Sexual Self-Concept Discrepancies Mediate the Relation between Gender Dysphoria Sexual Esteem and Sexual Attitudes in Binary Transgender Individuals

ABSTRACT

Sexual responding in transgender people has typically been investigated from a medical and functional perspective. Aligning with the biopsychosocial model, it is however equally important to consider psychological aspects of sexuality in this population. We propose that the Sexual Self-Concept (SSC) theory offers a valuable framework to understand (sexual) wellbeing in transgender people, while Self-Concept Discrepancy (SCD) theory could offer an explanation of the mechanisms underlying negative SSCs related to gender dysphoria. We investigated differences in SSC (consisting of sexual esteem, sexual attitudes, and sexual self-efficacy) in 197 binary transgender and 205 cisgender individuals using an online survey and explored the mediating role of actual/ideal self-discrepancies in explaining the relation between gender dysphoria and SSC. Transgender and cisgender individuals differed significantly in seven out of eight components related to sexual esteem and sexual attitudes. Actual/ideal self-discrepancies mediated the relationship between gender dysphoria and the SSC in transgender individuals for the sexual esteem components related to body perception, conduct, and attractiveness, as well as for sexual anxiety. We found no relation between gender dysphoria and the other SSC components in this group. We conclude that SSC discrepancies could be a valuable treatment target to improve transgender individuals’ sexual esteem and sexual attitudes.

Introduction

Transgender individuals experience an incongruence between their gender identity and their sex assigned at birth. When this incongruence causes persisting and invasive distress, individuals can be diagnosed with gender dysphoria (American Psychiatric Association, 2013). Alternatively, individuals can be diagnosed with gender incongruence, which has been moved from the chapter on “Mental health and behavioral disorders” to the chapter on “Conditions related to sexual health” in the most recent version of the International Statistical Classification of Diseases and Related Health Problems (ICD-11; World Health Organization, 2018). In order to alleviate their distress, some will apply for gender affirming treatment, such as gender affirming hormone therapy and/or gender affirming surgery (World Professional Association of Transgender Health, n.d.). Prevalence rates of gender dysphoria are typically based on the number of people receiving such clinical treatment, with estimates as low as .0046%, but rising over the years (Arcelus et al., 2015). Yet, up to 5% of the general population report an incongruence between their gender identity and sex assigned at birth, with only a minority of this group desiring gender affirming treatment, indicating that clinical data strongly underestimate the prevalence of transgender identities (Kuyper & Wijsen, 2014). Importantly, “transgender” serves as an umbrella term, referring not only to individuals with a binary gender identity (i.e., men and women), but also to people whose gender identity falls outside of this dichotomous norm, identifying as either non-binary or something else. The term cisgender applies to people whose gender identity aligns with their sex assigned at birth.

Body dysphoria and conflicting feelings between body and identity are central themes in transgender experiences (Cooper et al., 2020), although not in all (Fiani & Heather, 2019). Because being comfortable with one’s own body is an important aspect of sexual wellbeing (e.g., Sanchez & Kiefer, 2007), and sexual wellbeing is related to general happiness (Rosen & Bachman, 2008), it is important to investigate bodily self-perceptions in transgender persons (or self-related body perceptions) in relation to their sexual experiences. The World Health Organization considers sexual satisfaction/health an important determinant of quality of life (WHOQOL Group, 1994), indicating the importance of research on sexuality in transgender individuals. Although some studies indicate that sexual dysfunctions occur in a relatively large proportion of the transgender population (Kerckhof et al., 2019; Weyers et al., 2009), it was found that gender affirming treatment has a positive influence (Constantino et al., 2013). However, most of the research on sexuality in this population has typically applied a rather medical/functional approach, by focusing on neo-vaginal depth (Hess et al., 2018), frequency of masturbation and orgasm (Wierckx et al., 2011), and sexual functioning (Weyers et al., 2009). Such a functional approach tends to ignore the biopsychosocial nature of sexual responses, which are determined by a myriad of biological, psychological, relational and sociocultural factors. The handful of studies that have investigated subjective sexual experiences such as sexual agency (Nikkelen & Kreukels, 2018), sexual desire (Wierckx et al., 2014) and sexual anxiety (Dharma et al., 2019) in transgender people did not include cisgender participants, which keeps us from directly comparing the sexual experiences in both groups and examining the specific role of a transgender identity in relation to sexuality.

A concept that captures a wide array of psychological factors related to sexuality is the Sexual Self-Concept (SSC). It is broadly defined as all ideas, thoughts and feelings persons have about themselves as sexual persons (Deutsch et al., 2014). Research on the sexual self-concept lacks consistency and standardization as indicated by the wide variety of terms that have been used to describe this concept (e.g., sexual selfhood or sexual schemas) and the different questionnaires that have been applied. In an attempt to compile current knowledge on the sexual self-concept, Deutsch et al. (2014) constructed a unified, multidimensional model of SSC based on the work of Buzwell and Rosenthal (1996), who drew on three strands of research to conceptualize the SSC. First, they included sexual self-esteem, capturing a person’s self-evaluation of worth as a sexual being. Sexual self-esteem can refer to behavior (e.g., feeling good about one’s sexual behavior), conduct (e.g., believing one can be comfortable in a sexual situation with a partner), body perception (e.g., perceiving one’s own body as well developed), and sexual attractiveness (e.g., believing one is attractive to potential sexual partners). Second, sexual self-efficacy entails a person’s perception of mastery of their sexual world. This can be related to being able to be resistive (e.g., perceiving oneself as being able to say no to unwanted sex), to taking precautions (e.g., perceiving oneself as being able to negotiate the use of condoms with a new partner), and to assertiveness (e.g., perceiving oneself as being able to insist a partner respect one’s sexual needs). Finally, Buzwell and Rosenthal’s (1996) conceptualization of the SSC included a person’s beliefs about their sexual self-image, also denoted as sexual attitudes. This concept covers multiple areas, such as arousal (e.g., perceiving oneself as easily aroused), exploration (e.g., wanting to experiment when it comes to sex), and commitment (e.g., preferring one committed partner to multiple). The sexual attitudes component also includes a factor of sexual anxiety (e.g., worrying about showing discomfort during sex), indicating that the SSC covers both positive and negative affective components of a person’s sexual identity.

