will need body cannot fight any infections. DynamiX for a few weeks Often people get TB when they details of near the place have AIDS. surgeons where you had So a person can have HIV for a long overseas. surgery time before getting AIDS. to monitor that your body HIV is spread from one person to heals well. another through an exchange of some bodily fluids. This means if an infected person’s blood, cum, pre-cum or vaginal fluid mixes with yours, you are at risk of infection. 14  You can become infected by: doctor. They will ask you about your sexual practices, your partners and • having unprotected oral sex, when last you have had sex. They will or by having penetrative sex in also ask you for symptoms of STDs your vagina, front hole or anus and symptoms of TB, since people • sharing sex toys or needles to who are HIV positive are at a higher inject drugs or hormones risk of having TB. Then they will prick • sharing razor blades which are your finger and test your blood for not cleaned properly HIV. It takes about 15 minutes to get a result. After they tell you the result, Mothers can infect their babies they will counsel you on what the during pregnancy, birth or through next steps should be, depending on breast-feeding, but the baby of an whether you test positive or negative. HIV positive mother will not always be infected. An HIV test doesn’t actually test You cannot get HIV from kissing for the virus, but for the antibodies (unless you have open sores in your that your body produces when it mouth), sharing plates, cups or cut- gets infected. This does not happen lery, or from sharing toilets. immediately when you get infected, People who have penetrative sex and your body needs four to sixweeks (either in their vagina, front hole or to start producing antibodies. anus) have a high risk of getting HIV if they don’t use condoms. Oral sex has a lower risk for HIV, but you should follow the safer sex guidelines and What happens when use condoms or dental dams. Kiss- you test HIV positive? ing, scissoring, rimming, fingering and If you test positive: handjobs have a low risk for HIV. • you will receive counselling on Get tested for HIV what to do next and what being If you have had sex, you are at risk for HIV positive means for you contracting HIV. It is important that • you will be asked to come back to you know your HIV status so that the clinic for regular blood tests to you can protect yourself and others. see how you are doing Even if you think that you are not at • at every follow-up appointment, risk, you should get tested for HIV your blood will be tested for your regularly, regardless of your sexual CD4 count (the number of white practices. You can get tested for HIV blood cells that HIV attacks) and at your local clinic (free of charge) or your viral load (the amount of HIV at your GP. It is not enough to test for in your blood) HIV when you donate blood. • if your CD4 count is below 200 The person who tests you for HIV will (or below 350 if you also have TB), either be a counsellor, a nurse or a 15  These four to six weeks are called all your ARVs, the virus will become the window period. If you get tested resistant and the ARVs will not work during this period, the result could any longer. Then you can become come up as HIV negative when you sick faster. actually have the virus. That’s why if you get tested within three months ARVs and hormones of having unprotected sex you need to You have the right to get ARVs even if get tested again three months later you are on hormone treatment. to confirm that you are HIV negative. The person who tests you for HIV will You need to tell your HIV health care ask about your sexual practices and worker that you are taking hormones when you last had sex and will advise (even if they have not been prescribed you whether or not you will need to by a doctor), because some ARVs come back for a second test. work differently with hormones. Most ARVs however are not affected Taking ARVs by hormones. ARVs can also change When you take ARVs, it is important how hormones work, so you might that you take them regularly and not need to take more or less hormones miss a dose. This is called ‘adherence’. when you start taking ARVs. You will receive counselling on what Trans women might be prescribed a makes it easier for you not to forget higher dose of oestrogen if they take to take your ARVs. If you don’t take ARVs. If you stop taking your ARVs you must tell your health care worker because they might need to change your hormones. you should receive antiretroviral treatment (ARVs) • make sure you stay healthy – eat healthy, exercise and try to avoid stress • you need to have safer sex! Even if If you don’t take all your partner is also HIV positive, your ARVs, the virus they might have another variant of will become resistant HIV and you could get infected with and the ARVs will not this other HIV. Or you could infect work any longer! them with your HIV. • if you take ARVs you can stay healthy for a long time. 