HYGIENE AND SEXUAL HEALTH

A QUEER AND TRANS AFFIRMING, HARM REDUCTION APPROACH

This handout provides guidance on hygiene and sexual health across a range of bodies, identities, and types of sex.

There is no one “right” way to have sex or care for your body. The goal is to reduce risk, support comfort, and help you make informed choices without judgment.

GENERAL PRINCIPLES

• Sexual health is part of overall health
• Bodies vary widely and anatomy is unrelated to gender
• Harm reduction means safer practices, not perfection
• You deserve care that is respectful, affirming, and not based on assumptions

HAND HYGIENE

Hands are a common way bacteria enter the urethra, vagina, or rectum.

Helpful practices:
• Wash hands with soap and water before and after sexual activity
• Trim and file nails to reduce risk of microtears
• Avoid hand contact if you have cuts or infections
• Consider gloves (latex or nitrile) for anal or vaginal penetration, especially with longer nails

For people with vagina, front holes, or man caves:
• Hand hygiene is especially important to reduce UTI and bacterial imbalance risk

GENITAL HYGIENE

External genital care:
• Wash daily with gentle soap free from dyes, fragrances, or essential oils
• Wash between folds and pat dry
• Always wipe from front (genitals) to back (rectum)

If you have bottom growth or clitoral enlargement:
• Clean gently daily with soap and water

Internal care:
• Vaginas do not need to be washed or douched

Penile care:
• Wash daily with gentle soap and pat dry
• If uncircumcised, gently retract foreskin and clean underneath
• Do not force foreskin retraction

SEX TOY SAFETY

Sex toys can be used safely with proper cleaning and use.

Materials:
• Non-porous materials like medical-grade silicone are preferred
• These can be sterilized by boiling or dishwasher (if no electronics)

Toys with electronics:
• Cannot be fully sterilized
• Use a condom over the toy each time even if only used for yourself due to risk of bacterial vaginosis, yeast infection, urinary tract infection

Cleaning:
• Clean after each use
• Sterilize regularly (at least weekly for personal use toys)

Use across body sites:
• Do not move toys from anus to vagina/front hole without sterilizing or changing condom 

Gender-affirming items:
• Packers, prosthetics, and breast forms should be cleaned regularly
• Use silicone devices when possible for easier sterilization for devices that make contact with genitals
• Keep tucking/packing devices clean and dry

Replace toys if:
• Cracked, sticky, difficult to clean
• Recurrent infections occur (UTI, BV, yeast)

LUBRICATION

Lubrication reduces friction, tearing, and discomfort.

General guidance:
• Use for anal sex and often for vaginal/front hole sex
• Water-based = most versatile
• Silicone-based = longer lasting
• Oil-based = not safe with latex condoms

Trans-specific considerations:
• Testosterone can cause dryness
• Estrogen may change sensitivity
• Regular use of lube or vaginal moisturizers can reduce pain

Avoid:
• Fragrances, dyes, or flavored products

ANAL HEALTH AND DOUCHING

Anal douching is optional and not required.

Harm reduction:
• Keep it gentle and limited

Safer practices:
• Single-use saline enemas (fleet enemas) are safest
• Avoid repeated or forceful douching

Risks:
• Irritation of rectum
• Increased infection risk

Stop if pain, bleeding, or irritation occurs

GENITAL ATROPHY AND ESTROGEN

Estrogen can cause:
• Decreased penile and testicular size
• Erectile changes

Treatment options:
• Topical testosterone cream
• Medications such as sildenafil or tadalafil

Important:
• Do NOT combine ED medications with “poppers” (amyl nitrites) due to risk of severe low blood pressure

BARRIER PROTECTION AND STI PREVENTION

Risk depends on type of contact (oral, genital, anal).

Barrier options:
• External condoms
• Internal condoms
• Dental dams
• Gloves

Helpful practices:
• Use new barriers between partners or body sites
• Use lubrication to reduce breakage
• Test regularly

Additional options:
• PrEP (HIV prevention)
• PEP (after exposure)
• DoxyPEP (reduces bacterial STIs like chlamydia, gonorrhea, and trich)
• Vaccines (HPV, hepatitis A and B)

URINARY AND GENITAL HEALTH

Helpful practices:
• Urinate after sex
• Shower within 1 to 2 hours

Trans-specific considerations:
• Testosterone may increase UTI risk, bacterial vaginitis risk, and yeast infection risk due to vaginal atrophy or thinning
• Tissues may be more sensitive depending on hormones or surgery

Seek care if:
• Burning with urination
• Unusual discharge
• Pain or odor

POST-SURGICAL CARE

If you have had gender-affirming surgery:

Vaginoplasty:
• Follow dilation and hygiene guidance
• Monitor for discharge, odor, or pain

Phalloplasty or metoidioplasty:
• Monitor urinary function
• Clean surgical areas as directed

Always follow your surgeon’s instructions

CONSENT, COMFORT, AND DYSPHORIA

• You can stop or change activities at any time
• Pain is a signal, not something to push through
• Dysphoria may affect what feels safe

• Preferred sexual activities, sexual attraction, and sensations may change with use of gender affirming hormone therapy

Helpful approaches:
• Use affirming language
• Communicate boundaries
• Adjust positioning or activities

WHEN TO SEEK MEDICAL CARE

Seek care if you have:
• Persistent pain or bleeding
• Signs of infection
• Genital itching, odor, or discharge
• Painful urination
• Rectal pain or bleeding, pain with bowel movements
• Persistent sore throat or swollen tonsils
• Possible STI exposure
• New or concerning symptoms

FINAL NOTES

There is no perfect way to approach sexual health.

Small steps like hand washing, barrier use, cleaning toys, and lubrication can significantly reduce risk.

Your care team is here to support you without judgment.

You deserve care that respects your body and identity.