“It’s easier to think outside the box when you are already outside the box”: A study of transgender and non-binary people’s sexual well-being

Gender-affirming care, sexual health, and sexual well-being

Historically, transgender people have been viewed through medicalized lenses, were a wish to identify “true transexuals” in clinical settings has been part of creating pathologizing views on their sexual lives (Prunas, 2019). Still, research on desire, sexual health, and sexual well-being among transgender and non-binary people is scarce. A survey with a self-selected sample of 237 individuals showed that sexual experiences were strongly affected by how well one confirmed to one’s body, and that gender-affirmative care was connected to sexual health (Gäredal and Orre, 2011). Follow-up studies after gender-affirming genital surgery focus on physical aspects like physical function, orgasm ability, and desire (e.g., Wierckx et al., 2014). However, less attention is paid to how sexual well-being can improve following gender-affirming treatment. One exception is a study on how gender-affirming treatment affects sexual behavior (intercourse and masturbation) and sexual feelings (sexual autonomy, sexual pleasure, and sexual self-esteem). Based on a non-clinical sample of 325 MtF and 251 FtM ¹ , the results showed an increase in masturbation frequency among FtM in the beginning of testosterone treatment. Individuals identified as MtF reported positive feelings regarding sexual autonomy, sexual pleasure, and sexual self-esteem following gender-affirming treatment (Nikkelsen and Kreukwla, 2017).

Studies on differences in sexual desire in connection to hormonal treatment show that FtM experienced an increase in sexual desire from testosterone, and MtF receiving estrogen experienced a decrease (Doorduin and van Berlo, 2014; Thurston and Allan, 2018). A decrease in sexual desire (due to hormonal treatment and surgery) among MtF has been reported to be experienced as problematic (Doorduin and van Berlo, 2014). On the contrary, a review on support to improve sexual function showed that a decrease in sexual desire among MtF was not necessarily experienced as negative, as some individuals appreciated this (Holmberg et al., 2019). For individuals undergoing gender-affirming care, it is important to examine the person’s wishes and hopes regarding future sexual function before hormonal or surgical treatment, as this can affect the results of the treatments. In addition, sexual problems can be transgender-specific, but not necessarily; therefore, this needs to be understood from the individual’s sexual history (Holmberg et al., 2019). It is also worth noting that among transgender individuals who do not wish to undergo gender-affirming treatments, sexual difficulties can persist (Nikkelsen and Kreukwla, 2017).

Norms affecting sexuality

Physical bodies matter, but sexuality is also socially constructed. The theory on sexual scripts (Gagnon and Simon, 2015) can inform this understanding. Sexual scripts, or manuscripts, dictate how sexuality is created in cooperation between people, and how individuals incorporate societal views on sexuality into their own, and thereby create a societally acceptable sexuality. Sexual scripts are context-dependent and matter in the constant creating of and acting upon what is seen as an “acceptable sexuality”. Sexual scripts can be divided into three levels: cultural (the societal norms and values, laws and policies that shape individual sexual freedom), interpersonal (individuals’ interactions with, for instance, sexual partners, friends, family, and colleagues), and the intrapsychic level (individual specifics that more or less consciously guide individual sexual behavior and activity). Scripts are in a constant flux, as the three levels constantly depend on and interact with each other (Gagnon and Simon, 2015). Research underlines that societal norms and normative ideas (i.e., sexual scripts on various levels) affect sexual health and well-being for transgender and non-binary people. In a mixed-methods paper, qualitative data (20 semi-structured interviews) and quantitative data (796 online respondents) were combined (Lindroth et al., 2017). The results showed that normative ideas on sexuality, experiences of bodies in transition, and lack of respect in relationships created negative emotions in sexual encounters, such as anxiety, insecurity, and fear. This sometimes led to avoiding flirting or not seeking potential sex partners, thus limiting possibilities for sexual health and well-being (Lindroth et al., 2017). A thematic analysis of seven qualitative studies describes how, during gender-affirming treatments, transgender individuals reflected on existing norms (their own and their partner’s) and social expectations in order to adjust to socially accepted norms and behaviors (Thurston and Allan, 2018). In addition, the result detailed how changes in sexual desire made informants re-evaluate their sexual preferences, and as a result, new sexual possibilities arose (Thurston and Allan, 2018).

