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DEFINITIONS & CONCEPTS

The term sexual and gender minorities (SGM) refers to a broad group including lesbian women and gay men; bisexual, pansexual, and queer people; and transgender and gender non-binary people—also commonly referred to as “LGBTQ.” Cisgender refers to people whose gender identity (a person’s internal sense of gender) and sex assigned at birth are congruent (ie, they are not transgender). Transgender people may also be sexual minorities (ie, lesbian transgender women or gay transgender men). For the sake of expediency in this chapter, the sections on sexual minority men and women omit the term “cisgender”; however, readers of content in these sections should take into consideration that, for example, gay transgender men may have vaginal receptive sex with their cisgender male sexual partners, and therefore should be screened for contraception needs, and cisgender lesbian women may have transgender female partners who retain their penis. A growing number of people identify as pansexual, which describes an attraction to people of any gender, male, female, or on the spectrum between the two. The term queer, historically a pejorative term, has been reclaimed by many SGM people to represent someone with a sexuality or gender identity or expression that differs from that of a cisgender (ie, non-transgender), heterosexual person. Sexual orientation refers to a deep-seated sense of one’s sexuality that encompasses three dimensions: identity, behavior, and desire. Sexual identities include gay or homosexual (those who are predominantly attracted to and/or sexually active with members of the same gender), bisexual (those who are attracted to and/or sexually active with both men and women), and heterosexual or straight; however, several other terms may be used, and terminology may change over time.

The three dimensions of sexual orientation—identity, behavior, and desire—do not necessarily overlap. For example, less than 50% of men who have sex with men (MSM) in one national, probability-based survey identified as gay. MSM who identify as heterosexual rather than as gay or bisexual may be more likely than their gay-identified counterparts to be married to women, foreign-born, of minority race, and of lower socioeconomic status. The incomplete overlap of identity and behavior means that clinicians cannot rely upon self-reported identity to infer sexual behavior, and vice versa. It is important to distinguish sexual orientation from their gender identity. Knowing someone’s gender identity does not identify one’s sexual orientation. Just as cisgender people may be sexually attracted to and have sex with people of any gender, so too can transgender men, transgender women, and non-binary people have partners of any gender. Routinely asking about sexual orientation, and when relevant for the clinical issue at hand, sexual behavior, helps build trust between the patient and clinician, ensures appropriate medical care (for example, appropriate screening tests for sexually transmitted infections [STIs] and family planning), and contributes to better health outcomes. To inquire about gender identity, the following two questions are recommended: “What is your current gender identity?” and “What sex were you assigned at ...

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