16  infected person • By sharing sex toys • From a mother to her unborn baby or newly born baby Sexually You cannot always tell if you have an transmitted STD as there are not always signs you can see. diseases If you think that you have an STD This is what you should do: • Go to a clinic with a trans-friendly health care worker. • Tell your partner(s) to go for HOW DOES A PERSON treatment. You and your partner GET INFECTED WITH A will both need treatment to get rid SEXUALLY TRANSMITTED of the STD completely. DISEASE (STD)? • Your health care worker will give you tablets or injections to treat Sexually transmitted diseases (STDs) the STD. are also known as STIs, venereal • Always finish the course of diseases or vuilsiekte. There are more treatment, even if you start to feel than 25 different kinds of STDs. Some better or if the signs of infection of the most common ones are herpes, go away. syphilis, genital warts, gonorrhoea and HIV. • It is best to stop having sex. Rest and recover. STDs are transmitted in the • If you choose to have sex, use a following ways: condom every time. You can also • Through sexual contact with an try and stick to fingering and hand infected person jobs and give oral sex until you • Through close skin contact with an are better. SOME SYMPTOMS OF AN STD • Pain or burning when peeing genitalia, vagina or front hole • Pain during sex • Puss or smelly fluids coming • Pain in the pit of the stomach out of the penis, pre-op genitalia, vagina or front hole • Swelling near the penis, t-penis, pre-op genitalia, • Blisters or sores or warts on vagina or front hole or around the penis, t-penis, pre-op genitalia, vagina or • Itching on or around the front hole 17 penis, t-penis, pre-op  OVERVIEW OF SEXUALLY TRANSMITTED INFECTIONS HOW TO REDUCE INFECTION AND WHAT IT CAN MEDICAL YOUR CHANCE HOW YOU GET IT FEEL LIKE TREATMENT OF GETTING AND GIVING IT HIV • Unprotected penetrative sex (in • You will have to • Use a condom vagina, front hole take ARVs that you when having sex or anus) • Many people do not get from a clinic or have symptoms your GP • Make sure to use • Any contact new needles, between blood/ • In the initial • There is no cure and not to share cum and mucous infection phase for HIV, however needles membranes/ people sometimes it is not a death damaged skin feel like they have sentence and can • Avoid contact with • It can be passed a flu be treated with vaginal fluid, blood from mother to medications to and semen child during keep you healthy birth, but this is preventable • Many people do not • Use condoms for have symptoms penetrative sex (in SYPHYLIS • Some people get a vagina, front hole • Unprotected oral painless open or anus) with penis sex or penetrative sore on their body • Go to a clinic or and pre-op genitalia sex (in vagina, front (genitals, anus, or your GP. and strap-ons hole or anus) mouth) • It can be fully cured • Use gloves for • Contact with a • Some people with antibiotics if it handjobs syphilis sore experience hair loss, is caught early • It can be passed rashes (especially • Use dental dams from mother to on the hands and for oral sex with child during birth feet), fever, swollen vagina or front glands, muscle and holes joint pain • Go to your clinic or GP • There is no cure • Use condoms for • Many people do for genital herpes, oral and penetra- not have symp- however there are tive sex (vagina, GENITAL toms, but if they do drugs that can help front hole, anus) HERPES the symptoms will reduce or prevent with penis and occur 1 week after symptoms pre-op genitalia • Skin-to-skin transmission contact with the • Keep the area clean and strap-ons. infected area, even • Itching or tingling and dry, avoid tight • Use gloves for if there are no in the genital area underwear and hand jobs. symptoms. • Tender or swollen pants glands • Use dental dams • Unprotected oral or • Bathe quickly and for oral sex with penetrative sex (in • One or more use a hairdryer, vagina or front the vagina, front blisters that may instead of a towel, holes. hole or anus) turn into painful to dry around the • Kissing sores sores • Try to avoid • Headaches, fever, • If you or your having sex during muscle pain partner have a an out-break, cervix, have a pap if you can. smear to check for related cancer 18  OVERVIEW OF SEXUALLY TRANSMITTED INFECTIONS HOW TO REDUCE INFECTION AND WHAT IT CAN MEDICAL YOUR CHANCE HOW YOU GET IT FEEL LIKE TREATMENT OF GETTING AND GIVING IT • Some people do not have symp- toms, but those who do may notice them 2-5 days after transmission • Use a condom for oral and penetrative • Yellow or bloody • Go to your clinic GONORRHOEA or GP sex (vagina, front fluids from penis, hole, anus) • Unprotected oral, pre-op genitalia, • Gonorrhoea is or penetrative sex vagina, front hole, • Use a dental dam treatable with for sex with a va- (vagina, front hole, or anus antibiotics anus) gina or front hole • Pain during • Untreated, • It can be passed penetration • If you have gonorrhoea can gonorrhoea, go from parent to