Why should I need to know this?
To acknowledge this diversity amongst our patients and community. And to recognise that people need to be able to self-identify as and how they feel fit.
And to maintain an inclusive environment in which to deliver their care.
Isn’t this all just some fad? These letters seem to be changing all the time.
No. A persons self identity is often complex and changing over time. It is important to be aware of these terminologies for no other reason than that they are REALLY meaningful to a large number of people.
People that can include your patients, but also your friends and your colleagues.
Sex: the physiological, genetic and genital components of our body that are generally assigned as female or male.
Note: sex does not necessarily determine a persons gender.
Gender: a group of characteristics (behavioural, cultural, social etc) that contribute to a persons perception of being feminine (female) or masculine (male).
Gender identity: The gender that a person identifies with irrespective of sex.
This is important.
Sexual orientation: describes the emotional attachment, physical and sexual attraction (including sexual behaviours) that a person has to another.
Note: A persons gender identity does not necessarily determine their sexual orientation (and vice versa).
Lesbian: woman with same-sex sexual orientation.
Gay: generalising word used to describe people who have a same sex orientation regardless of gender.
Bi-Sexual: person with a sexual orientation that encompasses both males and females ( this may be in equal or unequal proportions).
Transgender: are people who have a gender identity or gender expression that differs from their assigned sex.
Transgender is also used as an umbrella term: to include people whose gender identity is the opposite of their assigned sex, it may include people who are not exclusively masculine or feminine (people who are genderqueer, e.g. bigender, pangender, genderfluid, or agender)
Intersex: people have genital, chromosomal or other physical characteristics that are not strictly male or female.
“…intersex is often associated with a medical diagnosis of disorders, or differences of sex development (DSD). Some intersex individuals may prefer to be described as a ‘person with an intersex variation’ or be identified by their specific variation.” (ABC News 2017)
Queer: encompassing term for people who are lesbian, gay, bisexual, transgender and any other self perceived marginal orientations. Originally a derogatory term, it has now been largely embraced by the LGBTQ community.
Note: The Q in LGBTIQ can also stand for questioning for those people who are still exploring their sexuality and personal identity.
Asexual: people, who although they may be in romantic relationships, are so without feelings of sexual attraction.
Heterosexual: people attracted to the opposite sex.
How can I foster an inclusive and respectful environment for LGBTIQ patients?
The most important thing to remember is that the LGBTIQ community are just that. People who happen to fall into this particular grouping. They have some specific health issues and things we can do to help normalise their self-identity…. otherwise their care is no different to any other patient centred delivery.
Language: One important aspect in developing a relationship of trust is to remain non-judgemental in your language. For example, when taking a sexual history don’t make assumptions based on appearance, or perceptions instead ask open questions to ALL your patients such as “Do you have a partner?” or “Are you in a relationship?”
Here is a pdf that discusses useful vocabulary, terms to avoid, and a few key messages for talking about various issues (from the US).
Look for environmental issues that may cue your patient to the acceptance of their sexual identity. For example:
- Forms and other paperwork, electronic health records.
- Provision of gender-neutral wash rooms and other neutral/safe spaces (this is becoming more common in many public spaces now.
- Availability of LGBTIQ health related pamphlets and other educational resources.
- Competence and awareness amongst staff in caring for this community.
Make yourself familiar with health issues that might be specific to this population.
- Higher incidence of sexually transmitted infections.
- Increased incidence of unhealthy behaviours including smoking, drug use.
- Higher rates of contemplated or attempted suicide
- Higher rates of violence & victimisation.
- Specific health recommendations for some specialities. For example: “mammography is suggested for male-to-female transgender persons over age 50 who have taken feminizing hormones for more than ve years due to a theoretically increased risk for breast cancer” [LGBT Health Disparities 2017)
Of course your patient may have none of these problems.
If in doubt ask the expert.
If in doubt as how to respond to specific situations, your best course is to ask the person openly for help.
ABC News. (2017). LGBTQIA glossary: Common gender and sexuality terms explained. [online] Available at: http://www.abc.net.au/news/2016–04–07/sexuality-gender-glossary-definitions/7287572 [Accessed 9 Feb. 2017].
Anon, (2017). [online] Available at: http://www.lgbthealtheducation.org/wp-content/uploads/LGBTHealthDisparitiesMar2016.pdf [Accessed 9 Feb. 2017].
Criticalmediaproject.org. (2017). LGBTQ | The Critical Media Project. [online] Available at: http://www.criticalmediaproject.org/cml/topicbackground/lgbt/ [Accessed 9 Feb. 2017].
National LGBTI Health Alliance. (2017). National LGBTI Health Alliance -. [online] Available at: http://lgbtihealth.org.au [Accessed 9 Feb. 2017].
Positivespaces.ca. (2017). Introduction to Understanding LGBTQ Newcomers by Among Friends | PositiveSpaces.ca. [online] Available at: http://www.positivespaces.ca/toolkit/educational/introduction-understanding-lgbtq-newcomers-among-friends [Accessed 9 Feb. 2017].
The Conversation. (2017). Hate crimes against LGBTQ people are a public health issue. [online] Available at: https://theconversation.com/hate-crimes-against-lgbtq-people-are-a-public-health-issue–61186 [Accessed 9 Feb. 2017].