Honestly, I struggle with this, too.
I do not and will not receive any form of penetration or even touching of my "region" by another person without having a prosthetic attached. My wife has never even seen me completely naked and we have been sleeping together for 3 years. So having a strap-on is the only option for me - otherwise, when we have sex, I will use my mouth or fingers if I can't be bothered (i.e., feel uncomfortable and embarrassed) getting my "erection" out.
When I first started having sex with her with my strap-on (the first time in my life I had ever used one on another person), it felt natural and right and it was great. But now, three years later, it feels unnatural - it looks fake, feels fake and adds to my dysphoria.
My solution is going to be to try the ReelMagik prosthetic after my top surgery is over next month. I think that with it being able to be glued on instead of strapped on, it will help with the realism (I hope). But yes, it's a struggle - I have a huge sexual urge, but get too dysphoric, embarrassed and uncomfortable using the strap-on.