Trans Sex

Clinical Approaches to Trans Sexualities and Erotic Embodiments

Lucie Fielding

• Publisher: Routledge
• Year: 2021
• ISBN:
  9781000376852
• Edition: 1
• Topic: Psychology
• Subtopic: Psychotherapy Counselling
• Index: Psychology

Finalist, 2022 Lambda Literary Awards (Trans-Non-fiction Category)

Winner, of the 2022 AASECT Book Awards (Book for Sexuality Professionals)

Winner of the 2023 SSTAR Consumer Book Award!

Despite the increasing visibility of trans and non-binary folx in media, political representation, and popular culture, their sexual lives and erotic embodiments are woefully under-attended-to in both scholarship and clinical practice. The aim of this book is to equip providers with both conceptual frameworks and concrete tools for better engaging their trans, non-binary, and gender expansive clients in pleasure-centered discussions of sexual health.

Challenging the dominant images of trans sexualities that appear in the existing literature, such as an emphasis on avoiding gender dysphoria, the preservation of sexual function, or on sexual losses that may arise as a result of transition pathways, Trans Sex offers a pleasure-positive approach to working with trans clients. Providing concrete clinical practices and practical activities that utilize social justice, intersectional trans feminism, and radical queer theory as key conceptual frameworks, this groundbreaking text is designed to be accessible to a wide range of providers. This book draws on Fielding's experiences as both a trans client/patient and as a therapist to shift and expand the conversation and includes contributions from other trans and non-binary providers working at the intersection of gender-affirmative care and sexuality.

Trans Sex seeks to move trans sexualities from the margins of gender-affirmative clinical practice, to center pleasure, and to spark creativity and empathic attunement within the client-provider relationship. Whether they be mental health or medical providers, trainees, or seasoned practitioners in gender-affirmative work or sexualities, readers will be able harness creative strategies to enhance their practice and become more imaginative providers.

1

Unimaginable Bodies

Lucie Fielding

Before we can begin to discuss clinical approaches for how trans sexualities and erotic embodiments might be better integrated into gender-affirmative practice, we must first delve into the dominant narratives that have, to date, shaped how we, as providers, consider and conceptualize the sexualities and erotic lives of trans and non-binary folx. These are narratives that have been featured in the clinical literature since practically the advent of gender-affirmative clinical practice. As such, they greet our clients the moment they walk through our doors—they are the absent presences on our couches; they charge and hang in the air; they settle like dust particles on every surface of our office spaces. Moreover, in addition to lodging themselves in us—how we conceptualize, how we work—they are also carried by our clients and tend to show up lurking behind many of the concerns they bring with them into the room.

I will explore and unpack four of these structuring narratives: the “unimaginability” of trans bodies; trans narratives as ones defined by trauma and oppression; a discourse centered on sexual losses; and a clinical focus on sexual function. My argument is that a deconstruction of cultural and historical narratives that have structured how we conceptualize trans sexualities can, ultimately, enrich clinical practice and create space in us to promote alternative, client-centered, and pleasure-oriented narratives for joining with our trans and non-binary clients and supporting their pursuit of erotic embodiment.

Imaginable Bodies

Although we often see who we desire and are attracted to as a highly subjective set of tastes and preferences (“I like who I like!”), these tastes and preferences do not exist within a vacuum. Rather, they are subject to social construction and are intimately bound up in structures of power. This is what some Black, fat, feminist thinkers have called the politics of desirability.¹ The politics of desirability accounts for the fact that our desires and attractions occur within contexts that privilege some and marginalize others. Capitalist systems tell us that we are not “enough”—thin enough, “fit” enough, happy enough, productive enough, or even queer or trans enough. Cultural standards of beauty, attractiveness, and desirability communicate in ways subtle and decidedly unsubtle that beauty and desirability are solely the province of white, light-skinned, cis, thin, able-bodied, high SES, tall, fit and toned folx.² We can see desirability politics in action when on dating platforms such as Grindr and Tinder folx outright state racialized dating preferences, or even body type and gender expression preferences.³ And just as racism, colorism, ableism, ageism, and fatphobia often inform whether one is perceived as desirable, so does one’s gender identity.⁴

Trans and non-binary folx often report experiencing a phenomenon referred to colloquially as “dating while trans,” a discrimination faced while seeking romantic, play, and/or sexual partners based generally in one’s trans identity and often more specifically in a trans or non-binary person’s ability to “pass/blend” as cis. In fact, the mere disclosure of one’s gender identity seems to have a clear negative impact on whether a trans or non-binary dating prospect is seen as attractive.⁵ In a recent study published in the Journal of Social and Personal Relationships, researchers found that across a sample (n= 958) of cis heterosexual and LGBTQ folx, 87.5% indicated that they would not consider dating a trans person, with cis heterosexual men and women being the populations most likely to exclude trans and non-binary folx from their dating pool.⁶ Moreover, for those respondents who indicated a willingness to consider a trans or non-binary individual as a dating prospect (n=120), trans masculine individuals were favored far more than trans feminine folx. Studies like this confirm: dating while trans is a thing; desirability and attractiveness are heavily inflected by cisnormativity, transphobia, and transmisogyny.⁷

The lens of desirability politics applies chiefly to interrogating the extent to which sexual and romantic desire and seemingly subjective measures of physical attraction are culturally constructed. In short, it examines desirability, a subject’s ability to be desired. Building upon this framework, I propose we also consider desire-ability, a given person’s capacities for desiring, experiencing desire. The lens of desire-ability emerges from work in disability studies and discussions of sex and ageing.⁸ In this framework, only certain bodies within a given socio-cultural landscape are sexualized and afforded the capacity to desire sex or possess an erotic imagination. As Ana Cristina Santos and Ana Lúcia Santos assert in their qualitative study of disabled cis women’s narratives in Portugal, “sexual engagement is inaccessible to those bodies that do not fit a particular aesthetic or functional ideal,” namely, that of cis, heterosexual, younger than middle-age, thin, able-bodied folx.⁹ Put simply, trans and non-binary folx are not only excluded from being objects of desire, but are not imaginable as beings able to experience sexual desire.

