1 - (SYM 130)“it Would Be a Program That Is Made for Me and Sees Me”: Adapting an Online, Cognitive Behavioral Therapy-based Sexual Wellbeing Intervention for Transgender Women

Introduction: There are few sexual health resources that address the needs of transgender (trans) women, who have unique sexual concerns related to their gender identity and gender affirming care (GAC). This study aims to adapt eSense, an online intervention that focuses on increasing sexual arousal and desire, for trans women. eSense has two arms: a cognitive behavioral therapy (CBT) arm and mindfulness-based therapy arm. In this study, we collaborated with trans women to identify key areas for adaptation in the CBT arm. 

Method: Participants were recruited from a community health center in Boston, MA that primarily serves LGBTQ+ individuals. Eligible participants identified as trans women or transfeminine, were at least 18 years old, and were assigned male or intersex at birth. Participants attended a virtual “think aloud” session to provide feedback on the first two eSense modules, reviewed the remaining six modules independently and provided feedback via REDCap surveys, and then attended an additional virtual session to offer final feedback. Transcripts of the sessions and survey responses were analyzed via rapid analysis.

Results: Data from eight participants (M_age = 37.4, SD = 13.5) revealed three key areas to be tailored. First, participants stressed the importance of providing education about the effects of different forms of GAC on sexual wellbeing (e.g., “re-learning how to have sex post-surgery or post [gender affirming hormone therapy (GAHT)]”, “re-familizaring yourself with your body and brain on [GAHT]”). Second, participants expressed the need for increased inclusivity, via altering language to be inclusive of “all gender identities and orientations with all kinds of bodies,” and describing the range of experiences associated with different types of GAC. Third, participants provided examples of trans-specific challenges that should be addressed, such as gender dysphoria, changing relationships with their bodies and sexual activity, and partner communication.   

Discussion: Participants highlighted the importance of including education about the sexual sequelae of GAC; inclusive language and experiences; and specific examples of relevant sexual concerns in an adapted version of eSense for trans women. The adapted intervention (to be called eSense+) will be tested in an open pilot to assess for feasibility, acceptability, and signals of efficacy. Ultimately, we hope that patients will be introduced to eSense+ in the context of GAC, increasing access to evidence-based sexual healthcare while also reducing stigma.