Introduction

Pelvic pain in transmasculine individuals is a complex issue, encompassing both physical and psychosomatic aspects. This article aims to explore the multifaceted nature of pelvic pain, considering both biological and psychological perspectives.

Physical Aetiology

1. Hormonal Changes: Testosterone therapy, a common aspect of gender transition, can lead to significant hormonal shifts, potentially causing pelvic pain.
2. Surgical Implications: Gender-affirming surgeries, such as hysterectomy or lower surgery, can lead to post-surgical pain or complications.
3. Anatomical Factors: The unique anatomical variations in transmasculine individuals may contribute to pelvic discomfort.

Psychosomatic Aetiology

1. Stress and Trauma: Ongoing societal challenges and personal traumas can manifest as physical pain, including in the pelvic region.
2. Gender Dysphoria: The psychological distress from gender dysphoria can exacerbate physical pain, creating a complex interplay between mind and body.
3. Mental Health Conditions: Prevalent mental health issues in the transgender community, like anxiety and depression, can also contribute to psychosomatic pain.

Approach to Care

1. Inclusive Healthcare: It’s vital for specialists to offer a sensitive, inclusive approach, recognising the unique needs of transmasculine individuals.
2. Comprehensive Treatment: Treatment should address both physical and mental health aspects, offering a holistic approach to care.
3. Support Systems: Ensuring access to supportive communities and mental health resources is crucial for addressing the broader aspects of pain management.

‘Puberty blockers’

GnRHa (Gonadotropin-Releasing Hormone agonists) can play a role in managing pelvic pain for transmasculine individuals. These medications are used to suppress natural estrogen production, which can be a factor in pelvic pain. By reducing estrogen levels, GnRHa agonists can potentially alleviate some forms of pelvic discomfort that are hormonally influenced.

Hysterectomy

A hysterectomy, the surgical removal of the uterus, can have both pros and cons in managing pelvic pain for transmasculine individuals:

Pros:

1. Effective Relief: It can provide significant relief from pelvic pain, especially if the pain is linked to menstrual cycles or other uterine-related issues.
2. Gender Dysphoria Alleviation: For some transmasculine people, it can help in alleviating gender dysphoria related to having a uterus.

Cons:

1. Surgical Risks: As with any surgery, there are risks involved, such as infection, bleeding, or complications from anesthesia.
2. Permanent Change: It’s a permanent procedure that eliminates the possibility of pregnancy.
3. Cost and Availability: The cost and availability of a hysterectomy for transmasculine individuals can vary widely, depending on factors like healthcare system, insurance coverage, and geographical location.

Research Review

Pelvic pain can have various possible causes, including urinary tract infections and sexually transmitted infections. In people who have vaginas and uteruses, common causes are endometriosis (a condition where uterine tissue grows outside the uterus) and pelvic inflammatory disease (inflammation of the genital tract usually due to infection). However in many cases, no cause is found.

Gender affirming hormone treatment itself does not directly cause pelvic inflammation. However, there is a possibility that masculinising hormone treatment could increase the risk of pelvic pain. A recent study found that transmasculine adolescents often reported pelvic pain after initiating testosterone (Moussaoui et al., 2022). The reasons for this are not fully understood. Nonetheless, it is known that testosterone can cause vaginal atrophy and thinning of the lining of the uterus, which may increase the risk of irritation or infection of the genital tract (Perrone et al., 2009). If this becomes a problem, topical oestrogen cream be successful at decreasing the effects of vaginal atrophy and restoring comfort.

If you are experiencing pelvic pain, it is recommended that you see your doctor or attend a sexual health clinic to be investigated for common causes, including urinary tract infections and sexually transmitted infections.