From the earliest days of gender-affirmative care in the United States, desire-ability has been a capacity denied to trans and non-binary clients. According to Harry Benjamin, for example, most trans folx were thought to “have no overt sex life at all,” at least prior to medical interventions, and particularly bottom surgeries.¹⁰ Moreover, trans folx, per Benjamin, were thought to perceive their genitals and sexual characteristics as “disgusting deformities that must be changed by the surgeon’s knife.”¹¹ Benjamin ultimately positioned hatred of the sexual body and aversion for engaging in sexual activity as a “central feature” of trans experiencing, and as a primary diagnostic criterion for determining whether a patient is a “true transsexual.”¹² This would later form the basis for access criteria to gender-affirmative care up to and through the first decade of the twenty-first century in some clinical settings.¹³

Considered together, desirability and desire-ability point to a particular kind of privilege, one I refer to as erotic privilege. Erotic privilege is a type of privilege afforded to certain kinds of bodies within a given culture. These bodies, in a Western European and American cultural idiom, are typically white, cis, able-bodied, thin, tall, and between the ages of 18 ̶ 35. Bodies that do not conform to—or, literally, embody—one or more of these cultural ideals are erotically marginalized and deemed “unimaginable.”¹⁴ These bodies are simultaneously erased and subjected to intense objectifying or fetishizing scrutiny; and they afforded neither desirability nor desire-ability.

Think, here, of how often fat bodies become the butt of jokes in many Hollywood comedies, or how the mere thought of people having sex after 60 becomes a source of derision, discomfort, and outright disgust. I often think of a September 2016 opinion piece in the New York Times by poet Jennifer Bartlett, written partly in response to Jessica Valenti’s memoir Sex Object.¹⁵ Bartlett, who has cerebral palsy, spoke to having a very different experience of the male gaze or sexual advances than Valenti does, asserting that Valenti, an able-bodied cis woman, universalizes the experience of male sexual advances as problematic and invasive. Bartlett notes, “I’ve never been aggressively ‘hit on’ in a bar, despite the fact that I have frequented them alone throughout the years. In fact, I’ve rarely been approached in a bar at all.”

A couple of years ago I was walking down the street in LA with my wife. We were holding hands and as we passed a gaggle of guys on the corner, one of the guys looked me up and down, whistled, and catcalled, “Lookin’ fine, ladies!” I’d never been catcalled before, and before I could collect my feminist wits about me, I turned back to the guy who had just catcalled us, and with a huge grin on my face, exclaimed, “Thank you!” It was only a few steps down the street, when the glow of having been sexually objectified had worn off a bit, that I turned to my wife and said, “I probably shouldn’t have thanked the guy for catcalling me, huh?” “Yeah,” she responded, sighing with bemusement.

I’m not saying that unsought sexual attention is a good thing. And having experienced sexual and gender-based harassment in the workplace too many times to count, I’m not saying that sexual harassment is a good thing either—the times I’ve experienced it have felt pretty damned dehumanizing in fact. Rather, I want to highlight that within this particular cultural moment, not everyone has the same access to being viewed as a desirable, desire-able sexual being; some sexual bodies are more imaginable than others. The implication, here, is that as providers working affirmatively with trans and non-binary clients, we need to acknowledge and make visible some of the structural barriers many of our clients face in dating or even gaining access to sex-positive spaces and communities.

Biases, assumptions, and stereotypes around desirability and desire-ability also have an insidious way of showing up in our clients’ erotic self-concept, part and parcel of dynamics of internalized transphobia. For example, the recent documentary by Sam Feder, Amy Scholder, and Laverne Cox, Disclosure (2020) powerfully shows how messages and assumptions about the desirability and desire-ability of trans bodies are embedded in popular culture.¹⁶ It is easy to believe oneself undesirable and incapable of experiencing desire when one is constantly spoon-fed images of trans bodies provoking violence, disgust, and even literal vomiting, as in the case of films of my childhood and adolescence such as Soapdish (1991), The Crying Game (1992), and Ace Ventura: Pet Detective (1994). Negative images, attitudes, and prejudices can, over time, become internalized. So, in addition to the microagressions and macroagressions many trans and non-binary folx experience, and the stresses of doing even the most routine activities, such as going to the bathroom, some of us have the added joy of experiencing a voice inside us that insists on adding to society’s chorus to tell us that our bodies are repulsive, that we are un-fuckable, that we are less-than, or that our desires and needs are not as important as those of other people in the world.

When I first began affirmatively exploring my gender identity I had a ton of questions about sexual experiencing. And many arose from my own internalized transphobia. When I would question whether I would be attractive o...