Understanding Sex, Gender and Sexuality for LGBTIQA+ Inclusive Healthcare
Written by: Steph, 25th May 2023
As we know, stigma and discrimination are significant barriers to accessing healthcare for LGBTIQA+ patients. When accessing sexual or reproductive healthcare, the knowledge, attitudes, and values that a practitioner holds can make or break a patient’s experience. Experiencing stigma and discrimination from healthcare professionals can impact a patient’s future help-seeking behaviours by discouraging them from accessing healthcare. It is a human right for everyone to access healthcare and information, free from discrimination based on gender or sexuality.
So, what does inclusive LGBTIQA+ inclusive healthcare look like?
1. Knowing the difference between sex, gender and sexuality
The first step in LGBTIQA+ inclusive healthcare is understanding the difference between sex, gender, and sexuality, so you can find out what you need to know, in a respectful way. As a Health Promotion Officer, I educate people on human immunodeficiency virus (HIV), sexually transmitted infections (STIs), and blood-borne viruses (BBVs), using an LGBTIQA+ inclusive approach. A lot of people I work with talk about ‘gay sex’ when they mean anal sex, or gender when they mean biological sex. To provide accurate sexual health information, part of my job is to share correct, inclusive terminology.
So, what is the difference between sex, gender and sexuality?
- Sex refers to biological and anatomical characteristics such as genitals, hormones, chromosomes. This may be relevant when enquiring about a patient’s body parts or fertility. We use the phrase sex presumed at birth to connote sex, for example, male, female, and intersex variations.
- Gender refers to personal identity and social expression in the world. Gender is a social construct that may be relevant when discussing how a patient feels about and understands themselves on an intrapersonal level. Examples of genders include cisgender man, transgender woman, and non-binary.
- Sexuality refers to sexual or romantic orientation, and feelings about, or attraction to, others. This may be relevant when enquiring about a patient’s sexual partners or romantic relationships. Examples of sexuality include heterosexual, homosexual, bisexual, and asexual.
2. Avoiding assumptions about sex, gender and sexuality
Respecting a patient’s sex, gender and sexuality is only possible without assumptions. Assumptions about LGBTIQA+ people are likely to be based on harmful stereotypes, biases, and outdated ideas about queerness. For healthcare providers, the first step in avoiding assumptions is to stop assuming that all patients are heterosexual or cisgender.
Using gender neutral language when talking about sexual partners, or asking what body parts a sexual partner has, can make a world of difference to a patient’s wellbeing, while giving the practitioner an even clearer understanding of the patient’s health behaviours. For transgender patients, using gender neutral language, and clarifying preferred terminology for body parts (for example, using the term chest instead of breasts), can be respectful and affirming.
A patient’s sex, gender or sexuality does not tell us about what type of sex they are having. For example, a lesbian patient may be engaging in predominantly penetrative sex, a straight man may be engaging in predominantly oral sex, and a married woman may be engaging in predominantly group sex – you never know! As a sexology student, I have learnt about the expansive world of sexual behaviours, and I know that they do not always align with sex, gender and sexuality. To get an accurate picture of a patient’s sexual health, try asking questions about their sexual behaviours, rather than making assumptions based on their sex, gender or sexuality.
3. Expanding ideas around safer sex
As a Health Promotion Officer delivering sexual health workshops, I teach people how to have safer sex and prevent HIV, STIs and BBVs. (We use the phrase safer sex to connote the idea that no sexual activity is 100% safe from HIV, STIs and BBVs.) When the time comes for condom demonstrations during these workshops, I am sometimes met with, “I’m a lesbian, why do I need to know this?”. That’s when I pull out the dental dams, internal condoms and gloves.
It is important for healthcare professionals to recognise that condoms are not the only form of safer sex. Barrier methods, such as condoms, dams, and gloves, are all effective ways of reducing the transmission of HIV, STIs and BBVs. In order to be inclusive while promoting sexual health, practitioners must recognise the fact that not all sexual activity involves a penis or penetration. Dental dams are perfect for oral sex on a vulva or anus, and gloves are great for touching and fingering.
Instead of asking a patient if they have been using a condom, try asking whether they have used a barrier method, or whether they have practiced safer sex. If they are not clear what you mean, take it as an opportunity to educate them on the diversity of safer sex barrier methods, such as dams and gloves!
4. Showing that your healthcare practice is inclusive
LGBTQIA+ patients scan for signs of inclusivity from the moment they engage with a healthcare practice. Whether it’s browsing the bios of doctors online, identifying posters in the waiting room, or noticing pride badges on staff, LGBTIQA+ patients want to feel assured that they are entering a safe space. Being LGBTIQA+ and dealing with a lifetime of stigma and discrimination, patients are often on high alert in all settings, especially healthcare practices. Hospitals and GPs are the least gender-sensitive healthcare settings (according to the 2018 Australian Trans and Gender Diverse Sexual Health Survey), which means that these settings need to do the most work to become inclusive and safe, particularly because of the highly sensitive and intimate nature of their work.
On top of the above recommendations relating to sex, gender and sexuality, there are some simple ways to show that your practice is inclusive. First, consider implementing ongoing whole staff inclusivity training, facilitated by LGBIQA+ community. This goes for the admin staff and receptionists to healthcare professionals themselves! Furthermore, using gender neutral language on forms, and asking for pronouns and chosen name, are simple steps that can make a patient feel seen and understood. Adding pride badges and pronoun pins is also a great start. Additionally, consider printing and stocking the EmbraceU resource for health professionals, to give patients the opportunity to demonstrate how they would like to be treated and referred to.
Finally, if you’ve tried your best but still feel out of your depth, know where to refer on. There are many WA based and Australia wide organisations dedicated to providing healthcare and support for LGBTQIA+ patients.
- MClinic provides clinical sexual health testing for men who have sex with men, trans and gender people, along with gender affirming care,
- Freedom Centre provide social support for LGBTIQA+ youth,
- Sexual Health Quarters support LGBTIQA+ patients with reproductive health and have multiple resources on them EmbraceU website
- TransFolk of WA have a webpage list of resources for clinicians with transgender patients,
- TransHub outline gender affirming sexual health language for clinicians on their website.