Identity, body image, and sexuality

To be comfortable with one’s body is essential in relation to sexual behaviors and emotions, and may be even more important than gender-affirming treatments per se (Nikkelsen and Kreukwla, 2017). This appears especially important for individuals not wanting a medical transition (Public Health Agency of Sweden, 2016). When sexual well-being was examined among 12 transgender individuals, it was found that the experience of incongruence toward one’s body, and to other people’s labeling of one’s identity, was negative for sexual well-being (Doorduin and van Berlo, 2014). In addition, the study found ambivalent emotions in relation to sexuality. However, an interview study with 20 transitioned transgender and non-binary individuals suggest that sexual well-being can be experienced as a re-birth or a new puberty, and can include a wish to explore new sexual practices (Public Health Agency of Sweden, 2016). Different strategies, such as fantasies, can be used to overcome experiences of gender incongruence leading to increased sexual pleasure and orgasm ability (Doorduin and van Berlo, 2014). In an ongoing study on transgender and non-binary gendered people’s sexual health, one open-ended question specifically focused on how trans masculine men and non-binary participants use their body during sex (Anzani et al., 2021). The analysis of answers from 361 participants showed a wide range of sexual activities, and only a small number of participants (12.5%) avoided having sex.

To summarize, previous research shows that access to desired treatments and body self-esteem appears connected to sexual well-being. In addition, societal norms appear to interfere with possibilities for sexual health and well-being. Lastly, we agree with both Anzani and colleagues’ (2021) and Holmberg, Arver, and Dhejne’s (2019) findings that transgender and non-binary peoples’ sexual experiences need to be seen as one part of human sexual variation and therefore understood holistically. This paper aims at such an understanding.

Design

A phenomenological approach within a qualitative and flexible design was applied to explore conditions, and more specifically, functional strategies that transgender and non-binary people have in relation to sexual pleasure and sexual well-being. Ten individuals in Sweden participated. Qualitative design is suitable when non-normative identities or sexualities are examined, as this allows for modifying theories, concepts, or norms used to describe human behaviors (La Sala, 2005). We chose to draw from phenomenology because it addresses the lifeworld—the space humans are born into and experience through their senses (Sages, 2003). Central to this approach is to seek understanding from different subjective experiences. Although the subject is central, subjective experiences are always part of a social context and a shared culture (Gagnon and Simon, 2015; Sages, 2003).

The study was also framed as action research with an aim to empower, both participants and transgender and non-binary people in general. Action research can be criticized for being partial, while advocates of the method see advantages with the engagement that can occur if problem solving (in this study: functional strategies) is examined (Bryman, 2018). Research aiming at empowerment is dual. On the one hand, the objective problem (in this study: sexual ill-health) is addressed as in need of change. On the other hand, it aims at developing subjective capacity for positive change (in this study: toward sexual desire, sexual health, and sexual well-being). Much research regarding transgender and non-binary people is problem focused. Although this is both important and needed, it also risks reinforcing negative and discriminating discourses. Therefore, we focus on the possibilities of being transgender or non-binary.

Participants

Purposeful sampling was used (Robson, 2002), and individuals who were in social or medical transition, and had positive experiences of sexual desire and sexual well-being were sought. Information of the study was spread in trans-related groups online, through professional networks, and through trans care teams throughout Sweden. Ten individuals wanted to participate and contacted the first author. Aiming at flexibility, the participants could choose if they wanted to write down their experiences or talk about them in an interview. One open and broad question was formulated, inspired by different themes in an information pamphlet called “Sex and Trans” from the NGO, the Swedish Association for Sexuality Education (2021):

Write down/tell of your thoughts, emotions, experiences, and associations in your sexual development in relation to body, dysphoria, self-stimulation, sexual fantasies, sex aids/toys, flirting, communication and, if relevant, a “coming-out,” in sexual meetings through different phases of social and/or medical transition. Focus on positive experiences and sexual well-being. Please write/tell of how you have experienced cultural sexual norms in relation to experiencing your sexual development.

During the end of 2019 and the beginning of 2020, three participants wrote texts and seven were interviewed. The interviews lasted 45–90 min and were transcribed verbatim. Two interviews were face-to-face and five were conducted on the telephone or via Skype. For an overview of the participants, see Table 1.

