It is complicated: gender and sexual orientation identity in LGBTQ youth.

Changing language, changes lives: Learning the lexicon of LGBTQ+ health equity.

LGBTQ cultural competence for pharmacists

Lesbian, gay, bisexual, transgender, and queer (LGBTQ+) individuals face social, economic, legal, health, and health care–related disparities amid evolving threats to sociopolitical advances made in the last decade ([1][1],[2][2]). In response, organizations, including the National Institutes of

Eleven self-identified gay/lesbian individuals were interviewed about the age at which they became aware of their gender and sexual identity and whether they recalled specific life events associated with that awareness. Thematic analyses focused on individuals who recalled a specific age and event in early childhood in which they became aware of their gender and sexual identity versus individuals who did not recall a specific age tied to their awareness of their sexual and gender identities. Results showed that five participants gave non-specific ages (e.g., “always” and “at an early age”) when their gender identity became particularly salient, the remaining 6 participants reported a specific age and typically a specific event when their gender identity became particularly salient. Findings are discussed in the context of intersectionality, gender and sexual identity development, and the coming out process. Findings suggest that experiences related to gender identity and expression and sexual orientation are non-linear processes that vary widely, and that there is no one “master narrative”. Implications for mental health and the need for ongoing support services are also highlighted.

Gender and sexual identity play a significant role in the lives of developing youth. The developments of gender and sexual identities are shaped by a variety of factors including, but not limited to, biological, cognitive, and social elements. It is crucial to consider that gender and sexual minority individuals face additional complexities in the two processes of gender identity and sexual identity development. Cisgender identity development is most commonly understood with the help of early cognitive and social theories, although biological components play a part as well. Specifically, the theories of Lawrence Kohlberg, Sandra Bem, Alfred Bandura, and David Buss have made significant contributions to the understanding of cisgender identity development. Modern transgender identity development models are helpful in exploring transgender identity formation with the most popular being the Transgender Emergence Model founded by Arlene Lev. Similar to cisgender identity development, heterosexual identity development is typically understood with the help of early psychosocial theories, namely that of Erik Erikson. Sexual minority identity development is often comprehended using stage models and life-span models. Sexual minority stage models build off the work of Erik Erikson, with one of the most popular being the Cass Model of Gay and Lesbian Identity Development. Offering more flexibility than stage models and allowing for fluid sexual identity, life-span models, like the D’Augelli model, are often more popular choices for modern exploration of sexual minority identity development. As both sexual and gender identity spectrums are continuing to expand, there also comes a need for an exploration of the relationship between sexual and gender identity development, particularly among sexual minority populations.

BackgroundThere is growing recognition that autistic females present with more diverse gender and sexual identities than their non-autistic counterparts. Likewise, autistic females are also at an increased risk of adverse sexual experiences. As higher rates of sexual victimisation are observed in individuals with diverse sexual identities in the broader population, rates of negative sexual experiences among autistic females remain unclear. This study aimed to investigate the representation of gender and sexual diversity within autistic females and examine their rates of regretted, and unwanted, sexual encounters among females with a transgender gender identity and non-heterosexual sexual orientation.MethodsTwo hundred and ninety-five females completed the Sexual Behaviour Scale-III (SBS-III) online. Self-reported gender identity and sexual orientation were compared between 134 autistic (Mage= 26.2 years, SD = 8.7) and 161 non-autistic females (Mage = 22.0 years, SD = 4.6). Differences in the prevalence of negative sexual experiences were compared across diagnosis and each gender identity and sexual orientation label.ResultsAutistic females were more likely to identify with a transgender gender identity (p < .05) and non-heterosexual sexual orientation (p < .007) compared to non-autistic females. Autistic homosexual females were more likely to have experienced a range of negative sexual experiences than autistic heterosexual females (OR ≥ 3.29; p < .01) and were more likely to have experienced unwanted sexual experiences than non-autistic females regardless of sexual orientation (OR ≥ 2.38; p < .05). There were no differences in rates of negative sexual experiences between autistic bisexual and both autistic heterosexual and non-autistic bisexual females. Non-autistic bisexual females (OR = 0.24; p = .018) presented with a reduced risk of regretted sexual experiences than non-autistic heterosexual peers. There were no differences in negative sexual experiences across gender identity in the autistic sample.LimitationsThe use of fixed format response items may have restricted participants’ abilities to provide rich responses pertaining to their sexual identities and nature of negative sexual experiences. The small number of participants who identified as transgender (n = 40) limits the reliability of results pertaining to sexual experiences across gender identity. Moreover, although multiple recruitment methods were used in this study, non-representative may bias estimates of prevalence rates. Thus, the data may not be representative of the broader population.ConclusionsResults indicate that autistic females present with greater diversity in their sexual identities than individuals without autism, with those with a homosexual sexual orientation being at greater risk of experiencing adverse sexual encounters. Findings suggest the importance of increased clinical attention to this diversity and the need to provide support to facilitate the development of a healthy sexual identity and reduce the risks identified in this study.

