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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 a person’s sexuality and encompasses three dimensions: identity, behavior, and desire. The term sexual and gender minority (SGM) refers to a broad group including lesbian women and gay men, bisexual, pansexual, and queer people, and transgender and gender nonbinary 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.

Population estimates of SGM adults in the United States range from 4.5% to 6.8%, depending on definitions; reliable population estimates, however, 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

Transgender people have a gender identity that differs from the sex that was assigned at birth, including those who identify as nonbinary and those who have a gender identity that is neither man nor woman. Transmasculine refers to those who have a male- or masculine-spectrum gender identity but were assigned female at birth, and transfeminine refers to those who have a female- or feminine-spectrum gender identity but were assigned male at birth. Cisgender refers to people whose gender identity and birth assigned sex are the same (ie, they are not transgender). Transgender people may also be sexual minorities (ie, lesbian, gay, bisexual, etc) or straight/heterosexual. For the sake of expediency in this chapter, the sections on sexual minority (SM) 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 or sexually active with members of the same gender, or both), bisexual (those who are attracted to or sexually active with someone of the same gender and another gender, or both), and heterosexual or straight (someone who is attracted to or sexually active with people of another gender [historically the “opposite” gender], or both); however, 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 along the spectrum between the two. The term “queer” has been reclaimed by many SGM people to represent someone with a sexual orientation, gender identity, or ...

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