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Table 1.

Overview of participants.

Pseudonym	Gender identity	Preferred pronoun	Sexual orientation
Noah	Non-binary	They	Fluid
Olof	Non-binary	Him	Queer
John	Non-binary	Him	Bisexual
Mo	Non-binary	They	Sexual
William	Binary	Him	Heterosexual
Thomas	Binary	Him	Bisexual
Peter	Binary	Him	Homosexual
Lennie	Binary	Him	Heterosexual
Valerie	Binary	She	Lesbian
Sandra	Binary	She	Bisexual

As can be seen in Table 1, participants constitute a homogenous group: four identified as non-binary, and participants preferred various pronouns, and had various sexual orientations. All had or were currently accessing gender-affirming care, and were in different stages of transition. All but one were or had been in medical transition (gender confirming hormones and/or gender confirming surgery), and all were in social transition.

Theoretical framework and analysis

A theoretical framework was used to interpret the results, and Ahmed’s (2006) queer phenomenology was a foundation. With this approach, Ahmed (2006) aims to acknowledge people’s bodily desires and feelings as contributing to the choices they make when not only following the paths presented to them in life, but also in creating new paths. Trans identities and bodies challenge the separation of a social constructivist and essentialist understanding of gender (Lev, 2004), and we were interested in both material and social experiences, and aimed to understand bodily experiences in addition to cognitive perceptions. We used concepts from Butler (1990, 1993), such as the heterosexual matrix (i.e., the social hierarchy that divides humans into groups of men or women, which can only find wholeness when they are heterosexually united with each other), and performativity (i.e., the way we repetitively perform and (re)define gender identities through speech and non-verbal communication). We expected that not only heteronormativity would have affected participants sexual well-being, but also cis-normativity (i.e., assumptions that cis-gender is the norm) and trans-normativity (i.e., assumptions that transgender people should fit into cis-gender normalcy, see Konnelly, 2021). Connecting these concepts to sexuality, we understand hetero-, cis-, and transnormativity as primarily cultural sexual scripts (Gagnon and Simon, 2015) that are also constructed on interpersonal and intrapsychic levels. Additionally, Bettcher’s (2014) concept of erotic structuralism (i.e., the complex structure that forms the content of arousal and always involves the eroticized other, the eroticized self, and the erotic interactions between them) was used in the analysis. The first author read and reread the texts and aimed at finding functional strategies for sexual well-being. Themes were formulated and reformulated, and the second author took part of the evolving results.

Researcher reflexivity

We share Haraway’s (2004) notion that researchers are always involved in their research and thus a part of the research process. Therefore, a description of our positions is warranted. Frida is a clinical physiologist working at a gender care team in Copenhagen, Denmark. In her work as a psychologist, she has met transgender individuals who felt free in their sexuality and were not hindered by gender incongruence or gender dysphoria, but rather, were playful and creative. She has also met transgender individuals and cis-gendered individuals who have experienced dysphoria toward their bodies, experienced difficulties regarding sexual desire, and pain in relation to sexual activities. The present study was conducted as part of her master’s thesis in sexology. Malin works as a researcher at the Centre for sexology and sexuality studies at Malmö university, Sweden, where she also teaches in the master’s program in sexology. Her research is mainly on sexual health and rights for vulnerable or exposed groups (e.g., young people in secure state care), and she has also conducted an interview study ON?/REGARDING? sexual health with transgender and non-binary people. Despite our previous and current experiences, we are both outsiders in relation to the participants since we do not share their lived experiences of gender dysphoria.

Ethical considerations

Approval for conducting a master thesis was sought and received by a local ethics review board at Malmö university. Ethical guidelines on information, consent, and confidentiality were followed throughout the study. When the participants were given the master thesis results as agreed, the first author received consent from all participants to prepare a manuscript for a scientific paper. No personal data is presented apart from gender identity, preferred pronoun, and sexual orientation.