Previous research on the SSC has included only participants with a cisgender identity. While the SSC as defined above includes mainly affective (e.g., sexual esteem, sexual anxiety) and cognitive (e.g., sexual self-efficacy) aspects, various studies have found that the SSC is related to and predictive of behavioral variables such as sexual risk taking (Breakwell & Millward, 1997; Lou et al., 2010), intentions to engage in sexual activities (Hensel et al., 2011; O’Sullivan et al., 2006), sexual communication (Lou et al., 2010), contraceptive use (Winter, 1988), and STI status and disclosure (Newton & McCabe, 2008). Importantly, it has also been shown that SSC is related to sexual satisfaction (Anticevic et al., 2017; Mueller et al., 2016). Additionally, Snell et al. (1993) found that response patterns on a multidimensional SSC questionnaire predicted communal versus exchange approaches toward sex, indicating the heuristic value of this multidimensional construct over a single SSC factor. Interestingly, cisgender individuals have been found to show gender differences on several SSC components. For instance, men score higher on arousal and exploration (Deutsch et al., 2014) and sexual self-esteem (Rosenthal et al., 1991) than women. To our knowledge, the SSC has not been applied to transgender people so far, with most studies on sexuality in this population focusing on single factors rather than multidimensional constructs despite the fact that sexuality in transgender people (as in cisgender people) is complex and multifaceted (Holmberg et al., 2018).

Another concept with potentially high explanatory value regarding the relation between self-perceptions and sexual wellbeing that is strongly related to the SSC is the idea of self-concept discrepancies (Higgins, 1987). In the literature on self-concept discrepancies, the self-concept is typically described as consisting of various guides, such as the actual self-concept (“Who am I?”), the ideal self-concept (“Who do I want to be?”), and the ought self-concept (“Who should I be?”). Large discrepancies between different self-concept guides are thought to negatively affect a person’s wellbeing by creating emotional discomfort (Higgins, 1987). More specifically, a discrepancy between one’s actual and ideal self-concept is related to feelings of disappointment and has been associated with depression (Higgins, 1987; Higgins et al., 1994). Self-concept discrepancies and the accompanying distress can further motivate behavioral tendencies, which may promote dysfunctional strategies to decrease the discrepancy. The concept has successfully been applied in various populations such as individuals with eating disorders (Lantz et al., 2018), chronic pain patients (Morley et al., 2005), and patients with depression (Tangney et al., 1998). Recently, the theory about self-concept discrepancies has been applied in the sexuality field, showing that higher SSC discrepancies are related to more negative outcomes in women with and without genital pain (Dewitte et al., 2017).

Actual/ideal discrepancies have clear heuristic value to understand the sexual experiences of transgender people. That is, a discrepancy between the actual SSC (“Who am I as a sexual person?”) and ideal SSC (“Who do I want to be as a sexual person?”) is likely to arise from gender dysphoria, given the gender-body incongruence that gets “in the way” during sex (Doorduin & van Berlo, 2014), and might affect components of the SSC such as anxiety and esteem. Indeed, it has been shown that transgender individuals reported disappointment and depressive feelings related to the mismatch between their body and gender identity (Cooper et al., 2020), as would be predicted by the theory about self-concept discrepancies (Higgins et al., 1994). This mismatch and the related distress become less prominent after transition (Cooper et al., 2020), indicating that the discrepancy between the actual and ideal self-concept might decrease as transgender individuals transition toward their experienced gender. While it is clear that improving gender dysphoria (by gender affirming treatment) has a positive effect on body image and sexual functioning, it is less certain whether “becoming yourself” also results in a more enjoyable sex life (Holmberg et al., 2018), prompting the question whether actual/ideal SSC discrepancies indeed might explain the relation between gender dysphoria and SSC in transgender individuals.

For the present study, we conducted an online questionnaire study with cisgender and transgender participants on SSC and SSC discrepancies to investigate subjective sexual experiences in transgender people. Transgender people across various transition stages were invited to participate. Based on the studies described above, we expected differences in SSC between transgender and cisgender individuals. More specifically, we hypothesized that transgender individuals would score lower on sexual self-esteem and sexual self-efficacy, and higher on sexual anxiety. Secondly, we predicted that transgender individuals would present larger actual/ideal SSC discrepancies than cisgender individuals. In addition, we hypothesized that for those SSC components in which transgender and cisgender individuals differ, actual/ideal SSC discrepancy would mediate the relation between gender dysphoria and these SSC components in transgender individuals.

Method

Participants

Participants had to be at least 18 years old and proficient in either Dutch or English, as these were the languages the questionnaires were presented in (all questionnaires were back-to-back translated). In total, 514 participants completed at least part of the survey. From these, three were removed from the dataset because they were younger than 18 years old; three were removed because they did not enter their age; five were removed because they did not enter any information on gender identity; 21 were removed because of a clearly invalid response profile. Based on the information about sex assigned at birth and gender identity provided, participants were assigned to one of five groups: transgender men (n = 125), transgender women (n = 72), cisgender men (n = 98), cisgender women (n = 107), non-binary/other (n = 80). This classification was confirmed by asking participants whether they identified as transgender. Given that our current research questions focus on binary identifying individuals, the latter were not included in the current analysis, resulting in a final sample of 402 participants (age; M= 30.14, SD = 10.92). Of those, 213 participants lived in the Netherlands (52.99%), 77 were from United States of America (19.15%), 54 from Belgium (13.43%), and the remaining 58 from various other countries in Europe (10.95%), North America (1.493%), Oceania (1.00%), Asia (0.50%), Africa (0.25%) and South America (0.25%). The English version of the survey was completed by 224 participants, while 178 participants completed it in Dutch.

Procedure

After approval by the Ethics Review Committee Psychology and Neuroscience (ERCPN) of Maastricht University (approval code: 225_95_07_2020), the survey was programmed in Qualtrics. The study was administered online between July 16^th and October 2^nd 2020. Transgender participants were mainly recruited online via social media in the LGBTQI+ community, including the use of Facebook groups, Twitter, and support organizations advertising the study. In order to reach cisgender people, we advertised the study within the broader university and sex research community. Finally, we asked participants who had completed the survey to spread the link among potentially interested people in their network.

Participants provided informed consent at the beginning of the survey, which in total took 15–25 minutes per participant. As a reward, participants could enter a raffle for a €10 gift voucher at the end of the survey (one voucher per 20 participants; participants were made aware of the odds). The e-mail addresses provided for the raffle were stored separately from the questionnaire responses.

Measures

Demographics

We developed a questionnaire including open questions on age, country of residence, mother tongue, and the number of children participants had, as well as multiple choice questions on educational level, occupation, housing (e.g., living with family, living alone), and relationship status and length. Sexual orientation was assessed by presenting two sliding scales (one for men, one for women) on which participants could indicate how much they were attracted to these genders in general (scored from 0 to 100, with lower scores indicating lower attraction). Sex assigned at birth was assessed via a multiple-choice question including Male, Female, Intersex, and an open option. Gender identity was assessed via a multiple-choice question including Man, Woman, Non-Binary, and an open option. Finally, participants were asked whether they identified as transgender, in which case they were also asked when they had first become aware of their transgender identity and whether they had received a diagnosis of Gender Dysphoria.

