Saúde sexual de pessoas trans : fatores associados às experiências de afirmação de gênero, corpo e sexualidade

Abstract

Transgender persons are those whose gender identity is not aligned with sex assigned at birth. In the Brazilian context, they are subject to several vulnerabilities and are systematically at risk of suffering deleterious adversities, which include high prevalence and exposure to HIV/AIDS and other sexually transmitted infections, trends already well documented in national and international literature. Aspects of general sexual health, such as satisfaction with gender assertion procedures, sexual assertiveness and fears related to sex have been insufficiently addressed. Seeking to contribute to fill this gap, the objective of this thesis was to investigate factors associated with gender affirmation, body and sexuality experiences in transgender individuals. The thesis is composed of one theoretical, three empirical and two clinical studies. The first study compiled evidence on technical aspects related to healthcare needs of transgender persons, presenting the main barriers of access faced by these individuals and discussing the technical and political implications of health care. The second study investigated whether self-esteem, depression and resilience (psychological variables) and the performance of body modification surgery are associated with the outcomes sexual fear, sexual anxiety, sexual dissatisfaction, level of satisfaction with body modification procedures and concerns with sexual body image (sexual variables) in 462 trans men and women. The main results indicated that higher levels of depression and lower levels of resilience were associated with sexual dissatisfaction. Still, depression and resilience were associated with the score composed of sexual dissatisfaction and sexual anxiety. These outcomes suggest that damage to mental health can negatively impact the sex life of trans individuals. The third study found associations between condom-protected sex, self-efficacy in negotiating condom use, self-esteem and four dimensions of minority stress (misgendering experiences, “passing” concerns, anticipated prejudice and perceived prejudice) in 260 transgender men and women. The findings suggested that self-efficacy in negotiating condom use, “passing” concerns, and experiences of “misgendering” were predictors of condom-protected sex. Structural strategies and clinical interventions have been suggested to address self-efficacy in negotiating condom use and “passing” concerns in transgender populations. The fourth study presented qualitative data about gender affirmation, body, and sexuality obtained in semi-structured interviews with six participants, analyzed through content analysis. The main thematic axes were defined a priori and indicated a wide variety of meanings attributed to these experiences, demonstrating the heterogeneity present in transgender communities. The fifth study carried out a basic review on sexual dysfunction in transgender persons and presented a proposal for cognitive sexual therapy for this population. The clinical discussion suggested procedures to assess, conceptualize, and treat sexual demands and complaints, highlighting the supportive role of psychologists in gender-based medical procedures. The study also indicates psychotherapeutic interventions that break the strictly behavioral pattern of traditional sex therapy. The sixth study, based on the assumptions of dialectical behavioral therapy, described detailed interventions on how to manage body rumination in transgender individuals who have gender dysphoria. The necessary balance between acceptance and change strategies was emphasized through fictitious vignettes and detailed clinical instructions. The set of studies points out the heterogeneous sexual health experiences in transgender population, demonstrating the impact of mental health impairments on sexual outcomes and the manners on which how prejudice against these individuals negatively affects sexual outcomes. It is concluded that more studies need to be carried out to inform programmatic and affirmative clinical interventions to address sexual health concerns in transgender population.