child lead to a chronic during childbirth • Blood in your shit to the clinic or inflammation your GP to get • Burning or painful sensation when antibiotics you pee • Pain in your lower belly, fever, and chills • There is no cure, but once warts are • Many people do not present, you can GENITAL WARTS have symptoms choose to freeze • Use condoms, • Single or clusters them, burn them, or dental dams, and/or • Skin-to-skin of warts on, in, and use topical creams gloves for oral and contact with the around the genitals to get rid of them. penetrative sex, and infected area and/or anus. • Without treatment, for handjobs • Unprotected oral • Warts may be it can lead to • Warts from the or penetrative sex round, flat, or a cancers hands can be (vagina, front hole, cauliflower shape • If you or your transferred to the anus) that are flesh partner have a genitals coloured or grey cervix, have a pap smear to check for related cancer • Some people do not have symp- toms, but for those that do, symptom • Use a condom for CHLAMYDIA may appear 1-3 oral and penetra- • Unprotected oral weeks after trans- • Go to your clinic tive sex. or penetrative sex mission or GP • Use a dental dam (vagina, front hole, • Abnormally watery for oral sex with anus) • Chlamydia is or thick fluids from treatable with vagina or front hole • It can be passed the penis, pre-op antibiotics genitalia, or vagina, • If you have from parent to child Chlamydia, go to during birth front hole your clinic or GP • Pain during sex or to get antibiotics while peeing • Pain in abdomen 19 • Fever Dildos, vibrators, and packers are Sex Toys toys that many people use when they are having sex. You have a very low risk of spreading HIV or other STIs as long as you follow some simple suggestions. With all toys, it is important to use lubricant to avoid injuries. When you use toys, make sure you always clean them between different Glass, acrylic and steel toys holes and partners. • Clean with water and soap (or toy Toys made of 100% silicone cleaner) and dry in the air. These toys are also nonporous. • 100% silicone toys are nonporous, so they will not keep bacteria and • Glass and acrylic toys are very they are not allergenic. safe and durable, but they can break or chip if they get dropped. • Silicone toys can be washed with Handle them with care. You can soap and water (or toy cleaner) change the temperature of glass and dried in the air. If you want to toys by putting them under hot or sterilise silicone toys (only ones cold water. Don’t put them in the that do not contain batteries!), boil freezer or microwave. them in water for 3 minutes • A silicone toy can last for years, Jelly, rubber, elastomer and but once it has a tiny nick it can silicone-blend toys tear easily. Keep it away from sharp • Wash them with water and soap objects, teeth or cat claws. and dry in the air every time you • Use water-based lubricants. use them. You should use a condom Silicone-based lubricants can hurt on them each time, because they the silicone and make it porous. are porous and cannot be sterilised. This is especially important if you use the toy in a vagina/ front hole and an anus, or if you share the toy with your partner. • Store your toy in a bag (or a sock). When you use toys, make sure you Some toys can cause harm to always clean them between different the surface of other toys if they holes and partners! are left with them. 20  ALCOHOL AND DRUGS Cyberskin packers USE AND UNSAFE SEX • After cleaning your cyberskin Alcohol and other drugs can packer, dust it with packer dust or make you forget you promised cornstarch to make it less sticky. yourself to have safer sex. The Don’t use baby powder or talcum use of too much alcohol or any – some research says these might amount of drugs often leads to cause cancer. high-risk sex. Vegetables Keep the following in mind: • Cucumbers for example can work • Decide what you and your great as toys. Before inserting partners rules are for having safer them, make sure to wash them sex. Don’t decide to take drugs thoroughly with soap and water, or drink alcohol if this will affect and check that there are no rough your judgement. bits and that they are still good. It is best to use a condom. • Try not to have sex when you are Expired vegetables can cause too high – it’s much safer when yeast infections. you have your head together. • Don’t use unknown drugs. Lubricant • If you do sex work, don’t go with • Water-based lube: this is the best a client who is obviously drunk lube to use. It is safe to use with all or high. toys and condoms. Sharing needles • Silicone-based lube: it lasts very long, and can be used with Needles are used by people for condoms. It also works underwater. various reasons. Some people use However, silicone-based lube can them to inject hormones. Some damage silicone toys. people use them to inject drugs • Oil-based lube: do not use this lube such as heroin. And some people with condoms or toys. have silicone injections to change • You can also try to