Transgender Medical Care

This part of the survey was presented only to those who identified as transgender. Participants were asked whether they were on a waiting list for gender affirming treatment at the time of filling in the survey and what type of treatment they had already received (gender affirming hormone therapy and/or gender affirming surgery).

Gender Dysphoria

Feelings of gender dysphoria were assessed using the Utrecht Gender Dysphoria Scale (UGDS; Cohen-Kettenis & van Goozen, 1997; Steensma et al., 2013), which has two different versions depending on the sex assigned at birth of the respondent (male/female). Each version consists of 12 items which participants had to rate on a five-point scale ranging from 1 = Entirely disagree to 5 = Entirely agree. Because some of the questions would not apply to transgender people who have already undergone certain types of gender affirming treatment (e.g., “I hate having breasts” for a transgender men who has undergone mastectomy), we included the response option not applicable, which was scored to one (low gender dysphoria). Participants’ final score on the UGDS was calculated by averaging the scores for all items, with the final scores ranging from one (no gender dysphoria) to five (high gender dysphoria). Both versions had high reliability in our sample (McDonald’s ω = .97 for male sex assigned at birth version; McDonald’s ω = .94 for female sex assigned at birth version).

Sexual Self-Concept

Sexual Self-Concept was assessed using the Sexual Self-Concept Questionnaire (SSCQ; Buzwell & Rosenthal, 1996; adapted by Deutsch et al., 2014). The SSCQ consists of three measures (sexual self-esteem, sexual attitudes, and sexual self-efficacy) and has 84 items in total. For the self-esteem and attitudes measures, all statements had to be rated on a five-point scale ranging from 1 = Strongly disagree to 5 = Strongly agree. A sum score ranging from one to five was calculated for each subscale by averaging all the item scores. The self-efficacy measure consisted of two steps. First participants had to indicate whether they thought they would be able to perform a certain action. If this was the case, they had to indicate their confidence to do so on a five-point scale ranging from 1 = Very uncertain to 5 = Very certain. A sum score ranging from zero to five was calculated for each subscale by averaging all the item scores.

The Sexual Esteem measure consists of four subscales. The Behavior subscale assesses perceptions about one’s sexual behavior (e.g., “Intimate partners have found (or would find) me sexually satisfying”) (five items, McDonald’s ω = .81). The Body Perception subscale assesses body satisfaction and feelings of bodily maturity (e.g., “When other people look at me they must think I have a poorly developed body,” reverse item) (nine items, McDonald’s ω = .66). The Conduct subscale assesses feelings of adequacy in sexual situations and with a partner (e.g., “Most of my friends are (or would) feel more comfortable sexually with their partners than I do,” reverse item) (four items, McDonald’s ω = .78). The Attractiveness subscale assesses feelings of attractiveness and sexual desirability (e.g., “I am confident that people find me attractive”) (six items, McDonald’s ω = 0.67).

The measure of Sexual Attitudes consists of four subscales. The Arousal subscale assesses feelings of sexual desire (e.g., “I have a lot of sexual energy”) (ten items, McDonald’s ω = .84). The Anxiety subscale assesses anxiety related to sexual situations (e.g., “I would feel bad about having sex”) (ten items, McDonald’s ω = .76). The Exploration subscale assesses sexual adventurousness and openness (e.g., “I would like an adventurous sexual partner”) (ten items, McDonald’s ω = .77). The Commitment subscale assesses the preference for one committed sex partner over multiple partners (e.g., “I like to commit myself to a relationship”) (nine items, McDonald’s ω = .74).

The Sexual Self-Efficacy measure consists of three subscales. The Resistive subscale assesses the perceived ability to say no to unwanted sex (e.g., “Could you refuse to do something with your sexual partner which you don’t feel comfortable about?”) (ten items, McDonald’s ω = .89). The Precautions subscale assesses the perceived ability to use and discuss sexually transmitted disease (STD) protection (e.g., “Are you able to buy condoms in a store?”) (five items, McDonald’s ω = .71). The Assertiveness subscale assesses the perceived ability to be assertive in achieving sexual satisfaction (e.g., “Could you insist your partner respect your sexual needs?”) (five items, McDonald’s ω = .77).

Sexual satisfaction

Sexual satisfaction was assessed using the Global Measure of Sexual Satisfaction (GMSEX; Lawrance & Byers, 1995), a five-item measure assessing satisfaction on a seven-point scale (e.g., 1 = “unsatisfying” and 7 = “satisfying”). Scores ranged from 7 to 35, with higher scores indicating higher sexual satisfaction. The scale showed sufficient reliability in our sample (McDonald’s ω = .96).

Sexual Self-Concept Discrepancies

We developed a concise measure of two types of sexual self-concept discrepancies (based on Higgins, 1987): actual/ideal and actual/ought. The following text was presented to the participants for the actual/ideal item:

“Think about your actual sexual self-concept, and your ideal sexual self-concept. Your actual self-concept entails all the ideas and feelings you have about who you currently are as a sexual person. Your ideal sexual self-concept entails all the ideas and feelings you have about who you ideally would want to be as a sexual person. How far away is your actual sexual self-concept from your ideal sexual self-concept?”

The phrasing was identical for the actual/ought item, except “ought” was used instead of “actual,” and “who you should be” instead of “who you ideally would want to be.” Participants used a sliding scale to indicate how large the discrepancies between their self-concepts were. The positions on the scale were coded into a score ranging from 0 = Entirely overlapping away to 100 = Very far away, with higher scores indicating a higher SSC discrepancy.

General Life Satisfaction

Life satisfaction was assessed using the Satisfaction With Life Scale (SWLS; Diener et al., 1985). The questionnaire consists of five items (e.g., “So far I have gotten the important things I want in life”) (McDonald’s ω = .92) which had to be rated on a seven-point Likert scale ranging from 1 = Strongly disagree to 7 = Strongly agree. Sum scores ranged from 7 to 35, with higher scores indicating higher life satisfaction.

Anxiety and depression

We assessed anxiety and depression using the Hospital Anxiety and Depression Scale (HADS; Zigmund & Snaith, 1983). The questionnaire combines a seven-item anxiety scale (e.g.; “I feel tense or ‘wound up’”) (McDonald’s ω = .87) with a seven-item depression scale (e.g., “I feel cheerful,” reverse item) (McDonald’s ω = .73), presenting participants four response options per statement. For each scale, scores range from 0 to 21, with higher scores indicating higher anxiety/depression.

