Abstract
BACKGROUND: Transgender and/or gender expansive (TGE) individuals in the United States (US) face barriers to sexual wellbeing. TGE communities have largely been excluded from sex education programs, putting the onus of programming on community agencies and healthcare providers. Acceptable TGE-tailored educational programming for sexual wellbeing has been understudied. Sexual health experts have recently outlined a framework for supporting sexual wellness via comprehensive public health education, recommending attention to the intersecting pillars of sexual health, sexual pleasure, sexual wellbeing, and sexual justice. Guided by this framework, the objective of our study was to ascertain sexual wellbeing program needs among TGE communities. METHODS: As part of a community-engaged research study, we conducted qualitative interviews (n = 29) with TGE individuals (age range: 21-55; 62.1% people of color) residing in Philadelphia to understand sexual wellbeing programmatic needs and preferences. Participants were presented with 11 topics based on the pillars of sexual wellness, and asked to expand upon the three they believed deserve prioritization. Our team performed a thematic analysis on all interviews. RESULTS: Participants' most highly ranked topics were consent, boundaries, safety, security, and agency in interpersonal dynamics, trauma-informed and sex-positive sexual wellbeing approaches, and shame, self-esteem and acceptance of gender and sexual identity. Participants identified several intervention strategies for addressing these topics, including in-person, trans-led didactic sessions (e.g. workshops and classes for TGE people) to discuss effective sexual health communication with partners. Participants thought that sexual wellness interventions should be implemented in community-based settings as well as in centralized online resources. CONCLUSION: Our study provides insights for leveraging community priorities into community- and clinic-based programming to support equity in sexual wellbeing for TGE individuals. By incorporating education around safety and trauma-informed approaches, providers may facilitate sexual wellbeing among TGE individuals. Future studies should develop TGE-tailored sexual wellbeing interventions and evaluate their impact on sexual wellbeing indicators.