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. 2025 Apr 3;25(1):1261.
doi: 10.1186/s12889-025-22417-9.

Exploring the barriers and enablers of oral health care utilisation and safe oral sex practices among transgender women in Malaysia: a qualitative study

Lahari A Telang  1   2   3 , Hezreen Shaik Daud  4 , Abdul Rashid  5 , Aoife G Cotter  6   7   8
Affiliations

Exploring the barriers and enablers of oral health care utilisation and safe oral sex practices among transgender women in Malaysia: a qualitative study

Lahari A Telang et al. BMC Public Health. .

Abstract

Background: Transgender women in Malaysia face social and healthcare marginalisation. Research about their oral health and oral health care utilisation is sparse. Despite growing clinical evidence highlighting the risk of transmission of sexually transmitted infections (STIs) through oral sexual practices, research in this area remains less explored. This study aimed to understand the experiences of transgender women in Malaysia by exploring oral health care needs and the barriers and enablers of oral health care utilisation as well as safe sexual practices relating to oral transmission of STIs.

Methods: Participants were recruited through a snow-balling method of sampling with the help of community workers. Semi-structured in-depth interviews (IDIs) with transgender women in northern Malaysia and Focus group discussion (FGD) with a mixed group of transgender women and health care professionals were conducted to gain insights into the needs of the community. Data obtained from IDIs and FGD were coded, transcribed, and thematically analysed to derive codes and themes through the interpretative lens of the Information, Motivation and Behavioural skills (IMB) theory.

Results: Participants of the IDIs were transgender women (n = 20, median age 39.8 (9.75 IQR) years). Aesthetic dental needs were prioritised, yet poor utilisation of dental services was reported, with many opting for self-medication or care from a non-qualified dental practitioner. Routine engagement in oral sex practices, primarily receptive fellatio with or without ejaculation with multiple cis-gender male partners, was reported. Low awareness of oral STIs, along with a perceived low risk of transmission of STIs through oral sex, was reported, with most (18, 90%) not using condoms for clients/partners or inconsistently using them during oral sexual practices. The themes identified from IDIs and FGD included: 'Place in the society' 'Attitudes and beliefs linked with dental care', 'Access to dental care', 'Lack of trans-specific health care' and 'Use of condoms for oral sex'.

Conclusion: The study's findings report poor dental service utilisation among transgender women despite aesthetics being prioritised. Gaps in knowledge regarding the oral transmission of STIs were also noted. These insights underscore the need for trans-specific health campaigns designed to address these concerns and enhance awareness through an integrated approach to improve access to inclusive oral health care and sexual health care for this vulnerable population.

Keywords: Dental service utilisation; Malaysia; Oral health needs; Oral transmission of STIs; Transgender women.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: The study was approved by the University College Dublin, UCD Human Research Ethics Committee – Sciences (HREC-LS) (LS-C-22-158-Telang-Cotter), and the Joint Penang Independent Ethics Committee (JPEC 22 − 0002). The participant information sheet and informed consent were made available in English and translated into the local language (Bahasa Malaysia). Written consent was obtained from participants. All procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

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