Kirstin Rebecca Mitchell

Background Trans, non-binary and gender diverse (TNBGD) sexual function has historically been narrowly defined as physical capacities following medical and surgical gender affirming (GA) interventions; and this population's sexual health has been researched more in terms of external influences considered risky rather than being founded in individuals' desires and needs. This can produce discrepancies between services and people who access them. This study explores the service-related barriers, facilitators and compensatory strategies for TNBGD people seeking healthcare related to sexual function. Methods Based on qualitative interview data from n = 19 TNBGD adults in the UK, the dataset was deductively analyzed using Levesque's framework of healthcare access. Results TNBGD people face barriers in distance and transport to appropriate sexual health services, overlaps between sexual healthcare and GA services, and limits in professionals' TNBGD specific knowledge and cultural competence. To navigate these TNGBD people pursued independent knowledge acquisition, were selective during clinical interactions and access, and sought to meet their needs outside clinical settings. The analytical themes demonstrate varied barriers and their interrelatedness. For example, acceptability of a service was informed by the appropriateness of clinician's knowledge and interactions. In turn, TNBGD people's anticipation of un (der) met needs motivated compensatory measures, such as seeking information online or from peers before approaching formal services or sometimes instead of approaching them. Conclusions Healthcare services' design and delivery can present significant barriers to TNBGD adults seeking healthcare to support their sexual function. Providers' ways of interacting may offset some of the barriers and TNBGD adults may deploy strategies that enable them to access care that leads to satisfactory health outcomes. However, while significant barriers persist, TNBGD adults are liable to have unmet needs and consequent health inequalities.