change your their bodies. diet to increase self-lubrication. The following points are important Okra is a good example for this, to keep in mind if you are using whole soy foods, flax seeds needles: and zinc. • Always use a new, clean needle every time you inject something 21 • Hormones are usually injected with a different sized needle than Keeping drugs. Don’t use hormone needles for drug injections or the other Safe way around. • Try not to share needles or use needles more than once. Sharing needles has a very high risk for HIV and hepatitis C. • Don’t just throw needles out! Put them in a plastic water bottle also very common, and there are and take them to your local clinic many suggestions to make it legal. or GP so that they can safely be If you choose to do sex work, here disposed of. are some ways to make it safer for • Make sure to keep your injection yourself and your clients: sites clean by swabbing them • Always carry condoms and lube. with alcohol before injecting and Don’t rely on the client to using band-aids after. bring these. You can get free condoms from most clinics and SEX WORK/ government services. But be aware that if you carry a lot of TRANSACTIONAL SEX condoms, the police may use We know that some people, them as ‘evidence’ against you if including transgender and gender they do stop-and-searches. non-conforming people engage in • If you can, get money first, get transactional sex or sex work. down second. In South Africa, sex work is illegal. • If you are robbed, attacked, or The Sexual Offenses Act from 2007 raped consider speaking to a sex makes it an offense to see and to workers support organisation purchase sex work. It is illegal for if there is one in your area (see the sex worker and for the client. resources at the end of this This means that the police can stop booklet) and search you, and arrest you, if • Working in pairs or in groups they suspect that you are a sex can help if you are working on the worker. A lot of transwomen get street. Write down the license stopped and searched by police, plate numbers of the clients your regardless if they actually do sex friends go with, and have them do work or not. However, sex work is the same for you. 22  • Avoid wearing necklaces or scarves. • Dates with more than one client These can be used to choke you if can be risky. If you feel the date goes bad. uncom-fortable, get out of there • Find a trustworthy friend to call right away. before and after dates. Let them • For more information contact know the client’s name, phone SWEAT. Their contact details are number, email, and/or license plate at the end of this booklet. number, in case the date goes bad. If you can’t find a friend to do this, pretend to call a friend when the RAPE AND client arrives and tell this “friend” the client’s name and what they SEXUAL ASSAULT look like, and that you’ll call again Whether you are a transwoman, after the client leaves. This lets a transman, or gender non- the client think that there will be conforming, any act of sexual someone out there who knows penetration that you do not where you are supposed to be consent to is rape. and who will alert the police if you go missing. If you get raped or sexually assaulted, there are a number of things you need • Wearing lipgloss or lip balm can to think about: help prevent you from getting cuts or tears on your lips, especially • Are you injured or physically during the winter. Cuts and tears in harmed? Do you require your lips will increase your risk health care? of getting HIV, and other STIs. • Do you want to report the person • Don’t carry valuables or too many who assaulted you to the police? pieces of identification, if you can. • Are you safe or are you in a Sometimes a bad client will rob you situation where you can be and you might be left with no ID. assaulted again? • Never believe the client. Always be aware that they might be lying Health care to you. You have the right to health care after • Be clear and firm about your prices being raped or sexually assaulted. and your limits. If you prefer to Youhave the right to receive health use condoms for blowjobs, be firm care even if you choose not to report about it, even if they offer you extra the rape or sexual assault to the money or say they won’t have sex police. This includes the following: with a condom on. Better to lose • Get treatment for any injuries you the money and find another client might have. than to risk your health. 