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Addressing tucking in transgender and gender variant patients
Oct 20, 2016 by Jenn Matsui De Roo, MA, Registered Clinical Counsellor
Tucking is practiced by trans-feminine or other gender diverse people for a variety of reasons. Tucking may help to reduce dysphoria, make people feel more at ease in their bodies, and affirm their gender. Tucking can also be done for performance reasons by people who may or may not identify as trans, such as drag performances.
The purpose of tucking is to provide a visibly smooth appearance in the genital area and to hide external genitalia. It involves tucking the scrotum and penis between the buttocks. The testicles are often gently pushed into the inguinal canals.
The tuck may be held in place with medical or other kinds of tape, and/or with tight underwear or a gaff (specialized support underwear that helps to flatten and smooth the area). Medical tape is recommended, as duct tape and other kinds of tape may cause irritation and damage to the skin.
There is currently little research on the physical outcomes associated with tucking. Much of the information on tucking comes from lived-experience and anecdotal accounts from medical practitioners who work with trans clients.
Effects of tucking
Tucking can cause a variety of complications. These include mechanical damage due to pulling or tearing, and urinary trauma or infections.[1,3] It can also cause scrotal content pain and complaints, including the possibility of torsion.
Prolonged tucking may cause urinary reflux and symptoms of prostatism or infection including epididymorchitis, prostatitis, or cystitis. In addition, tucking the penis back between the buttocks may result in a compressed urethral meatus; being close to the anus for lengthy periods of time, this may also serve as a portal for infection.
As tucking has the potential to cause mechanical damage, and insertion of the testes in the inguinal canals can raise the temperature of the testes, there is the potential for fertility issues.
When working with trans patients, it is important to provide gender-affirming care. This includes:
- using the patient’s correct chosen name and pronoun consistently;
- providing a clinic space that is welcoming of gender diversity;
- creating clinical systems and procedures that are structured to reduce barriers to access.
Some language may be triggering for trans people, particularly when discussing the genitals. It can be helpful to use more general language, such as “external genitals” rather than “penis” and “testes”. It is good to check with patients first about their preferred language for body parts.
Physical examination of the genital area can trigger dysphoria or trauma in some trans people. Sensitive, informed care is essential throughout the entire examination. This includes:
- explaining the examination process and the reasons for it;
- using the patient’s preferred language for body parts;
- building trust with the patient to ensure consent before undertaking any examination.
Assessment for tucking
When discussing tucking with a patient, take time to understand the role tucking plays in their life as well as any concerns they may have.
These questions may useful:
- Do you tuck?
- How often and for how long do you tuck?
- What method do you use? If you use tape, what kind do you use?
- How does tucking contribute to your well-being?
- How important is it for you to tuck?
- Are you experiencing any irritation, pain or discomfort?
- Have you seen any blood in urine or ejaculate?
- Do you have any fertility concerns?
Many issues with tucking can be resolved through education about safety and better ways to tuck. This may include suggesting shorter periods of tucking, not tucking as tightly, and keeping skin dry and clean. If skin is irritated, check if non-skin safe tape is being used and suggest medical tape instead. Adhesive remover can be purchased from medical supply stores.
Pain in the scrotal contents can be due to tucking, but may also be due to unrelated factors. For instance, pain at the onset of hormone therapy is common. The cause of this symptom is unknown and it usually resolves without treatment. Non-steroidal anti-inflammatory drugs can be used to manage this problem.
If there is acute pain of the scrotal contents, rule out conditions that need further investigation. This includes a physical exam to exclude tumors, hernia, hydrocele or other causes of pain, and appropriate imaging if needed.
Investigation for torsion, infection (including gonorrhea and chlamydia), inguinal hernia, and occult trauma should be performed when appropriate.
If ongoing pain does not respond to treatment, orchiectomy should be considered a possible solution in some cases. While orchiectomy should not be considered for cis men until other options are explored, this may not be the case for trans-feminine people. Orchiectomy is often a desired gender-affirming surgery for many trans feminine people.
- PHSA Transgender Health Information Program. Tucking. Retrieved from http://transhealth.phsa.ca/social-transition-options/binding-packing-tucking/tucking
- Zevin, B. Testicular and scrotal pain and related complaints. Centre for Excellence in Transgender Health. Retrieved from: http://transhealth.ucsf.edu/trans?page=guidelines-testicular-pain
- Deutsch, M. Binding, packing, and tucking. Centre for Excellence in Transgender Health. Retrieved from http://transhealth.ucsf.edu/tcoe?page=guidelines-binding
- Wesp, L. Transgender patients and the physical examination. Centre for Excellence in Transgender Health. Retrieved from http://transhealth.ucsf.edu/trans?page=guidelines-physical-examination
Categories: Current practice