"Trans persons appear to report generally lower levels of sexual health, according to several studies, though it should be noted that the field of trans medicine is advancing quickly. Trans men appear more likely to report orgasms and sexual arousal post-transition compared to trans women, though it is unknown whether this is related to the fact that most trans men do not go through "bottom surgery" and retain their clitoris and vagina. In addition, trans women historically demonstrate higher levels of discomfort with their genitals and sexual arousal, compared to trans men. Trans women are much more likely to report sexual arousal without orgasm, and lower levels of sexual desire in general. Studies with trans women in particular find a wide variance in ability to experience orgasm post vaginoplasty surgery, ranging from 17-100% across 140 different studies. However, these studies are focused mostly on adults who transitioned in adulthood. At this time, there do not appear to be any studies which examine sexual health or orgasmic experience in trans individuals who initiated affirmative treatment prior to adulthood or the onset of puberty."