ABSTRACTLittle is understood about how sexual orientation and gender identity actually interconnect with transgender men. Eight transgender men were interviewed in depth, multiple times, and their perspectives gave insight into how sexual and gender identities are related, and how one informs the other. The present study found fluidity in gender and sexual identities among transgender men, but some trans men were more binary than others with regard to gender. These binary-leaning trans men also tended to be more binary in their sexual orientation. Fluidity in gender in pre-transition often reflected fluidity in sexual orientation. Mental health professionals may gain a better understanding of how the intersectionality of sexual and gender identities manifests in trans men. Implications for practitioners are included.

Chapter 14 - Sexual Assault Risk and Prevention Among Sexual and Gender Minority Populations

This research analyzed how sexual minority individuals discussed identity when critiquing two sexual orientation scales. To better understand the diversity of sexual minority experience, analyses focused on the patterns of responses across sexual orientation identity (monosexual, plurisexual, and asexual) and gender identity (cisgender and transgender). Participants were self-identified sexual minorities who represented a range of gender identities. Using thematic analysis, four main themes were identified related to sexual orientation identity: (1) salience of identity, (2) social identity, (3) identity development and change, and (4) identity and the body. Discussion focuses on understanding the findings in the context of intersectionality theory and emphasizes the need to conceptually disaggregate sexual orientation and gender identity. The conceptualization of sexual orientation as centered on normative assumptions of monosexuality, verisexuality/nonasexuality, genderism, and cisgenderism is also explored.

A Systematic Review of Inflammatory Bowel Disease Epidemiology and Health Outcomes in Sexual and Gender Minority Individuals

LGBT people in the United States continue to experience discrimination because of their sexual orientation and gender identity, despite increasing acceptance of LGBT people and legal recognition of marriage for same-sex couples nationwide. This ongoing discrimination can lead to under- and unemployment, resulting in socioeconomic disparities for LGBT people. In addition, empirical research has linked LGBT health disparities, including disparities in health-related risk factors, to experiences of stigma and discrimination. Currently, federal statutes in the United States do not prohibit discrimination based on sexual orientation or gender identity in employment, housing, or public accommodations, leaving regulation in this area primarily to state and local governments. This creates a limited and uneven patchwork of protections from discrimination against LGBT people across the country. Despite public support for LGBT-inclusive non-discrimination laws across the country, in 28 states there are no statewide statutory protections for LGBT people in employment, housing, or public accommodations. To date, only 20 states and the District of Columbia have enacted comprehensive non-discrimination statutes that expressly prohibit discrimination based on both sexual orientation and gender identity in all three of these areas. One additional state has statutes that prohibit sexual orientation discrimination, but not gender identity discrimination, in these areas. One other state prohibits discrimination based on sexual orientation and gender identity in employment and housing, but not in public accommodations. In states without statutes that prohibit discrimination based on sexual orientation and/or gender identity, there are other policies that afford LGBT people at least some limited protections from discrimination. In some of these states, state executive branch officials have expanded non-discrimination protections for LGBT people under their executive or agency powers. For example, in three states, state government agencies have expanded broad protections from sexual orientation or gender identity discrimination through administrative regulations. And, in 12 states without statutes prohibiting discrimination against LGBT people, governors have issued executive orders that protect state government employees (and sometimes employees of state government contractors) from discrimination based on sexual orientation and gender identity. In addition, local government ordinances provide another source of protection from discrimination; however, these laws are generally unenforceable in court and provide much more limited remedies than statewide non-discrimination statutes. In recent years, lawmakers have increasingly attempted to limit the reach of state and local non-discrimination laws, which can leave LGBT people vulnerable to discrimination. For example, some states have passed laws allowing religiously motivated discrimination and others have passed laws prohibiting local governments from enacting their own non-discrimination ordinances that are broader than state non-discrimination laws. While most of these bills have not passed, the recent increase in the introduction of these measures suggests that state legislatures will continue to consider rolling back non-discrimination protections for LGBT people in the coming years. Continued efforts are required at both the state and federal levels to ensure that LGBT people are fully protected from discrimination based on their sexual orientation and gender identity throughout the United States, including federal legislation and statewide bills in over half the states.