23 • Get post-exposure prophylaxis (PEP) treatment to prevent the Sexual transmission of HIV if you are HIV negative (PEP only works within 72 Violence hours of the assault. The sooner you take it the better). PEP means that you take ARVs for one month to prevent you from becoming HIV positive. PEP does not eliminate your risk for HIV, but it reduces it a lot. • Get prevention treatment for STDs. police should take you to a private • Get a pregnancy test and area, out of the sight and hearing emergency contraceptives if you of other people. They have to take are a transman or female-bodied your report seriously. gender non-conforming person (you can only get this if you go to • The police officer should introduce the hospital within 5 days of the him/herself. assault). If you become pregnant • A docket will be opened and as a result of the offence, you recorded in the Occurrence Book, have the right to a termination of but a full statement will only be pregnancy (abortion), free taken after you have received of charge. health care services at the hospital • Get a forensic exam to collect or clinic. evidence. • The officer should give you a form • You have the right to refuse any called ‘Notice of Services Available of these treatments. to Victims’ (SAPS 580) which summarises your legal rights. The The right to report officer will explain this form to you if you have any problems reading or You have the right to report the rape understanding it. or sexual assault at a police station. You should ask to be taken to a When you first get to the police hospital/clinic for medical treatment station, you only need to give an initial (including PEP, see above) and a statement with a brief account of the forensic exam. The police should event. You will get a chance to give take you there or they will call an them more information later. ambulance to take you. At the police station Within 36 hours (one and a half days), • Once you have said that you want the Investigating Officer in charge of to report a sexual offence, the your case should contact you and 24  will then take a full statement. The given the docket/case number. following will happen: Write this information on the chart. • The Investigating Officer will tell • If after giving the statement you you his/her name and contact remember something else later, you details. They should keep you can call the Investigating Officer informed of the progress of the and add to your original statement. investigation and you should You can then get a copy of the contact them with any questions, updated statement. concerns or information you may Hospitals and police stations can have. Contact them if you change be very discriminatory spaces your phone number or address. for transgender and gender non- • You have the right to be conforming people. It is your right to accompanied and supported by a receive health care and to report to person of your choice while making the police. Contact Gender DynamiX, your statement. However, this S.H.E. or TIA to find out about trans- person should not have witnessed friendly hospitals and police stations. the offence. If you are younger than You can also contact rape support 18 years old, a parent or guardian organisations in your area and ask should support you while you them to help you. give your statement, even if they witnessed the offence. If you are being abused or assaulted at home, there are safe places where • You have the right to give the you can go. Contact Gender DynamiX, statement in your own language TIA or S.H.E to find out about where and an interpreter should be these places are and how you can provided if the Investigating Officer access them. does not speak your language. • When you give your statement, try Your rights as a patient to remember as much as you can, The South African Constitution says: providing all the details that you can. The Investigating Officer will write everything down. • Read the statement and only sign it “The state may not unfairly discriminate directly or if you agree with everything that indirectly against anyone on has been written down. You should one or more grounds, including get a copy of the statement, so ask race, gender, sex, pregnancy, for it. marital status, ethnic or • A docket should already have social origin, colour, sexual been opened, and you should be orientation, age, disability, religion, conscience, belief, 25 culture, language and birth.“ The constitution also guarantees • If you are not satisfied with the everyone the right to access health service of the public health care services: “Everyone has the system, it is your right to challenge right to have access to ¬health care government to supply you with the services, including reproductive health relevant services for your condition care (Section 27(a))” • Many transgender and gender non- This means: conforming people suffer prejudice at health care facilities because • You have the right to get health of their gender identity or sexual care (for HIV, or any other orientation. This is against the SA condition), and nobody is allowed to Constitution. Every citizen of this discriminate against you because country can hold public health care of your gender identity or sexual providers accountable. Contact orientation. Gender DynamiX, S.H.E. or TIA if • You have the right to undergo you need support. various gender reassignment *The Standards of Care are released by procedures (for example hormone the World Professional Association for treatment) to the extent that Transgender Health (WPATH) and outline how you want. transgender health care should be like. They • It is your right to find the are internationally accepted guidelines for appropriate person to treat you. medical, health and service providers about trans health care. Health care workers sometimes require a diagnosis of gender dysphoria by a medical professional (a psychologist or a psychiatrist) before you can access hormone treatment. Some professionals might be more knowledgeable than others. This is often the case when health care workers don’t know enough about the updated Standards of Care* (SOC) for transgender health. Contact Gender DynamiX, S.H.E. or TIA for more information. 