Affirming oneself

It was important for participants to affirm oneself and to have self-acceptance. This was a prerequisite for being comfortable with one’s body and sexuality. Affirming oneself was described as providing inner peace and safety, and a sense of having found oneself. This affirmation was often the result of a process where one had unsuccessfully tried to fit into culturally normative gender roles. Noah said:

It was hard that I tried to put myself into boxes that weren’t mine, where I didn´t belong. That was a sad process. Then I realized that I hadn´t been wrong. I had been right all the time. (Noah)

Participants described that the affirmation of identity made them more consolidated in themselves, and that this had been vital in relation to sexual well-being. Using Ahmed (2006), these earlier attempts to affirm identities and sexualities can be seen as trying to fit into paths presented to them based on their biological gender, that is, cis-normative paths. To have tried to act according to gender norms, and to have performed body, body language, and practices based on these norms, made participants alienated to themselves. Thomas reflected on how this had changed:

I am myself, I don´t have to play a game, I am me. /…/ I can enjoy just being, and am allowed to feel. It isn´t just the female in my appearance, it´s all of me. It´s difficult to explain. I have become much more present and open, and more content with everything since I came out, and of course, that is a more relaxed feeling /…/ I can feel pleasure in a different way. Perhaps it is more mutual. (Thomas)

To interact in a sexual encounter provided a new presence, and an opportunity to be in a mutual interplay with someone else. Sandra had previously been interpreted or gendered as male in sexual encounters, and experienced that this was a given biological role she was not comfortable with:

Unfortunately, I rarely managed to be the submissive. Girls I wanted to be under had no interest in conducting, so I entered the role of the gentleman, and gave them what they needed. That is pretty central to why I am a woman now. I’m allowed to be weak and submissive in a different way. (Sandra)

Participants, especially those with a binary understanding of gender, described that they felt more at ease in their bodies, identities, and sexualities when their gender identity was read as what Butler (1990) defines as the culturally performative gender expression. Identities were created by experiences of continuity, and in the reflection of others, and to feel at ease and safe in one’s (gender) identity was to feel safe in relation to others. According to the assumption that intimacy is essentially gender differentiated, gender identity is a primary factor for intimacy (Bettcher, 2014). Individuals are, consciously or unconsciously, affected by cultural gender norms when creating identity, and in how they feel that others perceive them. Thomas and Noah described a feeling of relief in being themselves—a feeling that was connected to not trying to act according to the gender given to them at birth. For Sandra, it was important to be recognized as the self-identified gender, and the positive emotions she connected to being “weak and submissive,” was to her attributes ascribed to being a woman. This could also be seen as expressions of explicit sexual roles. Being submissive or being a receiver in sexual situations were two common positions found in an interview study on sexual fantasies among non-binary and cis-gendered people (Lindley et al., 2020).

Having access to care

When trans identity, gender incongruence, and gender dysphoria presented itself, all participants felt the need to seek care and be given the option of gender-affirming care. All but one wanted to receive this care, and for them, the time between their decision and actual access to care had put boundaries on sexual exploring. Participants described that they instead “focused on passing” as the preferred gender, and that sexual practices connected to the not-preferred gender (e.g., penile–vaginal intercourse) were impossible. This strategy has previously been described (Doorduin and Van Berlo, 2014).

Commencing hormonal treatment and having breast surgery was seen, by all participants who had these experiences, as contributors to increased self-esteem as well as a evoking a curiosity to explore the new body. Peter explained that gender-affirming care decreased both gender dysphoria and social dysphoria.

Following my mastectomy, and when hormones started to show results, my self-confidence was strengthened. I started to like my body, more and more. /…/ My body looked the way it should, and my voice sounded the way it should. /…/ Thanks to hormones, my genitals have changed a bit, and I´m actually content with what is there. I have no need for an operation, to have a “proper” penis. I don´t miss a penis, I don´t need a penis to feel like a real man, I do that anyhow. I have a “male” voice, I have a beard, I have no feminine hips, I have a “normal” chest without scars (my mastectomy was made with tiny cuts, close to the nipples, there was so little to remove, so I only have minimal and practically invisible scars at the nipples), and I pass 100%. I am actually really pleased with all of my body, including my genitals.

