Editorial: Trans Reproductive and Sexual Health

Trans people have long been at the vanguard of reproductive and sexual health in terms of meeting the needs of their own communities. In the face of restrictive government policies and expensive or simply unavailable health care, trans people have supported one another to fulfill their reproductive and sexual health needs. Think of, for example, Eilis Ní Fhlannagáin providing orchiectomies from her own home. As she notes, “No one was going to take care of us. We had to take care of ourselves” (qtd. in Dodds, 2022). Or think about the late and great Mira Bellwether, who created the zine Fucking Trans Women (Bellwether 2010). The outpouring of tributes on Twitter following Mira’s death at the end of 2022 all spoke to how her words gave trans women and their lovers a voice to speak about desire and pleasure, when no one else outside of trans communities was speaking about trans women as desirable. Trans women like Eilis and Mira have provided care and support for trans people with regard to their reproductive and sexual health needs in the face of systems that have either actively opposed, or have just been uncaring about, the needs of trans people.

That trans people have so often had to take the lead in developing reproductive and sexual health resources and services for one another speaks to how long it has taken professionals working in services to even begin to recognize trans people’s needs. Certainly, we can think of examples where earnest health-care professionals have long attempted to meet the needs of trans people. Think of, for example, Lili Elbe receiving a uterine implant in 1930s Germany. While this is a very early example of the provision of affirming care, ultimately the lack of clinical knowledge resulted in the death of Lili. In a different place in the history of trans people’s engagement with reproductive and sexual health professionals, we have people like John Ronald Brown (aka “Butcher Brown”), who performed illegal surgeries on trans women in the 1990s, leading to mutilation for many women and for some women death (Dodds, 2022). And across these histories of (potentially) well-meaning but ultimately harmful health care, we have a consistent theme of pathologizing health-care provision that has actively ignored the reproductive and sexual health needs of trans people (Pearce, 2018).

It is only since the turn of the millennium that we have seen any real, serious, supportive focus on trans people’s reproductive and sexual health needs within academia and among health-care professionals, with trans reproductive and sexual health becoming a hot topic over the last five years especially. This is not to ignore that the work of those outside academia has long influenced or informed work within the academy and those working in practice. We might think of the National Latina Institute for Reproductive Health writing in 2013 about the importance of recognizing trans people’s needs within the context of reproductive justice (National Latina Institute for Reproductive Health 2013). Or Lowik (n.d.) writing within and beyond academia about trans people’s needs for access to abortion services. We document much of this in our recent book (Riggs et al., 2022); however, we would also note that as much as change certainly has happened in terms of academic and professional recognition of the needs and rights of trans people to reproductive and sexual health care, the phenomenon of “trans broken arm syndrome” still very much affects how trans people are received within the context of health care (Wall et al., 2023).

Yet, despite the relatively positive changes associated with growing recognition of the needs and rights of trans people to reproductive and sexual health care, it is vital that we acknowledge that this is not a universal phenomenon. In over 30 countries it is still the case that trans people are required to “consent” to sterilization in order to change their legal gender (Transgender Europe, 2021). In many more countries, access to affirming care more broadly is negligible, and in countries such as the United States and the United Kingdom we are seeing an increasing political push toward the curtailing of trans people’s rights, including in terms of reproductive and sexual health care. As is often the case for trans people in terms of visibility, then, as visibility increases and more people (including health-care professionals) become informed about the needs of trans people, so comes with this often increased pushback against trans people’s lives.

It is also important to provide comment on the inclusion of a special issue on trans reproductive and sexual health in the journal Women’s Reproductive Health. In one respect, it is vitally important that academic journals address the needs of trans people, both in general issues and as special issues. But we are also mindful that a journal badged as focusing on women (which of course includes all women regardless of gender modality) is a very particular space in which to publish a special issue that encompasses the reproductive and sexual health needs of people of a diversity of genders. We would hope that the inclusion of this special issue signifies that reproductive and sexual health cannot simply be seen as the purview of women, just as we would hope that the inclusion of the special issue in this journal speaks to the fact that reproductive and sexual health needs historically considered to be unique to women (e.g., childbirth, pap smears) are in fact needs relevant to a diversity of people.

In terms of the issue contents, we were pleased to receive submissions from a diversity of countries focusing on a wide variety of topics. Writing from Aotearoa, New Zealand, Parker and colleagues explore experiences of marginalization among trans people within perinatal services, while Lowik and colleagues explore how young trans people in the United States navigate pregnancy decision making. Plemons provides an important historical view on trans women and pregnancy, examining how new medical developments that may help trans women to achieve their parenting desires are framed as a problem to manage. Writing from the context of Germany, Salden and colleagues explore the barriers that trans people experience when compared to cisgender people in terms of accessing reproductive health care, while Lowik in the Canadian context explores how trans people either conceal or disclose their gender modality when accessing reproductive health care. Finally, Kattari and colleagues take up the topic of sexual health in detail, exploring how trans people understand and navigate the use of HPV test kits.

As a collection, this special issue highlights that despite significant changes in terms of recognition of the rights and needs of trans people to reproductive and sexual health care, much work still needs to be done. More broadly, this special issue speaks to the need for reproductive and sexual health care for trans people to sit within broader social structures that make trans lives possible in addition to being intelligible. To speak of Mira Bellwether, for example, as a powerful trans advocate also requires speaking about Mira as a woman who lived in the context of a health-care system that failed to meet her needs. Mira lived an intelligible life and impacted the lives of many, but ultimately her life was not livable because the context she lived in did not support her existence. As work in the space of reproductive (and sexual) justice has long argued, it does not suffice to say someone has the right to exist. Equally important are structures that make living possible and, ultimately, enjoyable. That trans people continue to face barriers to simply living highlights how much work is yet to be done to make this a reality, even as trans people continue to create spaces and resources that bring joy to trans communities.

Disclosure statement

No potential conflict of interest was reported by the author(s).