++
Key Clinical Updates in Sexual & Gender Minority Health
The SARS-COV-2 pandemic most likely has disproportionately affected the SGM community; sexual orientation and gender identity data, however, were not considered in reporting prevalence or outcomes.
One study documented that coincident with the pandemic, there is increased depression and anxiety within the SGM community in persons who did not have preexisting anxiety or depression.
A recent study evaluated pregnancy termination for transgender, nonbinary, and gender expansive people and found that the majority preferred medication abortion due to their belief that it was the least invasive, although the majority of the respondents had undergone a surgical abortion.
+++
DEFINITIONS & CONCEPTS
++
Gender identity is a person’s internal sense of gender, which is independent from the sex assigned at birth. Gender is also independent from sexual orientation, which refers to one’s sexuality and encompasses three dimensions: identity, behavior, and desire. 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 those who have a gender identity that is neither man nor woman. Transmasculine will refer to those who have a male or masculine-spectrum gender identity but were assigned female at birth, and transfeminine will refer to those who have a female or feminine spectrum gender identity but were assigned male at birth. Cisgender refers to people who have a gender identity and birth assigned sex that are the same (ie, they are not transgender). Transgender people may also be sexual minorities (ie, lesbian, gay, bisexual, etc). For the sake of expediency in this chapter, the sections on sexual minority men and women omit the term “cisgender”; however, readers of these sections should take into consideration that, for example, gay transmasculine persons 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 transfeminine partners who retain their penis. Sexual identities include gay (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. A growing number of people identify as pansexual, which describes an attraction to people of any gender—man, woman, or on the spectrum between the two. The term “queer” has been reclaimed by many SGM people to represent someone with ...