Peter described that he had enough male characteristics to “pass 100%” as a man, without having had genital surgery, and he was content with that. For the participants, it appears that an interaction between physical effects, and cognitive responses to these physical alterations, were central. These processes made them comfortable in their bodies and sexualities. This is in accordance with several studies claiming that access to preferred gender-affirming care is vital for sexual well-being (Doorduin and Van Berlo, 2014; Gäredal and Orre, 2011; Lindroth et al., 2017). Nikkelsen and Kreukwla (2017) make an even stronger claim—that transgender individuals who do not want gender-affirming care experience poorer sexual health compared to those who want it. However, experiences that Peter, and other participants had, showed that individual experiences vary.

Hormone treatment was described to have had various effects on sexual desire—a positive effect for participants on testosterone and negative for participants on estrogen. These findings also fall in line with previous research (Doorduin and Van Berlo, 2014; Lindroth, et al., 2017; Nikkelsen and Kreukwla, 2017). That the clitoris grew on testosterone treatment was described as being given an exciting new body part to explore. New erogene zones emerged (see Rosenberg et al. 2019). However, Olof said that, for him, it was the sense of increased security that came with feeling comfortable in his body that mattered the most. It was the cognitive aspects of gender congruence, not the changed body, that made his desire for sex return. Sandra experienced her skin as softer due to estrogen, and that physical touch and “being caressed and hugged feels much better now.” Valerie felt that estrogen treatment had resulted in a decrease in sexual desire, but in a controlled fashion: she could better decide over her sexual desire, and her pleasure was more intense. This confirms that a decrease in sexual desire can be appreciated, and there can be positive sexual emotions, and an increased sexual well-being despite lowered sexual desire (Holmberg et al., 2019; Nikkelsen and Kreukwla, 2017; Rosenberg et al. 2019).

Being seen and respected in one’s gender

Apart from finding their own identity, participants found it vital to be seen and respected in their gender identities. This was particularly important in sexual encounters. Participants shared that they had been strongly affected by societal norms such as hetero- and cis-normativity in relation to sexuality. These cultural sexual scripts (Gagnon and Simon, 2015) had an impact on both their affirmation of themselves, and on others they interacted sexually with. Some felt they had come a long way in their transitions, while others had only just come out. Those who had not started gender-affirming treatment said they used various gender expressions to become more feminine or masculine, and signal their gender identity to others, that is, performative actions (Butler, 1990)

Among the participants in gender-affirming care it was important for all that others respected their gender expressions. Some understood gender as a binary construct and expressed that they were “born into the wrong body”. Others understood gender as non-binary and questioned this dualistic explanation. These two understandings required different strategies in order to be seen as one’s gender, but to all being seen and desired were vital. Participants with a binary gender identity wanted to be seen as women or men, according to cultural gender structures. Some participants with a fluid or non-binary gender identity also said their sexual orientation was fluid, and they wanted their sexual partners to share this understanding. Nevertheless, all participants used a language built on binary concepts. This illustrates the claim from Bettcher (2014), that the gendered differentiation of intimacy is strongly rooted in contemporary culture.

Cotton (2012) writes that security, bodily congruence, sexual, and social factors, and quality of life interact and are connected to a wish for genital surgery among trans men. None of the men in the present study had wished for genital surgery, and some had feared not being seen “as real men”. Many described inner dialogues with themselves, and that they had to deal with normative assumptions on (male) gender identity. One of the women constructed her own cognitive images of how “to be a chick with a dick”. In relation to potential intimate partners, participants described feeling worried that they would not be adequate, and feared that a sexual partner would either be turned on by the gender given to them at birth, or else exotify them. Lennie had not yet started gender-affirming care, and described this dilemma:

If they are to have sex with me, they must enjoy a female body. But I am a guy, and do not want them to be with me due to my female parts. And, if they are bisexual, they will still be attracted to the female body. There are many thoughts that keeps me from even trying. I long for the day I get testosterone and a mastectomy. (Lennie)

Although being comfortable in his gender identity and sexual orientation, Lennie needed to adapt to people being turned on by breasts, genitals, skin, and fat distribution that could be interpreted as female, that is, turned on by what he himself experienced with dysphoria. As a functional strategy, Lennie had chosen not to be intimate at present.

