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The letters LGBTQIA refer to lesbian, gay, bisexual, transgender, queer or questioning, intersex, and asexual or allied. Initially starting as LGBT, the abbreviation has evolved over the years secondary to people feeling unheard under the LGBT nomenclature, which has now become more inclusive of sexuality, identity, and freedom of expression. Transgender (and gender nonconforming) individuals are those whose gender identity is not aligned with their sex assigned at birth. Queer is a controversial word given its past derogatory use. It is another term used to describe someone whose gender identity is outside the strict male/female binary. These are people whose gender identity and/or expression falls outside of the dominant societal norm for their assigned sex, who are beyond genders, or who are some combination of them. Questioning is used to describe people who are in the process of exploring their sexual orientation or gender identity. Intersex is a range of traits and conditions in an individual who is born with chromosomes, gonads, and/or genitalia that vary from what is considered typical for female or male bodies. Asexual people are those who lack sexual attraction to anyone. Finally, an ally is a person who shows support for LGBTQIA people and promotes their health and wellness in a variety of ways.

Most recent data report that 5–13% of men are gay, 3–7% of women are lesbian, and 2–5% of people are bisexual with high prevalence in women. In the 1940s, Alfred Kinsey, American sexologist and founder of the Institute for Sex Research at Indiana University, first reported these numbers at 10% for men and 2–6% for women. The US National Gay Task Force, led by Bruce Voeller, repeated an analysis in 1977 and found similar results. Approximately 1–3% of the population is transgender or gender nonconforming. Experts believe the actual prevalence to be upward of 5% of the population, although realistic estimates are challenging given most research only includes those easily identified as transgender. These numbers suggest physicians will care for LGBTQIA patients regardless of geographic location or the ethnic, religious, socioeconomic, or gender demographics of their practice, and perhaps without even knowing.


  • The first step in providing high-quality health care to LGBTQIA patients is a thorough and sensitive sexual history.

  • History forms can facilitate this, if including options relevant to LGBTQIA patients. For example, “marital status” should be revised to “relationship status,” or for gender, forms can have an option for other or transgender.

  • Comprehensive information about behavior is necessary as a foundation for optimal education and health screening.

Understanding patients’ gender identity and sexual orientation is the most important part of providing quality care—even if patients do not self-identify as gay or bisexual but engage in same-sex sexual encounters. Accomplish this by taking a thorough and sensitive sexual history with all new patients and any time sexual behavior may be ...

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