Conversion therapy is a set of practices that aim to change or alter an individual's sexual orientation or gender identity. It is premised on a belief that an individual's sexual orientation or gender identity can be changed and that doing so is a desirable outcome for the individual, family, or community. Other terms used to describe this practice include sexual orientation change effort (SOCE), reparative therapy, reintegrative therapy, reorientation therapy, ex-gay therapy, and gay cure. Conversion therapy is practiced in every region of the world. We have identified sources confirming or indicating that conversion therapy is performed in over 60 countries. In those countries where it is performed, a wide and variable range of practices are believed to create change in an individual's sexual orientation or gender identity. Some examples of these include: talk therapy or psychotherapy (e.g., exploring life events to identify the cause); group therapy; medication (including anti-psychotics, anti- depressants, anti-anxiety, and psychoactive drugs, and hormone injections); Eye Movement Desensitization and Reprocessing (where an individual focuses on a traumatic memory while simultaneously experiencing bilateral stimulation); electroshock or electroconvulsive therapy (ECT) (where electrodes are attached to the head and electric current is passed between them to induce seizure); aversive treatments (including electric shock to the hands and/or genitals or nausea-inducing medication administered with presentation of homoerotic stimuli); exorcism or ritual cleansing (e.g., beating the individual with a broomstick while reading holy verses or burning the individual's head, back, and palms); force-feeding or food deprivation; forced nudity; behavioural conditioning (e.g., being forced to dress or walk in a particular way); isolation (sometimes for long periods of time, which may include solitary confinement or being kept from interacting with the outside world); verbal abuse; humiliation; hypnosis; hospital confinement; beatings; and "corrective" rape. Conversion therapy appears to be performed widely by health professionals, including medical doctors, psychiatrists, psychologists, sexologists, and therapists. It is also conducted by spiritual leaders, religious practitioners, traditional healers, and community or family members. Conversion therapy is undertaken both in contexts under state control, e.g., hospitals, schools, and juvenile detention facilities, as well as in private settings like homes, religious institutions, or youth camps and retreats. In some countries, conversion therapy is imposed by the order or instructions of public officials, judges, or the police. The practice is undertaken with both adults and minors who may be lesbian, gay, bisexual, trans, or gender diverse. Parents are also known to send their children back to their country of origin to receive it. The practice supports the belief that non-heterosexual orientations are deviations from the norm, reflecting a disease, disorder, or sin. The practitioner conveys the message that heterosexuality is the normal and healthy sexual orientation and gender identity. The purpose of this medico-legal statement is to provide legal experts, adjudicators, health care professionals, and policy makers, among others, with an understanding of: 1) the lack of medical and scientific validity of conversion therapy; 2) the likely physical and psychological consequences of undergoing conversion therapy; and 3) whether, based on these effects, conversion therapy constitutes cruel, inhuman, or degrading treatment or torture when individuals are subjected to it forcibly2 or without their consent. This medico-legal statement also addresses the responsibility of states in regulating this practice, the ethical implications of offering or performing it, and the role that health professionals and medical and mental health organisations should play with regards to this practice. Definitions of conversion therapy vary. Some include any attempt to change, suppress, or divert an individual's sexual orientation, gender identity, or gender expression. This medico-legal statement only addresses those practices that practitioners believe can effect a genuine change in an individual's sexual orientation or gender identity. Acts of physical and psychological violence or discrimination that aim solely to inflict pain and suffering or punish individuals due to their sexual orientation or gender identity, are not addressed, but are wholly condemned. This medico-legal statement follows along the lines of our previous publications on Anal Examinations in Cases of Alleged Homosexuality1 and on Forced Virginity Testing.2 In those statements, we opposed attempts to minimise the severity of physical and psychological pain and suffering caused by these examinations by qualifying them as medical in nature. There is no medical justification for inflicting on individuals torture or other cruel, inhuman, or degrading treatment or punishment. In addition, these statements reaffirmed that health professionals should take no role in attempting to control sexuality and knowingly or unknowingly supporting state-sponsored policing and punishing of individuals based on their sexual orientation or gender identity.