Other questionnaires

Participants who identified as transgender were asked what type of gender affirming treatment they still desired. Those who had already received some type of treatment also indicated when they started gender affirming hormone therapy/when they underwent gender affirming surgery, and how satisfied they were with the outcomes. Finally, transgender participants were asked about their motives for (not) wanting (more) treatment using multiple-choice items constructed in consultation with community members. Furthermore, transgender participants completed the T-WORRY questionnaire (Dharma et al., 2019) on trans-specific body image worries. However, these questionnaires were not directly relevant to the current study questions and will be analyzed separately.

Analysis

All statistical analyses were performed using the software JASP (JASP Team, 2020). We applied a significance threshold of p= .05 for all analyses. Group differences in the demographic measures and questionnaires other than the SSCQ were analyzed using one-way ANOVAs in case of continuous variables, and chi-square tests of independence in case of categorical variables. In case of a significant ANOVA outcome, post-hoc comparisons were analyzed applying the Tukey HSD test for multiple comparisons. All correlations reported were calculated using Pearson product-moment correlation coefficients.

Given the expected gender differences as well as the hypothesized differences between transgender and cisgender individuals in sexual self-concept, we performed two-way ANOVAs using gender identity (man vs. woman) and cisgender/transgender identity (cisgender vs. transgender) as factors for each sexual self-concept component, using Bonferroni correction for multiple testing (11 components; p = .0045). In order to assess mediation effects, we applied a regression approach (Baron & Kenny, 1986; Sobel, 1982) to investigate whether self-concept discrepancies mediate the relation between gender dysphoria (i.e., UGDS score) and sexual self-concept components in transgender individuals, again applying Bonferroni correction for each component investigated. This approach consists of a series of four regression analyses to investigate the mediating effect of variable M on the relation between variables X and Y. First, Y is regressed on X (path c’). If the regression coefficient is significantly different from zero, the mediation analysis is continued by regressing M on X (path a) and Y on M (path b). In order to be able to speak of (at least partial) mediation, these regression coefficients also need to reach significance. Full mediation is indicated by the “disappearance” of the significant relation between X and Y when controlling for their relation with M (the product of the regression coefficients path a and path b does not differ from zero), as well as by a significant Sobel test statistic (Sobel, 1982).

Results

Sample Descriptives

Table 1 presents the group means and standard deviations for all four groups (cisgender men, cisgender women, transgender men, transgender women) as well as differences between the groups on age, gender dysphoria, general life satisfaction, sexual satisfaction, anxiety and depression, sexual self-concept discrepancies (actual/ideal and actual/ought), and sexual orientation (attraction to men and women). About half of the total sample indicated being in a romantic relationship (N= 211, 52.49%). The majority of the participants indicated having received at least some form of higher education (college or university; N= 239, 59.45%). Most participants were working full time (N= 164, 40.80%), studying (N= 132, 32.84%), or working part time (N= 47, 11.69%). In terms of living situation, participants were mostly living with their partner (N= 126, 31.34%), alone (N= 110, 27.36%), or with their parents/family (N= 81, 20.15%). Chi-square tests indicated that our sample was balanced in terms of educational level (X²(3, N= 399) = 7.79, p= .254). Regarding occupational status, a significant group difference was found (X²(3, N= 400) = 71.93, p< .001), with cisgender women and transgender men mostly being students (50.48% of cisgender women and 40% of transgender men) and cisgender men and transgender women mostly working full time (65.31% of cisgender men and 45.83% of transgender women). Furthermore, group differences occurred with regard to relationship status (X²(3, N= 402) = 9.86, p= .020), with 64.29% of the cisgender men indicating being in a romantic relationship and 56.8% of the transgender men indicating being single.

Table 1. Descriptive statistics and group differences for age, gender dysphoria (UGDS), general life satisfaction (SWLS), sexual satisfaction (GMSEX), anxiety and depression (HADS), sexual self-concept discrepancies, and sexual orientation

	Group				Group differences
	CM M SD (N)	CW M SD (N)	TM M SD (N)	TW M SD (N)	F p η^2	post-hoc significant comparisons
Age	31.91 11.18 (98)	26.83 8.86 (107)	27.22 9.09 (125)	37.74 12.17 (72)	21.58 <.001 .140	TW vs. TM (p < .001), TW vs. CW (p < .001), TW vs. CM (p < .001), TM vs. CM (p= .004), CW vs. CM (p= .002)
Gender dysphoria	1.24 .55 (71)	1.76 .47 (103)	3.97 .73 (122)	3.71 .90 (68)	374.53 <.001 .757	TW vs. CW (p < .001), TW vs. CM (p < .001), TM vs. CW (p < .001), TM vs. CM (p < .001), CW vs. CM (p < .001)
General life satisfaction	24.20 7.15 (64)	21.82 7.69 (96)	19.07 7.39 (107)	17.84 7.47 (57)	9.96 <.001 .085	TW vs. CW (p= .044), TW vs. CM (p < .001), TM vs. CM (p < .001)
Sexual satisfaction	29.06 5.56 (67)	27.60 6.68 (96)	23.72 9.48 (106)	20.79 9.10 (56)	15.08 < .001 .124	TW vs. CW (p < .001), TW vs. CM (p < .001), TM vs. CW (p= .003), TM vs. CM (p < .001)
Anxiety	6.55 3.54 (67)	8.36 3.97 (97)	9.35 4.90 (107)	8.36 4.48 (56)	5.80 <.001 .051	TM vs. CM (p < .001), CW vs. CM (p = .042)
Depression	5.87 2.58 (67)	5.85 2.67 (97)	5.88 3.84 (107)	6.27 3.99 (56)	0.23 .002
Actual/ideal SSC discrepancy	30.59 25.73 (83)	38.30 26.13 (95)	54.89 28.65 (103)	57.74 28.69 (53)	18.02 <.001 .141	TW vs. CW (p < .001), TW vs. CM (p < .001), TM vs. CW (p < .001), TM vs. CM (p < .001)
Actual/ought SSC discrepancy	29.09 22.86 (81)	34.17 28.35 (94)	50.39 29.87 (101)	48.28 29.95 (50)	11.68 <.001 .082	TW vs. CW (p = .008), TW vs. CM (p < .001), TM vs. CW (p < .001), TM vs. CM (p < .001)
Attraction to men	35.54 39.60 (57)	65.04 34.08 (93)	58.84 35.57 (121)	42.67 34.30 (69)	11.11 <.001 .090	TW vs.TM (p= .015), TW vs. CW (p < .001), TM vs. CM (p < .001), CW vs. CM (p < .001)
Attraction to women	59.40 39.55 (57)	39.13 32.39 (93)	64.71 34.94 (121)	71.51 30.99 (69)	14.50 <.001 0.115	TW vs. CW (p < .001), TM vs. CW (p < .001), CW vs. CM (p= .003)

CM = cisgender men, CW = cisgender women, TM = transgender men, TW = transgender women, M= mean, SD = standard deviation, n= sample size, SSC = sexual self-concept.

