LGBTQ+ Sexual Health: A Comprehensive Guide

Pleasure Without the Pamphlet (Because Those Never Included You Anyway)

If your sex education looked anything like most people's, it probably assumed everyone was straight and cisgender. The diagrams showed one type of body. The conversations assumed one type of relationship. And if you didn't fit that mold, you were left to figure things out on your own.

This is the guide that should have existed. Sexual health, pleasure, and intimacy information for everyone—regardless of who you're attracted to or what body you're in.

Foundational Truths

Your body is yours to enjoy. Whatever body you have, whatever configuration of parts, it's capable of pleasure. There's no wrong way to experience that pleasure as long as everyone involved is consenting.

The "right" way to have sex doesn't exist. What exists is what feels good for you and your partner or partners. Let go of any script about how sex is "supposed" to look.

Communication matters even more when the assumed defaults don't apply. You can't rely on your partner knowing what you want based on general assumptions. You have to talk. This is actually a gift—it leads to better, more tailored sex for everyone.

For Gay and Bisexual Men

Let's talk about anal sex, since that's often the focus but rarely discussed with actual useful information.

Preparation matters. The rectum doesn't self-lubricate like a vagina. You need lubricant—a lot of it—and you need to reapply throughout. Silicone-based lubricants last longer and are ideal for anal sex, though water-based works too if you're using silicone toys.

Relaxation is everything. The anal sphincters need to relax to allow comfortable penetration. This requires trust, patience, and usually significant warm-up. Start with fingers, work up gradually, and never rush.

Positions matter for comfort. The receiving partner often has more control in positions where they're on top or can control the pace and depth. Doggy style works for many but gives the penetrating partner more control.

Not everyone does anal. Some gay men love it. Some prefer oral, manual, frottage, or other activities. There's no requirement. Sex is whatever you and your partner enjoy.

Safer sex is essential. Condoms significantly reduce transmission of HIV and other STIs during anal sex. PrEP, pre-exposure prophylaxis, is highly effective at preventing HIV when taken consistently. Regular testing is important—the CDC recommends every 3-6 months for sexually active gay and bisexual men.

For Lesbian and Bisexual Women

Contrary to what some people assume, STIs can be transmitted between women. Less common than in some other configurations, but not zero risk. Herpes, HPV, and bacterial infections can all be transmitted through oral sex, genital contact, and shared toys.

Dental dams provide a barrier for oral sex. A condom cut open works too. For shared toys, either use condoms that you change between partners or clean toys thoroughly between users.

Communication about bodies and preferences is key. Every vulva is different, every person's preferences are different. What worked with one partner may not work with another. Ask. Explore. Learn this specific person's body.

Scissoring is real but not universal. Some people love it. Some find it awkward. It's one option among many, not the defining activity of sex between women.

Strap-ons expand possibilities but aren't required. Penetration with toys can be great if that's what you both want. It can also be completely absent from your sex life. Neither is more valid than the other.

For Transgender Individuals

Your genitals don't determine your sexual possibilities. Trans women, trans men, and nonbinary people have the same capacity for pleasure as anyone else—it just might look different than cisgender norms.

Hormone therapy affects sexual function. Trans women on estrogen may experience changes in erection, in what types of stimulation feel good, and in arousal patterns. Trans men on testosterone often experience clitoral growth, increased libido, and changes in lubrication.

These changes are individual. Not everyone experiences them the same way. Pay attention to your own body as it changes.

Surgery changes anatomy but not capacity for pleasure. Vaginoplasty creates a vagina that requires different care, including dilation and adequate lubrication. Phalloplasty and metoidioplasty create different configurations with different sensation. Work with what you have; it's capable of pleasure.

Disclosure is a personal choice. You don't owe anyone your medical history. But for your own safety and connection, honest communication with sexual partners is often valuable.

Finding affirming partners matters enormously. Sex with someone who respects your body and your identity is qualitatively different than sex with someone who's just tolerating you. Hold out for partners who genuinely want you as you are.

Safer Sex Across the Board

Know your status. Regular testing is the foundation of sexual health. How often depends on your activity level, but yearly at minimum, more frequently if you have multiple partners.

Communicate about status and risk. "When were you last tested?" "What are we doing to protect ourselves?" These conversations aren't mood killers—they're signs of someone who takes sexuality seriously.

Use protection appropriate to your activities. Condoms for penetration. Barriers for oral if there's risk. Clean toys between partners.

Finding Affirming Care

Not all healthcare providers are created equal when it comes to LGBTQ+ health.

Look for providers who are specifically LGBTQ-friendly. Many areas have LGBTQ health centers. Planned Parenthood generally provides affirming care. Ask around in your community for recommendations.

Be honest with your provider. They can only help you if they know what you're actually doing. If you don't feel safe being honest, find a different provider.

The Emotional Layer

Being LGBTQ+ in a heteronormative world adds layers to sexuality that straight, cisgender people don't navigate. Coming out stress. Family rejection. Internalized shame. Minority stress in all its forms.

These affect your sexual life. They affect your sense of worthiness to receive pleasure. They affect your ability to relax and be present.

If you're carrying baggage—and most of us are—consider working with an LGBTQ-affirming therapist. Not because something is wrong with you, but because everyone deserves support in untangling the knots that society tied.

You deserve pleasure. You deserve intimacy. You deserve a sexuality that's fully, unapologetically yours.