Both participants with a binary and a non-binary gender identity used the internet and online dating to find intimate and sexual partners. This provided them with an opportunity to be safe while getting to know the person, and a chance to avoid disclosing intimate details too soon: a strategy to avoid potential rejection in real life. The benefits of the internet, as a safe space for “the social connection of transgender people with each other and with cisgender people who recognize and affirm them” has previously been described (Scheim et al., 2019: p. 580). In queer internet communities, participants with a non-binary gender identity said they found it easier to find understanding friends, or potential sex partners. To have a partner or steady lover was mentioned as a support and comfort through different phases of transition, and as a safe way to explore body and sexuality while the body was changing.

Masturbating and fantasizing

Participants mentioned masturbation as one way to explore and accept the physical body in different stages of transition. This strategy is recommended as a way to explore one’s body and sexual responses, especially in transformative periods of life, as it can create a sense of control (Coleman, 2003). Participants said that they examined different parts of their bodies and discovered different erogenous zones (see also Rosenberg et al., 2019), a strategy that enabled pleasure from different parts of the body. Drawing from Bettcher (2014), new erotic structures were created with(in) the body. Participants also described how fantasies served to overcome gender incongruence:

To masturbate alone is fine. Then, one thing can happen below the duvet, and a totally different thing in my head (Sandra).

Masturbation and bodily exploration can be understood as strategies to create acceptance and safety. An opportunity to explore and challenge bodily boundaries, and to find out what parts of the body that can interact with other bodies. This is similar to the finding in a study on female sexuality, also based on a sex-positive sample, where masturbation helped many to experience sexual empowerment, increased sexual body image, and contentment with genitals (Bowman, 2014). Coleman (2003) states that masturbation also has the potential to increase sexual pleasure, orgasm, and satisfaction in sex with a partner. Peter illustrated this:

Regarding sex, it has been a long and successive journey to where I am today. In the beginning, it was only masturbation with clothes on, then with toys and less clothes (I usually kept my sweater on before the mastectomy) but still under the duvet and with the lights off. When I started to have sex with other guys, I could give them oral sex and caress them, but they weren’t allowed to touch me. Then I became more comfortable with myself and started to enjoy being fully naked when I had sex with myself, and I started to enjoy toys for penetration. After that, I started to have penetrative sex with other guys, they could touch me at the front, but not penetrate. Today I totally enjoy sex and like to be penetrated from the front. (Peter)

Peter described how masturbation had helped him to eroticize different parts of the body. To test his sexual boundaries alone, and then later with a partner, had made him more comfortable. Using Ahmed (2006), he challenged the lines and paths given for male sexuality and was able to enjoy vaginal penetration from others. Participants tell of how, in their sexual fantasies, they imagined being of “the other gender,” before they identified with it. Valerie identified as female and then found a way to enjoy both masturbation and sex:

I have realized that my whole sexuality, a big part of my attraction, was because I wanted to be, I fantasized myself into … tried to picture myself as the woman I was, the woman I was watching that is. That’s where my sexual stimuli was, in that. (Valerie)

Departing from Bettcher (2014) and erotic structuralism, Valerie’s identification with the other, and the physiological stimulation and sexual attraction to the other, are important elements. In addition, it appears to have been an effective strategy for her sexual well-being. Doorduin and Van Berlo (2014) explain that cross-gender fantasies can act as coping strategies to overcome gender incongruence and enhance sexual desire and orgasm, especially before affirming one’s gender identity and the coming-out process. Lennie experienced gender incongruence and dysphoria only in sexual interaction with others, but could express his sexuality through fantasies and dreams:

As a person, I am very easily aroused and can hang on to memories for a long time. They often become parts of fantasies and dreams, or dreams while sleeping. Sometimes I wake up hot and exhausted after a really deep and rich dream. It could include girls I’ve made out with or completely new ones, and we have sex. I am usually at the top, always penetrating. However, mostly it’s about smelling and caressing the other. That’s the focus of my dreams, when I´m asleep. (Lennie)

Rich sexual fantasies and dreams enabled Lennie to express the sexuality he wished to have with a partner. It has been suggested that sexual fantasies are at the intersection of cultural and intrapsychic structures or scripts (Larsson and Johnsdotter, 2015), and sexual fantasies are personal, private, and (often) secret parts of the self. To Lennie, the cultural level was marked by heteronormativity, where he was the active part—a (sexual) role he connected to masculinity.

