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DEFINITIONS & CONCEPTS
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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” or “LGBTQ+.” The plus sign is inclusive of individuals of other identities such as agender, genderqueer, and polysexual. Transgender people have a gender identity that differs from the sex which was assigned at birth, including those who identify as non-binary and have a gender identity that is neither male nor female. Cisgender refers to people who have a gender identity (a person’s internal sense of gender) and birth assigned sex that are the same (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 cisgender men as sexual partners, and therefore should be screened for contraception needs, and cisgender lesbian women may have transgender women 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, has been reclaimed by many SGM people to represent someone with a sexual orientation or gender identity or expression that differs from that of a cisgender, 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 someone of the same gender and another gender (historically men and women), and heterosexual or straight (someone who is attracted to and/or sexually active with people of another gender, historically the “opposite” gender); however, several other terms may be used, and terminology changes over time. Studies have demonstrated that there is a broad diversity among those who identify as SGM and that many people have multiple gender identities and/or sexual orientations.
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Population estimates of SGM adults in the United States range from 4.5% to 6.8%, depending on definitions. Reliable population estimates of persons who identify as SGM are lacking because there are no consistently applied federal and other administrative survey methodologies. Data about SGM demographics depend on sampling methods and study questions; for example, individuals identify as SGM in higher rates when asked about lifetime versus current SGM identity, and when asked about attraction versus behavior. Population estimates of SGM persons reach 20% if the definition of SGM includes gay or bisexual identity, any same-sex attraction, or same-sex sex in the last year.
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The three dimensions of sexual orientation—identity, behavior, ...