Post-hoc significance thresholds are Tukey corrected for multiple comparisons of a family of four.

Of the participants who indicated having a transgender identity (N= 190, 47.26%), 42.63% indicated currently being on a waiting list for gender affirming treatment (N= 81). Most transgender participants indicated receiving gender affirming hormone therapy (N= 141, 74.21%). Most transgender women had not undergone any gender affirming surgery (N= 40, 55.56%). In terms of gender affirming surgery, most transgender men indicated having undergone mastectomy (N= 71, 60.68%), while rates for genital surgery were rather low (e.g., for phalloplasty, N= 8, 6.84%). Of the transgender women, 70.8% indicated ever having been diagnosed with gender dysphoria or gender incongruence (N= 51). For transgender men, this figure was 77.6% (N = 97).

Differences in Sexual Self-Concept

Table 2 presents the descriptive statistics for the SSC components for each group. We conducted a series of two-way ANOVAs (one for each SSC component) to investigate the effects of gender identity (2 levels: man, woman) and cisgender/transgender identity (2 levels: cisgender, transgender) on SSC. The results of these analyses are presented in Table 3. Because most participants indicated living in the United States of America or the Benelux, and cisgender participants were overrepresented in the former group while transgender participants were overrepresented in the latter group, we performed additional ANOVAs controlling for this factor. This did not change the outcomes presented in Table 3, except for the Sexual Attitudes – Exploration component, where the effect of cisgender/transgender identity became non-significant (p= .666) after controlling for country of residence. All SSC components correlated positively with sexual satisfaction (p≤ .001 for all correlations, r values ranging between .18-.63, n ranging between 305–322). The Attitudes – Anxiety (r= −.45, p< .001, n= 322) and Attitudes – Commitment (r= −.17, p= .002, n= 322) components correlated negatively with sexual satisfaction.

Table 2. Descriptive statistics for the sexual self-concept components

		CM M SD (N)	CW M SD (N)	TM M SD (N)	TW M SD (N)
Sexual esteem	Behavior	3.94 1.20 (67)	4.14 .77 (99)	3.59 .95 (109)	3.42 .87 (58)
	Body perception	3.49 .77 (67)	3.64 .57 (99)	3.25 .65 (109)	3.34 .63 (58)
	Conduct	3.81 1.05 (66)	3.61 1.133 (99)	2.98 1.16 (109)	3.04 1.00 (58)
	Attractiveness	3.54 .81 (66)	3.61 .83 (99)	3.15 .86 (109)	3.20 .85 (58)
Sexual attitudes	Anxiety	1.92 .70 (64)	2.18 .76 (99)	2.48 .77 (109)	2.43 .71 (58)
	Arousal	3.79 .79 (64)	3.43 .84 (99)	3.47 .93 (109)	2.97 .86 (58)
	Exploration	3.85 .85 (64)	3.48 .81 (99)	3.50 .74 (109)	3.19 .75 (58)
	Commitment	2.95 .68 (64)	3.36 .86 (99)	3.48 .69 (109)	3.61 .69 (58)
Sexual self-efficacy	Resistive	3.36 1.29 (53)	3.91 .83 (96)	3.63 1.06 (103)	3.70 1.01 (55)
	Precautions	4.10 1.09 (53)	4.09 1.02 (96)	3.67 1.06 (103)	3.84 1.07 (55)
	Assertiveness	3.60 1.28 (53)	3.86 .91 (96)	3.44 1.08 (103)	3.34 1.24 (55)

CM = cisgender men, CW = cisgender women, TM = transgender men, TW = transgender women, M= mean, SD = standard deviation, N= sample size.

Table 3. Sexual Self-Concept scales as a function of gender identity (2 levels: man, woman) and cisgender/transgender identity (2 levels: cisgender, transgender)

Sexual self-concept component		ME gender identity F η^2	ME cisgender/transgender identity F η^2	Interaction F η^2
Sexual esteem	Behavior	.02 .000	25.09* .070	3.02 .008
	Body perception	2.63 .008	13.28* .038	.16 .000
	Conduct	.32 .001	30.52* .085	1.07 .003
	Attractiveness	.38 .001	17.92* .052	.01 .000
Sexual attitudes	Anxiety	1.60 .005	22.73* .064	3.23 .009
	Arousal	19.34* .054	15.46* .043	.51 .001
	Exploration	14.56* .041	12.50* .035	.09 .000
	Commitment	9.89* .028	20.89* .058	2.76 .008
Sexual self-efficacy	Resistive	6.33 .020	.06 .000	4.00 .013
	Precautions	.42 .001	7.32 .024	.56 .002
	Assertiveness	.36 .001	6.88 .022	1.87 .006

ME = main effect.

*p < .0045; Bonferroni correction for multiple comparisons (.05/11). Note: After controlling for country of residence, all significant effects remained significant except for the ME cisgender/transgender identity for Sexual attitudes – Exploration.

Mediation Analysis

Within the transgender group, gender dysphoria (UGDS score) correlated significantly with four SSC components: Sexual Esteem – Body Perception (r= −.23, p = .002, n= 167), Sexual Esteem – Attractiveness (r= −.24, p= .002, n= 167), Sexual Esteem – Conduct (r= −.22, p= .004, n= 167), and Attitudes – Anxiety (r= .27, p< .001, n= 167). Therefore, we performed four mediation analyses to assess whether actual/ideal SSC discrepancy mediates the relationship between gender dysphoria and these SSC components. The results presented in Figure 1 and Table 4 indicate that actual/ideal SSC discrepancies indeed do fully mediate all four relationships in the transgender sample.