26  S.H.E. Social, Health and Resources Empowerment feminist collective for more advice of transgender and intersex women of Africa Office 5, 5th Floor, NBS Building, Terminus St, East London 5200 Tel: +2773 811 0789 Fax: 086 260 3971 Blog: http://transfeminists. wordpress.com Skype: transfeminists SWEAT Sex Workers Education Gay & Lesbian Network and Advocacy Taskforce 187 Burger St, Pietermaritzburg 3201 19 Anson Street, Observatory 7925, Cape Town, South Africa Tel: 033 342 6165 Tel: 021 448 7875, Fax: 021 448 7578 Helpline: 0860 33 33 31 Helpline: 0800 60 60 60 Website: www.gaylesbiankzn.org Sms Please Call Me to 071 357 7632 Gender DynamiX email: helpline@sweat.org.za Situated at: Saartjie Baartman Centre, www.sweat.org.za Klipfontein Road, Manenberg 7764 Tel: 021 633 5287 TIA Transgender and Intersex Africa (Mon-Fri, 9:00-17:00) 2249 Block F, Soshanguve 0152 email info@genderdynamix.org.za Tel: 012 797 2612 www.genderdynamix.org.za email: transgender.intersex101@ FaceBook page: Gender DynamiX gmail.com Rape Crisis Counselling Lines Triangle Project Observatory: 021 447 9762 2nd Floor, Elta House, 3 Caledonian Road, Mowbray 7700, Cape Town Athlone: 021 633 9229 Tel: +2721 686 1475 Khayelitsha: 021 361 9085 Fax: +2721 686 1841 Helpline: 021 712 6699 Daily 1pm-9pm email: info@triangle.org.za website: www.triangle.org.za 27 GLOSSARY Continued from inside front cover Men who have Sex T-Penis with Men (MSM) Transmen who have taken testosterone can Men who engage in sexual activity with have an enlarged clitoris. In this booklet, we other men; a behavioural term which does call this a t-penis. not reference one’s identity or desires necessarily, there are many situations Transition where men engage in sex with men without The process of changing one’s gender identifying as gay or bisexual. expression to match one’s gender identity. Natal sex Transgender The sex assigned to a person at birth. People who have a gender identity, and often a gender expression, that is different Post-Exposure Prophylaxis to their sex assigned at birth by default Short-term antiretroviral treatment to of primary sexual characteristics. Some reduce the likelihood of HIV infection after transgender people opt for gender-affirming potential exposure (commonly administered treatment, while others choose to not, after rape). or only partially, undergo such treatment. Transgender people can be heterosexual, Pre-op genitalia bisexual or homosexual. Transwomen who have not had surgery still have a penis. Since the word penis is Transgender man usually associated with a male body, we use A transman, or female-to-male (FTM), the more neutral word ‘pre-op genitalia’. starts his life with a female body, but his gender identity is male. Always use male Sex pronouns in reference. The biological and physiological characteristics that define men Transgender woman and women. A transwoman, or male-to-female (MTF), starts her life with a male body, but her Sexual gender identity is female. Always use characteristics female pronouns in reference. Physical features that are considered to distinguish males and females from each Transphobia other; primary sexual characteristics An irrational fear of, and/or hostility refers to the physical features part of towards, people who are transgender the reproductive system, such as genital; or who otherwise transgress traditional secondary sexual characteristics are those gender norms. physical features linked to the physical sex that are not directly part of the Women who have Sex reproductive system. with Women (WSW): Sexual Women who engage in sexual activity with orientation other women; a behavioural term which does not reference one’s identity or desires A person’s sexual identity in relation to necessarily, there are many situations the gender to which they are attracted where women engage in sex with women (heterosexual, homosexual, or bisexual). without identifying as lesbian or bisexual.  S TION Y D ONA EATLY AN E GR D! LD B E WOU PRECIAT AP Gender DynamiX Saartjie Baartman Centre, Klipfontein Road, Manenberg 7764 PO Box 347 Athlone 7760, Cape Town, South Africa Tel: 021 633 5287, Fax: 086 614 2298 email: info@genderdynamix.org.za, www.genderdynamix.org.za First National Bank, Current account 6211 598 2747, Branch code 204 709 SWIFT code FIRNZAJJ • PBO registered, NPO No 052-178-NPO, VAT No 493 025 9454