Communicating

Participants described that becoming skilled in sexual communication was a positive outcome of being transgender or non-binary. Circumstances demanded that they communicated about gender identity, body, incongruence, and dysphoria in order to make sense to other bodies and circumvent limiting intrapsychic, interpersonal, and cultural sexual scripts (Gagnon and Simon, 2015). Communication as a strategy is suggested to improve sexual well-being (Mallory et al., 2019), and Noah mentioned the benefits of communication:

I´ve always been able to get what I want, but now I feel very present, that it’s fun. It depends on who you have sex with, but it´s fine, it’s communicative. I know what I like, and I can communicate that. I could tell clueless guys off before too. I mean, it´s not that I tell, it´s just that it becomes nicer if I know what the other one enjoys, and they know what I enjoy. It feels as if I am more … there´s not as much fumbling in the dark, more talk. Maybe it´s more verbal communication, about what one wants to do, it doesn’t just happen. I communicate more about sex now, before, and during, than I did before. Then it just happened, and you tried to solve it while it happened, and stuff like that. It wasn´t the best of conditions. It can depend on that I felt more comfortable in myself, absolutely. (Noah)

Drawing from Ahmed (2006), it can be difficult if you lose direction, if your body falls out of the paths available to you. If you do not have control over how you are perceived by others, while not being able to choose when to adapt to (binary) gendered lines, then there is a risk that queer moments occur for the other. Alternatively, being intimate with a person who understands gender dysphoria and that some parts of the body must not be touched or involved in sexual interaction can be a comfort. Mo described:

When I had sex with a non-binary for the first time was when I started to understand that I also had gender dysphoria. It was easier to understand certain discomforts, and to express it and talk about it when having sex. I was with people who were not total strangers to the trans thing. There was much more knowledge and consent about dysphoria and stuff. People asked, is this okay, or do you want me to touch your breasts and stuff? And, I could feel, “No, actually, I do not want that.” (Mo)

Other participants explained that with dysphoria in and for certain parts of the body, communication was a condition for the delicate delineating between pleasure and discomfort. William explained his strategy to overcome this:

But I have these — I have my limits, or how shall I put it, my limits for what cannot be done. It was my ex who realized it and said, “I´m not going to finger you.” And I asked “Why not?” And she said, “No, you are not okay with that, not afterwards.” She said, “Let´s give it three months, and if you want it then, we´ll do it.” We tested it again, like four months later, and I said, “No, I do not want to. Let’s skip this.” (William)

Being sexually free in queer spaces

The queer community was mentioned, specifically by participants who identified as non-binary, as a safe space and a way toward a sexuality beyond the given norms or structures—a safe space where no identities were taken for granted and it was possible to explore different sexual expressions. “The paradox perspective” (cited in Nichols and Shernoff, 2007) can be useful in understanding queer sexualities, as it does not take anything for granted, and questions hetero- and cisnormativity. With this perspective, queer sexualities can be seen as powerful, complex, and multidimensional, not only norm-breaking. In line with this, Nichols and Shernoff (2007) show how sexual minorities can be more resourceful, able to explore sexual variations, and possess an openness for different solutions to sexual problems. Correspondingly, Olof said that queer or norm-breaking sex aligned well with a queer or norm-breaking identity because “It is it is easier to think outside the box if you are already outside the box.” John says that this queerness and norm-breaking had enabled him to explore his sexual desire and find out what he really enjoyed, and that he now had more sexual possibilities:

I think that if you don’t break norms, you might not think, you might not find the thing that is even better. But, if you break norms, you have to think, and then you can also find the things that … I have been forced to explore my body, and found what I really enjoy, maybe I wouldn’t have done that otherwise. It has brought up something, even if I don’t need it, it is there as a possibility, and that’s fun. It is fun to have a larger repertoire to use. I have learnt all the fun you can have with toys in different ways. (John)

Limitations

The study has limitations limiting its transferability. For instance, the sparsity of similar studies limits the positioning of this paper within a wider literature. Additionally, being a study with a qualitative design, the transferability of the findings is limited to transgender and non-binary people in similar contexts, for instance, countries with human rights protection for transgender and non-binary people, and where access to gender-affirming care is a subventioned part of health care.