Table 4. Regression outcomes for the four mediation models

Model		R^2	Adjusted R^2	F	β	95% CI
						Lower	Higher
UGDS → EstP		.06	.05	9.67**	−.20**	−.33	−.07
UGDS → SSCD		.12	.11	20.17***	12.85***	5.81	19.20
SSCD → EstP		.17	.16	30.52***	−.01***	−.01	−.01
(UGDS and SSCD) → EstP	UGDS	.18	.17	16.51***	−.10	−.24	.03
	SSCD				−.01***	−.01	−.00
UGDS → EstC		.05	.05	8.74**	−.33**	−.54	−.05
UGDS → SSCD		.12	.11	20.17***	12.85***	5.81	19.20
SSCD → EstC		.32	.32	73.01***	−.02***	−.03	−.02
(UGDS and SSCD) → EstC	UGDS	.32	.32	36.34***	−.03	−.15	.19
	SSCD				−.02***	−.03	−.02
UGDS → EstA		.06	.05	10.32**	−.27**	−.46	−.09
UGDS → SSCD		.12	.11	20.17***	12.85***	5.81	19.20
SSCD → EstA		.31	.31	68.77***	−.02***	−.02	−.01
(UGDS and SSCD) → EstA	UGDS	.31	.31	34.78***	−.07	−.25	.08
	SSCD				−.02***	−.02	−.01
UGDS → AttAn		.08	.07	13.83***	.27***	.14	.41
UGDS → SSCD		.12	.11	20.17***	12.85***	5.81	19.20
SSCD → AttAn		.22	.22	43.75***	.01***	.01	.02
(UGDS and SSCD) → AttAn	UGDS	.24	.23	24.11***	.14	.01	.27
	SSCD				.01***	.01	.02

UGDS = Utrecht Gender Dysphoria Scale, SSCD = sexual self-concept discrepancy, EstP = Sexual esteem – body perception, EstC = Sexual esteem – conduct, EstA = Sexual esteem – attractiveness, AttAn = Sexual attitudes – anxiety, CI = confidence interval, SE = standard error. Confidence intervals were acquired using a bootstrap method over 5000 replications.

* = p< .05, ** = p < .01, *** = p< .001

Figure 1. Coefficients for mediation models assessing the mediating effect of actual/ideal sexual self-concept discrepancies on the relationship between gender dysphoria and Sexual Esteem – Body Perception, Sexual Esteem – Conduct, Sexual Esteem – Attractiveness, and Sexual Attitudes – Anxiety in the transgender sample. The values in parentheses present the direct (i.e. unmediated) path. Sobel test values for the four models: z= −3.18 (Sexual Esteem – Body Perception model), z= −3.83 (Sexual Esteem – Conduct model), z= −3.97 (Sexual Esteem – Attractiveness model), and z= 3.60 (Sexual Attitudes – Anxiety model) (p< .001* for all values). Betas are unstandardized.

*p < .0125; Bonferroni correction for multiple comparisons (.05/4).

In the cisgender group, UGDS score correlated significantly with the SSC components of Sexual Esteem – Conduct (r= −.36, p < .001, n= 162), Sexual Esteem – Attractiveness (r= −.24, p= .002, n= 162), Attitudes – Anxiety (r= .39, p< .001, n= 160), Attitudes – Arousal (r= −.35, p< .001, n= 160), and Attitudes – Exploration (r= −.23, p= .004, n= 160). However, since cisgender men and women differed significantly on UGDS score, we further investigated whether these correlations remained significant within each subgroup (cisgender men and cisgender women). They did not, indicating that these correlations might be caused by a baseline difference in UGDS score between cisgender men and women. Furthermore, due to the lack of a significant correlation between UGDS score and actual/ideal SSC discrepancy (r= .10, p= .227, n= 154) in the cisgender group as a whole, the latter factor could not be examined as a mediating factor in these relations.

Discussion

This study investigated different dimensions of the sexual self-concept (SSC) in binary identifying transgender and cisgender individuals, and the role of sexual self-concept discrepancies in explaining the contribution of gender dysphoria regarding the SSC in transgender individuals. Transgender individuals scored lower than cisgender individuals on all sexual esteem scales (behavior, body perception, conduct, and attractiveness) and one sexual attitudes scale (arousal), while they scored higher on two sexual attitudes scales (anxiety and commitment). No group differences were found on the sexual self-efficacy scales (resistive, precautions, and assertiveness) and the remaining sexual attitudes scale (exploration). Furthermore, transgender individuals showed larger actual/ideal and actual/ought SSC discrepancies than cisgender individuals. Overall, our results indicated that transgender individuals have a more negative sexual self-concept. For four of the seven SSC components on which transgender and cisgender individuals differed (sexual esteem – attractiveness, sexual esteem – body perception, sexual esteem – conduct, and sexual attitudes – anxiety), we found a correlation with the level of gender dysphoria in the transgender sample. This relation between gender dysphoria and the SSC components was fully mediated by actual/ideal SSC discrepancies.

Given that most studies on sexuality in transgender individuals to date did not include a cisgender sample as a comparison, it is difficult to relate our findings to the existing empirical literature on the sexual experiences of transgender people. Overall, it has been shown that many transgender individuals struggle with their sexuality. Kerckhof et al. (2019), for instance, found that 69% of the transgender women and 54% of the transgender men in their sample reported at least one sexual dysfunction, which is considerably higher compared to 11–27% in cisgender women and 11–19% in cisgender men (Christensen et al., 2011; Shifren et al., 2008). In both transgender groups, fear of sexual contacts was frequently reported, which fits with the current finding that transgender individuals report more sexual anxiety as part of their self-concept. Another study investigating sexual function in transgender women who had undergone gender affirming surgery also found that this group shows elevated rates of sexual dysfunctions (Weyers et al., 2009), such as problems with arousal. This coincides with our finding of lower scores on sexual attitudes – arousal in the transgender sample. In the following paragraphs, we will elaborate on our findings and their clinical implications.

Sexual Self-concept Discrepancies in Transgender Individuals

Transgender individuals showed larger discrepancies between their actual and ideal SSC, which fits with our predictions. It seems that transgender people perceive themselves as being further away from who they want to be sexually than cisgender individuals. This could be because they are unsatisfied with who they are, especially when they have not received their desired gender affirming care yet (Nikkelen & Kreukels, 2018). In a qualitative study, trans masculine individuals indicated how they indeed thought they would benefit sexually from having different body parts, and how they believed gender affirming care would increase their sexual satisfaction (Lindley et al., 2020). It may well be that the larger actual/ideal discrepancy score results from internalized transphobia (Cooper et al., 2020; Scandurra et al., 2019), which is the process of individuals internalizing the negative prejudices they commonly encounter in society about their (sexual) minority status. This is also indicated by the larger actual/ought SSC discrepancies that were observed in the transgender group. Although the actual/ideal discrepancy is most relevant in light of the current research questions, the higher scores on actual/ought discrepancy are also interesting. It is possible that when transgender individuals constantly receive a message from society that they are unworthy and they should change (which they do; see White Hughto et al., 2015), they start to believe that they are not who they should be. Future studies could investigate which norms transgender people experience when it comes to their SSC, and why their actual SSC is not in line with their ought SSC.

