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Your Vag on T: Dealing with Vaginal Atrophy

Front-hole health for vagina-owners taking testosterone

Photo by Dainis Graveris on SexualAlpha


By Baxstar Jonmarie

Some transmasculine folks who take hormones also want to get bottom surgery, and others, like me, are happy with a healthy vagina or front hole.

NOTE: As recommended by researchers published in the BMC Pregnancy and Childbirth journal, wherever the word “vagina” is used in this article, the trans-inclusive term “front hole” is also included. For more information, see here.

Maintaining sexual health during and throughout hormonal transition is incredibly important to me and to other trans folks everywhere. Watch out for these main challenges associated with testosterone masculinizing therapy and give yourself permission to enjoy the best parts of prevention — the orgasms!

Vaginal Atrophy: The Big Three

Also called atrophic vaginitis, vaginal atrophy describes the thinning, drying, and inflammation of vaginal tissue due to hormonal changes. These are common side effects of testosterone therapy as well as menopause, so these experiences aren’t entirely unique to transmasculine people, however it can present unique challenges for transmasc folks.

Keep in mind that while these symptoms are likely, they aren’t necessarily inevitable, and there are options to help prevent and treat them. If you have any concerns, reach out to your doctor, and don’t hesitate to use this guide as a jumping-off point for that discussion.

Don’t despair! Self-educate!

Drying Up

Likely the first symptom of vaginal atrophy to be noticeable, the changing pH in response to low estrogen levels, and the changes to the cells of the vagina or front hole and cervix means that your body is likely to produce less lubrication. This can result in dryness, itching, and potentially even pain.

You may notice a decrease in normal discharge and find that you don’t lubricate at all when aroused. This could happen as soon as 1 to 3 months after the initiation of hormone therapy. Alone this is an easy issue to address but watch for other symptoms.

Thinning Out

The problems associated with dryness are made worse by thinning. The vaginal wall, or epithelium, is made up of anywhere from 20 to 40+ layers of various cells. These cells are alive, in constant flux based especially on available hormones, like estrogen and testosterone. (Yes, your vagina or front hole needs testosterone too!)

Without estrogen, the epithelium can become as thin as only a few layers of cells. Combine this with a dry vagina or front hole and penetration, and you can see how problems arise. Abrasions are possible even from gentle sex, causing bleeding and dramatically increasing the risk for STI transmission. Not to mention, OUCH. If you like pain, enjoy, but safely — not like this!


The third major symptom of vaginal atrophy is inflammation. Dryness combined with thin and easily irritated vaginal walls easily becomes chronic inflammation. Changes to pH can also make you more susceptible to yeast and bacterial infections. The vagina may, in response, shorten or narrow which can cause further pain and inflammation during sex.

man sitting topless in bed
Photo by Shane on Unsplash


This all adds up to one unhappy hole. Dry, itchy, swollen, or worse! So what’s a trans dude to do? Luckily the easiest and least expensive options are also a lot of fun:

Keeping Your Front Hole Happy

There are two main ways that transmasculine folks and their healthcare providersrecommend to help keep a front hole feeling good: sex and hormones.

Estrogenic Options

The most common treatment for vaginal atrophy among otherwise healthy, young transmasculine people is, somewhat surprisingly, estrogen. This understandably freaks some people out. I know I don’t want to take something that could undo everything I’ve gained from taking testosterone!

Luckily, that isn’t a worry. If you are experiencing any of the above symptoms related to vaginal or front hole health — dryness, itching, irritation, inflammation, bleeding, or pain after sex—talk to your doctor about possible treatments.

They will likely prescribe a low-dose estrogen cream, an insertable tablet, or a longer-term insertable estrogen ring, to be applied directly to the vaginal tissue. The estrogen released by each of these delivery methods is localized to the pelvic floor only, so won’t conflict with your regular testosterone therapy schedule.

Now, the Good Stuff

Let’s talk about sex, baby!

Regular sexual activity, alone or with a partner, is a great way to maintain blood circulation in the pelvis. Increased blood flow brings healing to inflammation and helps keep epithelium cells healthy. There is a bit of a sense of “use it or lose it” when it comes to lubrication specifically, but don’t feel like if your front hole is already dry it’s too late and time to give up.

Whether you are just starting testosterone treatment or are several months in and experiencing dryness today, it’s always a great time to learn about lube. In my opinion, everyone of every gender and allosexual orientation would be having better sex if we all used lube, whether your body still makes your own or not. There are so many different kinds of lube available depending on what toys or safer sex items you might use, but my go-to will always be a slick, sexy water-based number — it will work with condoms and toys alike.

The best part is that you don’t have to be having penetrative sex in order for it to help your vaginal or front hole health. Any kind of sexual stimulation that arouses you is increasing your blood circulation. Asexual people who masturbate or who can be aroused by pornography or erotica can benefit from those activities. Even plain boring old nonsexual exercise can help with pelvic blood flow.

Just remember, as you enjoy your new healthy exercises, testosterone doesn’t prevent pregnancy, even if you are no longer menstruating. Talk to your doctor about birth control options, if you and your partner(s) need them, and most importantly, have fun!

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