Genital Tucking for Trans-Feminine Patients

Genital tucking is a practice employed by some transgender women and gender nonconforming individuals to minimize or hide the contour (bulge) of their genitals, creating a flatter and more feminine appearance. For many people, tucking is immensely helpful in relieving gender dysphoria and allowing them to wear clothing that affirms their gender. Others use genital tucking in order to wear drag and perform in drag shows. There are a wide variety of methods used to tuck, involving the use of athletic tape, tight underwear, and/or specialized supportive undergarments called gaffs.

Every method of tucking involves two basic steps. First, the testicles are gently pushed up into the inguinal canal. The scrotum and penis are then pulled backward and secured between the buttocks. This step is where methods tend to vary. Some individuals use tape (medical tape is recommended) to secure their tuck; others rely on gaffs and/or tight underwear, and some use all of the above. There is currently no research on whether any one method is safer than the others. General wisdom holds that tucking with tape produces a tighter and more secure result, whereas tucking using tight undergarments is more comfortable.

Safety of genital tucking for gender nonconforming patients

Genital tucking is critically important to the mental health of many transgender and gender nonconforming individuals. However, tucking is not without its health risks (though peer-reviewed research specific to genital tucking is sparse).

Infertility: It is unknown whether tucking–specifically, the insertion of the testes into the inguinal canal–may result in decreased fertility. Some speculate that the increased temperature results in lower sperm counts and fertility issues. Others contend that fertility is impacted more by hormone replacement therapy than by tucking. Either way, it is important to discuss the potential impacts to fertility with your transgender and gender nonconforming patients who are interested in tucking.

Testicular pain and torsion: Prolonged tucking can result in testicular discomfort and pain, including the possibility of testicular torsion. Patients who report a history of tucking and who have pain in their scrotum or testes should be evaluated for this and other serious complications such as epididymitis and orchitis.

Skin irritation: Chafing and skin irritation are common among people who tuck, especially those using tape. Ask your patients what kind of tape they are using to tuck–not all tape is skin safe. Healthline and Smart Sex Resource both recommend using medical tape, as duct tape and other kinds of tape are irritating to the skin. Healthline also recommends carefully shaving the area where tape will be used, so that the skin is not irritated further when the tape is removed. Be sure to ask your patients about any allergies, as some tape may contain latex or other allergenic materials. Irritation, rashes, and infections can also occur due to the increased moisture caused by tucking; advise your patients to thoroughly clean and dry their genitals daily after undoing their tuck.

Urinary tract infections: Tucking with tape makes it incredibly difficult to urinate, as the tape must be removed and then redone each time. Because of this, many people will avoid using the bathroom until they get home, a practice that can result in increased urinary tract infections or damage to the urinary tract from retention of urine. UTIs are also more likely because the opening to the urethra is situated close to the anus.

Dehydration: People may decrease their fluid intake in order to minimize trips to the bathroom while tucking. This increases the risk of dehydration. Advise your patients to use the bathroom before tucking, and, if they’re going to be tucking for an extended duration, to consider using methods that don’t involve tape.

For patients experiencing any of the above symptoms, decreased time and intensity of tucking should be recommended, in addition to treating any infections or trauma. For those experiencing skin irritation or urinary issues, using a gaff or tight underwear may be an alternative to tape. Recommend taking days off from tucking, especially if the patient is feeling any pain or discomfort. This can be achieved by wearing looser clothing, such as dresses, skirts, or loose pants, so that loosely tucked or untucked genitals will be less visible.

Additionally, ask your patients about whether or not they want bottom surgery in the future. While not all patients will want surgery, for those that do, starting the process early will reduce the overall duration of tucking and the complications that come with it.

Genital tucking resources

There are several online guides for various tucking methods, as well as vendors that sell gaffs and specialized underwear. Some of these resources are linked below.

  • The Girl’s Guide to Tucking Your Dick: Describes how to tuck using skin-safe tape, discusses some potential complications, and provides additional resources on where to buy gaffs and other trans affirming undergarments.
  • How Does Tucking Work and Is it Safe?: Describes tucking methods both with and without tape, and the pros and cons of each. Also includes a discussion on the potential health risks of tucking.
  • The Most Comfortable Way to Tuck: Instructional YouTube video on an alternative method of tucking that doesn’t require tape or gaffs.
  • En Femme Style: Sells gaffs with a range of compression and a variety of styles and colors. Prices range from $20 to $40.

When talking to patients about tucking, it’s important to discuss the options available as well as the risks involved with each method and how to minimize them. It is also crucial to ask patients about their future desires with regards to their transition–if applicable–and help counsel them on whether hormones and surgery might be right for them. Finally, being knowledgeable about the resources that exist in the community can help your patients find safe options that will allow them to affirm their gender and navigate their transition in a way that works for them.

Jamie Moffa

Jamie Moffa is an M.D. candidate at Washington University School of Medicine in St. Louis. When not in school, Jamie enjoys reading, writing, playing trumpet, and playing D&D with their friends.

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