For individuals who identify as LGBTQ+, disclosing sexual orientation and/or gender identity can be a complex and risky conversation. However, in the medical context this conversation frequently becomes a central part of communication between patient and provider. Unfortunately, this conversation can also become a barrier that prevents patients from receiving or even accessing necessary medical care. LGBTQ+ individuals have reported experiencing significant discrimination in day-to-day life, and more specifically in patient–provider interactions. This discrimination leads LGBTQ+ individuals to avoid seeking necessary medical care and also frequently results in unsatisfactory care and poor health outcomes. This is of concern as LGBTQ+ individuals present with significantly higher rates of health issues and overall higher risks of cancer, chronic illnesses, and mental health concerns. Unfortunately, many medical providers are unequipped to properly care for LGBTQ+ patients and lack opportunities for education and training. This lack of experience leads many providers to operate medical offices that are unwelcoming or even inhospitable to LGBTQ+ patients, making it difficult for those patients to access inclusive care. This can be of particular concern when the patient’s sexual orientation or gender identity becomes relevant to their medical care, as they may feel uncomfortable sharing that information with a provider. Patient self-disclosure of sexual orientation or gender identity to a medical provider not only can contribute to a more positive relationship and improved quality of care but also can improve the psychological outlook of an LGBTQ+ individual. However, potential stigmatization can lead to the concealment of sexual orientation or gender identity information. These acts of concealment serve as intentional mechanisms of impression management within the patient–provider interaction. When LGBTQ+ patients do discuss their sexual orientation or gender identity with a provider, it is most often because the information is directly relevant to their health and disclosure, and therefore becomes essential and often forced. There are instances where LGBTQ+ patients are motivated to disclose to a provider who they believe will respond positively to information about their sexual orientation or gender identity. Disclosure of sexual orientation or gender identity may be direct in that it is clear and concrete. It may also be indirect in that individuals may use particular topics, such as talking about their partner, to broach the subject. Participants may also use specific entry points in the conversation, such as during taking a medical history about medications, to disclose. Some individuals plan and rehearse their disclosure conversations, whereas others disclose when they feel they have no other choice in the interaction. Increasing inclusivity on the part of providers and medical facilities is one way to promote comfortable disclosure of sexual orientation or gender identity. Additionally, updating the office environment and policies, as well as paperwork and confidentiality procedures, can also promote safe disclosure. Finally, improvements to training and education for healthcare professionals and office staff can dramatically improve interactions with LGBTQ+ patients. All of these efforts need to make integration of knowledge about how LGTBQ+ individuals can disclose comfortably and safely a central part of program design.

Perspectives on gender, gender expression, sexuality identity, and sexual orientation differ within and between generations given the great extent to which these concepts are embedded within social, cultural, and historical context. Across contexts, questions of authenticity are critical. This research compares generational perspectives about authenticity, gender and gender-related constructs, and sexuality. Through semi-structured interviews with a nonprobability, purposive sample of heterosexual and LGBTQ younger (aged 18–22) and older (aged 65+) adults, how a sense of authenticity is experienced and the degree to which individuals experience authenticity around sexual and gender identities are compared. Data were analyzed using the constant comparison method of analysis, and results indicate that while younger adult respondents held expansive terminology and knowledge related to sexual and gender identities, older adult participants lacked such fluidity, and that lack was an inhibiting factor in older adults being able to name and embody their authentic sexual selves. In conclusion, both position in one’s life course (age) and one’s generational cohort (historical, cultural, and social context) influence how individuals experience authenticity around gender and sexual identities.

Background . Sexual orientation and gender identity are not taught in African health professions curricula. In order to improve the quality of care for lesbian, gay, bisexual, transgender and intersex (LGBTI) patients, health professionals need to shift their attitudes towards sexual orientation and gender identity, and learn about specific LGBTI health needs. Discussion. The curricula of African health professions education provide various opportunities to include teaching about sexual orientation and gender identity. Various disciplines can teach sexual orientation and gender identity issues in their context by challenging heteronormativity and highlighting specific LGBTI health concerns, and can do so more successfully with interactive teaching approaches that hold more potential than formalised lectures. Rights-based teaching frameworks should include sexual orientation and gender identity as markers of difference. To achieve this, educators need to build capacity to teach about these issues, and support LGBTI students in their institutions. Conclusion. Teaching about sexual orientation and gender identity is urgently needed in African health professions education, but it is complex. This article presents strategies to incorporate sexual orientation and gender identity into the curricula of medical schools, nursing colleges, and the allied health sciences.