{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,16]],"date-time":"2026-07-16T06:05:03Z","timestamp":1784181903629,"version":"3.55.0"},"reference-count":24,"publisher":"SAGE Publications","issue":"9","license":[{"start":{"date-parts":[[2026,6,15]],"date-time":"2026-06-15T00:00:00Z","timestamp":1781481600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Int J STD AIDS"],"published-print":{"date-parts":[[2026,8]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Testosterone-associated vulvovaginitis is an under-recognised cause of genital symptoms in transmasculine patients receiving testosterone as gender-affirming hormone therapy, with 5-years prevalence 64-78%. BASHH\u2019s Gender and Sexual Minorities Special Interest Group convened sexual health, gender, gynaecological and primary care experts and patient representatives to formulate a first-in-world best practice statement.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Method<\/jats:title>\n                    <jats:p>We searched Medline, Embase, CINAHL, UpToDate, Trip Medical Database and Cochrane, to April 2025, regarding testosterone\u2019s impact on transmasculine people\u2019s vaginal histology and microbiomes, symptoms, and management. Papers on cis- or transgender women, editorials, and study protocols were excluded. Included studies were assessed using the Critical Appraisal Skills Programme tool. Recommendations for best practice were graded using GRADE methodology where possible, and supplemented by expert group consensus where evidence was limited.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      14 papers were included, of which 11 were descriptive\/non-management focused. Testosterone is associated with vaginal\n                      <jats:italic toggle=\"yes\">Lactobacilli<\/jats:italic>\n                      depletion, increased speciation, pH changes, atrophy, inflammation, and epithelial cell differentiation shift. The diagnosis of testosterone-associated vulvovaginitis is clinical; symptom severity does not reliably correlate with any of the above, nor other markers such as hormone levels. Two small case series and one cohort study (total\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      = 12) discussed treatment; topical estrogen reduced vaginal symptoms and increased\n                      <jats:italic toggle=\"yes\">Lactobacilli<\/jats:italic>\n                      , with some refractory inflammatory cases requiring topical clindamycin +\/\u2212 topical steroids. Presumed efficacy and safety are extrapolated from topical estrogen use in cisgender menopausal women.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Specific evidence for testosterone-associated vulvovaginitis management is lacking; we suggest a culturally competent approach, considering it as a differential in any transmasculine people on testosterone with genitourinary symptoms. Offer examination (if possible) to exclude infection or dermatoses; offer first-line treatment with topical vaginal estrogens. Adjunctive\/alternative measures include emollients and lubricants; topical clindamycin +\/\u2212 topical steroids for refractory cases or aerobic\/desquamative vaginitis. Long-term maintenance therapy and review is advised. Robust trans-specific clinical trials are needed to strengthen the evidence and optimise long-term outcomes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/09564624261458272","type":"journal-article","created":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T05:15:01Z","timestamp":1781586901000},"page":"984-994","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["BASHH best practice statement on the management of testosterone-associated vulvovaginitis"],"prefix":"10.1177","volume":"37","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7750-650X","authenticated-orcid":false,"given":"Joe","family":"Smith","sequence":"first","affiliation":[{"name":"Devon Partnerships Trust"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0482-669X","authenticated-orcid":false,"given":"Sophie","family":"Ross","sequence":"additional","affiliation":[{"name":"Brighton and Hove Sexual Health and Contraception Service, University Hospitals Sussex NHS Foundation Trust"},{"name":"Gender Identity Clinic"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8591-0203","authenticated-orcid":false,"given":"Kate","family":"Nambiar","sequence":"additional","affiliation":[{"name":"Welsh Gender Service"},{"name":"Cardiff & Vale University Health Board"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-2362-3426","authenticated-orcid":false,"given":"Kathleen","family":"Rafferty","sequence":"additional","affiliation":[{"name":"Wellington Clinic Sexual and Reproductive Health Service, Sexual Wellbeing Aotearoa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Madeleine","family":"Crow","sequence":"additional","affiliation":[{"name":"Locala Sexual Health Bradford"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ruth","family":"Bond","sequence":"additional","affiliation":[{"name":"Leeds York Partnership Foundation Trust"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rudy","family":"Graves","sequence":"additional","affiliation":[{"name":"Leeds Teaching Hospitals NHS Trust"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,6,15]]},"reference":[{"key":"e_1_3_7_2_2","unstructured":"Critical Appraisal Skills Programme. CASP checklist: for case control studies. [online] Available at: https:\/\/casp-uk.net\/casp-checklists\/CASP-checklist-case-control-study-2024x.pdf (2024 accessed 22 May 2026)."},{"key":"e_1_3_7_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinepi.2023.05.010"},{"key":"e_1_3_7_4_2","volume-title":"Support for adults facing staggering waits for gender services","author":"Department of Health and Social Care","year":"2025","unstructured":"Department of Health and Social Care. Support for adults facing staggering waits for gender services. Department of Health and Social Care. https:\/\/www.gov.uk\/government\/news\/support-for-adults-facing-staggering-waits-for-gender-services (2025, accessed 12 December 2025)."},{"key":"e_1_3_7_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2023.08.035"},{"key":"e_1_3_7_6_2","volume-title":"Pelvic pain in transgender people using testosterone therapy: a national survey","author":"Zwickl S","year":"2022","unstructured":"Zwickl S, Burchill L, Wong AFQ, et al. Pelvic pain in transgender people using testosterone therapy: a national survey. Authorea. 2022. https:\/\/doi.org\/10.22541\/au.165388691.10496458\/v1"},{"key":"e_1_3_7_7_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.beem.2024.101908"},{"key":"e_1_3_7_8_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-024-72365-4"},{"key":"e_1_3_7_9_2","doi-asserted-by":"publisher","DOI":"10.1373\/clinchem.2018.293654"},{"key":"e_1_3_7_10_2","doi-asserted-by":"publisher","DOI":"10.1089\/trgh.2023.0249"},{"key":"e_1_3_7_11_2","doi-asserted-by":"publisher","DOI":"10.3389\/fcimb.2021.769950"},{"key":"e_1_3_7_12_2","doi-asserted-by":"publisher","DOI":"10.1093\/infdis\/jiaf114"},{"key":"e_1_3_7_13_2","doi-asserted-by":"publisher","DOI":"10.1093\/ajcp\/aqac107"},{"key":"e_1_3_7_14_2","doi-asserted-by":"publisher","DOI":"10.5858\/arpa.2021-0199-OA"},{"key":"e_1_3_7_15_2","doi-asserted-by":"publisher","DOI":"10.1038\/ijir.2013.9"},{"key":"e_1_3_7_16_2","unstructured":"Shone E Jones H Mason M et al. The unwanted effects of testosterone therapy: a case series of vaginal symptoms in trans men. In: British association of sexual health and HIV medicine annual conference bournemouth UK 17\u201319 June 2024."},{"issue":"1","key":"e_1_3_7_17_2","first-page":"A12","article-title":"C1 case series: managing desquamative inflammatory vaginitis in trans-men","volume":"91","author":"Nambiar K","year":"2015","unstructured":"Nambiar K, Williams D, Woodroffe T, et al. C1 case series: managing desquamative inflammatory vaginitis in trans-men. Sex Transm Infect 2015; 91(Suppl1): A12. https:\/\/doi.org\/10.1136\/sextrans-2015-052126.34","journal-title":"Sex Transm Infect"},{"key":"e_1_3_7_18_2","unstructured":"British Menopause Society. 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