The Role of Actual/Ideal Sexual Self-Concept Discrepancies in Explaining the Relation Between Gender Dysphoria and SSC

To advance current treatment aiming to develop a more positive SSC in transgender individuals, it is necessary to understand the mechanisms via which gender dysphoria affects SSC components. For many, the most common and effective way to treat gender dysphoria will include gender affirming surgery (World Professional Association of Transgender Health, n.d.), but this type of care is not always accessible for all transgender people (because of financial, social, or other circumstances) and often the waiting lists are long. Additionally, even after receiving the desired gender affirming surgery, some transgender individuals will still experience an incongruence between their gender identity and body (Doorduin & van Berlo, 2014). Therefore, some transgender individuals have to live with their gender dysphoria for a long time or even forever, which increases the need for additional treatment targets in order to improve sexual wellbeing.

For four of the seven SSC components on which transgender and cisgender individuals differed (after controlling for country of residence), we found a correlation with gender dysphoria scores in the transgender sample. For the sexual esteem – attractiveness and sexual esteem – body perception components, this can likely be explained by the link between gender dysphoria and body image/satisfaction (Mofradidoost & Abolghasemi, 2020; Van De Grift et al., 2016). Individuals with higher gender dysphoria might be less likely to value their body in a sexual context because of their poor overall body image, which becomes more salient in a sexual context. The relationship between gender dysphoria and the sexual esteem – conduct component indicates that on top of the body image worries, transgender individuals struggle with how to behave in a sexual situation. Mainstream sexual scripts (e.g., in the media or during sex education) typically assume an alignment between a person’s gender identity and body, which is a key missing factor in people with gender dysphoria. Finally, the sexual attitudes – anxiety component correlated with gender dysphoria. This indicates that the more gender dysphoria one experiences, the more one worries about not being able to enjoy sex. This lends further support for the importance of feeling comfortable in your own body in sexual situations in order to experience sexual pleasure (Sanchez & Kiefer, 2007). Interestingly, sexual esteem – conduct, sexual esteem – attractiveness, and sexual attitudes – anxiety were also correlated with gender dysphoria scores in the cisgender sample as whole, but not in the subgroups of cisgender men and cisgender women. It is possible that the gender dysphoria scale employed in this study partly captures body dissatisfaction, which could then be related to SSC in both transgender and cisgender individuals. We recommend that future studies quantitatively investigating the relation between gender dysphoria and other variables in transgender individuals include a cisgender sample as well, to further investigate which components of gender dysphoria are transgender-specific, and to establish the validity of gender dysphoria measures in cisgender samples.

To explore whether SSC discrepancies can further explain the relation between gender dysphoria and these four SSC components, we tested a series of models in which actual/ideal SSC discrepancies mediate the relation between gender dysphoria and the SSC in transgender individuals. We found that actual/ideal discrepancies fully mediated the association between gender dysphoria and sexual esteem – attractiveness, sexual esteem – body perception, sexual esteem – conduct, and sexual attitudes – anxiety. This suggests that the discrepancy transgender people experience between who they are and who they want to be plays a crucial role in explaining the interrelation between their sexual self-perception and feelings of gender dysphoria. Indeed, previous studies have shown that transgender individuals can make their sexual experiences more enjoyable by bringing their current self closer to their experienced gender identity, for instance, by the use of prosthetics or by recoding their body terminology in a way that matches their identity (Martin & Coolhart, 2019). Our results suggest that actual/ideal discrepancies might be a central target of intervention to reduce the potentially negative impact of gender dysphoria on SSC. For instance, it has been shown that Self Discrepancy Monitoring (SDM), in which individuals focus on the discrepancy between their actual and ideal self-concept even in positive situations, has a negative effect on psychological wellbeing (Caselli et al., 2014). This indicates that ruminating over and focusing on SSC discrepancies can exacerbate the negative effects of gender dysphoric feelings on the SSC. Because of this, an effective therapeutic approach could be to assist transgender individuals to reorient their attention away from these discrepancies, which might help them stop behaving in a (maladaptive) way to reduce these discrepancies (Higgins et al., 1994). This idea is in line with previous findings in the literature on how transgender individuals try to avert their focus away from the discrepancy between their body and their gender identity during sexual activities by, for instance, turning the lights off or by asking their partner(s) not to touch body parts incongruent with their gender identity (Martin & Coolhart, 2019). The latter indicates the importance of consent plans and communication with the sexual partner(s) in order to help decrease the negative effect of SSC discrepancies and gender dysphoria on sexual wellbeing (Lindley et al., 2020). It has even been suggested that clinical interventions targeting partner interactions might be more effective than medical interventions to increase sexual wellbeing in transgender individuals (Lindley et al., 2021).

It should be noted that given the cross-sectional design of our study, no definite conclusions about the directions of the effects can be made. One could also argue that SSC discrepancies cause gender dysphoria, and not the other way around. In any case, targeting these SSC discrepancies in a therapeutic setting could then still have a positive effect on transgender individuals’ SSC.

Other Factors Explaining Sexual Self-concept Differences

There were three SSC components on which transgender and cisgender individuals differed significantly, but for which no correlation was found with gender dysphoria in the transgender sample (sexual esteem – behavior, sexual attitudes – arousal, and sexual attitudes – commitment). For these components, the SSC discrepancies related to gender dysphoria can thus not explain the negative SSC patterns in transgender individuals. In these cases, the categorical distinction of (not) having a transgender identity (as opposed to the continuous differences in gender dysphoria) might better explain the observed differences. For instance, the fact that transgender participants scored higher on the sexual attitudes – commitment scale than cisgender participants, suggests that transgender individuals have a higher need to commit to a sexual partner. One likely explanation for this finding is that transgender individuals feel the need for a safe environment to express their sexuality, without having to fear how their sexual partner(s) react(s). This is supported by studies showing that transgender individuals sometimes report anxiety around sexually engaging with new people (Lindley et al., 2020). Partners who understand the transgender person’s gender identity and boundaries can provide more positive sexual experiences (Lindley et al., 2021), and these things are possibly more easily understood by (a) committed partner(s). Additionally, compared to cisgender people, transgender people have a higher risk of becoming a victim of sexual harassment (Mitchell et al., 2014), which could explain their need to be with a person whom they know they can trust. Furthermore, given that for most transgender individuals it is harder to “pass” when taking off their clothes (due to not having undergone gender affirming surgery or due to surgery scars), it is possible that transgender individuals will need to disclose their past to a potential sexual partner, elevating the threshold of engaging in sexual activities with a new person. This is in line with previous reports of transgender individuals indicating that they experience a hypervigilance for transphobia and a strong fear of rejection (Goldberg et al., 2019). Future studies should include measurements of experienced stigmatization and fear of sexual harassment to investigate whether such factors explain the differences in SSC between transgender and cisgender individuals further.

Interestingly, in contrast to the Sexual Esteem and Sexual Attitudes scales, transgender and cisgender individuals did not differ in the Sexual Self-Efficacy components. This indicates that transgender individuals feel just as in control as cisgender individuals when it comes to saying no to unwanted sexual situations (sexual self-efficacy – resistive), negotiating STD protection (sexual self-efficacy – precautions), and communicating their sexual needs (sexual self-efficacy – assertiveness). Compared to sexual esteem and sexual attitudes, which mostly pertain to affective components, the sexual self-efficacy component is more cognitive in nature (Deutsch et al., 2014), indicating that the emotional differences regarding their experience of sexuality between transgender and cisgender individuals might not necessarily extend into the cognitive level. Another explanation could be that while gender dysphoria does have a negative effect on sexual self-efficacy, this is compensated by a positive effect in transgender people. For instance, their sexual development might not have been as evident as for cisgender people (e.g., due to the lack of appropriate scripts or due to body dysphoria) and looking back at this journey might leave transgender people with a higher sense of self-efficacy. However, this is only speculative, since our data provide no indications of factors such as sexual development, so this possible explanation should be explored in future research. It should also be noted that the sexual self-efficacy scale was measured in a different format than the other two scales. While for the latter, participants had to simply rate statements on a Likert scale, the sexual self-efficacy questionnaire consisted of two steps (first indicating whether a participant thinks they are able to show a certain behavior, then indicating their certainty about this only if they think they can do it). The fact that this questionnaire was less straightforward is reflected in the attrition rates. This implies that we cannot rule out that psychometric differences are responsible for this finding. Finally, we want to point out that the statistical methods we employed were relatively strict in order to rule out false positive findings. The finding of a lack of differences in sexual self-efficacy hence needs replication in order to support our results, and our current interpretation should be considered tentative.

Gender Differences

Gender differences have traditionally attracted much attention in research on sexuality (Dewitte, 2016; Petersen & Hyde, 2011). In our sample, we found gender differences (regardless of transgender or cisgender identity) on three SSC components: sexual attitudes – commitment, sexual attitudes – arousal, and sexual attitudes – exploration. Regarding the sexual attitudes – commitment component, cisgender and transgender women scored higher than cisgender and transgender men, indicating that women have a stronger preference for one committed sexual partner than men. Although this finding is often explained using an evolutionary psychological approach (Buss, 1998), it is also likely that this response pattern reflects social expectations. Historically, in both Western and other societies, there is a sexual double standard in which having multiple sexual partners is more acceptable for cisgender men than for cisgender women (Crawford & Popp, 2003; Milhausen & Herold, 1999). The fact that men scored higher than women on sexual attitudes – arousal and sexual attitudes – exploration is in line with previous findings (Deutsch et al., 2014) and is usually ascribed to higher levels of testosterone in men. As most transgender men in our sample were undergoing gender affirming hormone therapy, it could be that higher perceptions of sexual arousability results from sudden increases in testosterone levels. It is likely that the stronger and more frequent experience of sexual arousal will become integrated in one’s self-concept, leading to individuals perceiving themselves as sexually more arousable.

We would like to highlight that no gender differences were found on the majority of the SSC components. For the sexual esteem components, this contradicts previous research indicating that men have higher sexual esteem (Rosenthal et al., 1991; although the opposite has also been found when it comes to attractiveness, see Garcia & Carrigan, 1998). Furthermore, previous studies have shown that women have more negative affect regarding sexuality (Petersen & Hyde, 2010), while in our study there were no gender differences on the sexual attitudes- anxiety component. Although these inconsistencies might be due to methodological differences (e.g., different questionnaires and the fact that we included transgender individuals), it is also plausible that the difference between men and women is decreasing over time as societies change (Petersen & Hyde, 2011). The fact that the men and women in our sample showed more similarities than differences regarding sexuality goes against many societal stereotypes and questions the binary classification of two very different genders.

Strengths and Limitations

To our knowledge, this is the first study to apply the SSC as well as the self-concept discrepancy literature to transgender individuals. In contrast to previous studies on sexuality in transgender individuals, this study investigated many psychological experiences related to the sexual self-concept. Furthermore, we forwarded an explanatory mechanism through which gender dysphoria can have a negative effect on sexual wellbeing, offering valuable insights for the clinical setting.

Nevertheless, some limitations apply to our study. First of all, the fact that this was an online study about sexuality likely induced a selection bias, mostly targeting people who feel comfortable in an online environment and are open to report about their sexual lives, explaining the relatively young and mostly Western sample. Secondly, participants were free to skip questionnaires or leave the study before finishing, resulting in different sample sizes for the different questionnaires and scales. We decided not to remove any participants who had not completed the full set of questionnaires in order to avoid bias. Thirdly, not all questionnaires have been formally validated for a transgender population, but we adjusted them where necessary to make them appropriate for this group. Furthermore, the cross-sectional nature of this study warrants caution when making strong causal claims. Another methodological shortcoming concerns the assessment of sexual orientation. We made no distinction between romantic and physical attraction and participants did not have the option to indicate attraction to non-binary individuals. Finally, it should be noted that the findings from this study might not generalize to the full transgender population, since we only analyzed the data from binary identifying individuals. Furthermore, the questionnaires were not tailored to asexual people or individuals with polyamorous relations. We will take these populations into account in our future studies and encourage other researchers to do the same.

Conclusion

Binary transgender and cisgender individuals show differences in their sexual self-concept, with transgender individuals presenting a more negative sexual self-perception. For several components of sexual esteem (related to conduct, body perception, and attractiveness) and for sexual anxiety, experiencing a mismatch between who one is and who one wants to be explains the relation between gender dysphoria and the sexual self in transgender people. While transgender individuals also differed significantly from cisgender individuals on sexual esteem related to behavior and on several sexual attitudes (related to arousal and commitment), this was not related to gender dysphoria in the transgender group. Finally, no group differences were found on sexual self-efficacy and sexual attitudes related to exploration. This indicates that actual/ideal discrepancies could be a promising treatment target to improve transgender individuals’ sexual self-concept, specifically the components related to sexual esteem and sexual anxiety.

Acknowledgments

We would like to thank Jessica Alleva and Margot Kennis for the time they put into the back-to-back translation of the questionnaires. We would also like to acknowledge the contributions of the people who provided their feedback on the transgender friendliness of the questionnaires, as well as the transgender and LGBTQI+ support organisations who advertised it. Finally, we would like to thank our participants who put their time in responding to our survey. This work was supported by the NWO under a Research Talent Grant 2018 [number: 406.18.513] and by a crowdfunding campaign to raise money for transgender studies at Maastricht University.

Disclosure Statement

The authors report no conflicts of interest.

Additional information

Funding

This work was supported by the Netherlands Organisation for Scientific Research [406.18.513].