INTRODUCTION
People who identify as lesbian, gay, bisexual, transgender, or queer (LGBTQ) come from all walks of life, including people of all races and ethnicities, all ages, all socioeconomic statuses, and from all geographic regions. The Centers for Disease Control and Prevention (CDC) and many professional organizations assert that the perspectives and needs of LGBTQ people should be routinely considered in all medically related interactions to improve overall health and eliminate health disparities. 1 To have productive and health-promoting interactions with LGBTQ patients, clinicians need to recognize the differences among sexual orientation, gender identity, and gender role, understand the health disparities faced by people who identify as LGBTQ, be able to identify specific health risks, and ensure they create a welcoming environment for all people. The purpose of this course is to discuss the disparities in healthcare and increased health risks that exist in the LGBTQ population; identify system, provider, and client barriers; and examine ways to provide better care. In addition, this CME learning activity is designed to improve the care and health of LGBTQ patients by educating providers on the perspectives and needs of LGBTQ patients as well as ways to improve practices, office settings, policies, and staff training to make them welcoming and supportive for everyone. The author would like to emphasize there is no single definition of the LGBTQ community. Instead, just as any other group or community, the LGBTQ community is made up of a group of individuals from a variety of racial/ethnic backgrounds, cultures, incomes, religions, and many other characteristics, resulting in unique diverse groups of individuals. 2 Stigma is a commonly shared experience among the groups. A note about acronyms This learning activity uses LGBTQ as the acronym for discussing the entire range of sexual orientation, gender, and sexual behavior, with the acknowledgement that there are some variations not captured explicitly by the terms “Lesbian,” “Gay,” “Bisexual,” “Transexual,” and “Queer.” (“Queer” and “genderqueer” are non-pejorative terms describing people whose sexual orientation is not exclusively heterosexual or homosexual.) LGBTQ is the acronym currently used by the Human Rights Campaign, the Gay and Lesbian Medical Association, and many (but not all) other organizations focused on sexual minority/gender non-conforming individuals. Still, language and usage are constantly changing. In the future, variations that attempt to be more inclusive such as LGBTQ+ or LGBTQ* may become more standard. To date, the available research has mainly focused on lesbian, gay, and bisexual individuals with limited information on transgendered individuals. Findings vary among different sources, primarily because of differing methodologies for data collection. 1 Sexual orientation is a multidimensional construct that consists of sexual identity, sexual and
romantic attraction, and sexual behavior. Sexual orientation describes a person’s identity in relation to the gender(s) that they are attracted to and how they act on that attraction. This orientation includes heterosexuality (attraction to the opposite sex), homosexuality (attraction to the same sex), bisexuality (attraction to both male and female sexes), pansexuality (attraction to all sexes), and asexuality (no attraction to any sex). 3 Similar to sexual orientation, significant changes have occurred over time in the scientific understanding of gender. Gender is a ubiquitous and multi-faceted social category. When discussing the concept of gender, scientists distinguish between biological sex, gender identity, and gender expression. Though one’s biological sex, gender identity, and gender expression are distinct constructs, society expects that they will align. For most individuals this is true – that is, most individuals who are assigned female at birth identify as girls or women and adopt a feminine gender expression, while most individuals who are assigned male at birth identify as boys or men and adopt a masculine gender expression. 4 However, for some individuals, these constructs do not align. The term transgender refers to individuals whose gender identity is not consistent with their sex assigned at birth. The terms gender nonconforming or gender incongruence refer to individuals whose gender expression does not conform to the stereotypical norms in their culture for any assigned sex at birth. 3,5 Infants’ biological sex is labeled at birth, almost always based solely on external genital appearance; this label given at birth is referred to as one’s assigned sex at birth. Sex assigned at birth helps to determine health risk factors and the need for screening, particularly if there are remaining natal organs (i.e., breasts, ovaries, testes). 6 Gender identity refers to a person’s deeply felt, inherent sense of being. A person can identify as a girl, a woman, or female; a boy, a man, or male; a blend of male or female; or an alternative gender. Gender expression refers to the ways a person communicates their gender within a given culture, such as clothing choices and communication patterns. A person’s gender expression, the ways in which a person demonstrates their gender, including naming conventions, social presentation, and pronouns, and often aligns with gender identity. 5 In the past, diverse sexual orientation has been considered pathologic or a medical condition in need of treatment. The first edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-I) listed homosexuality as a sociopathic disorder. Homosexuality was not removed as a diagnostic category until 1973 when the American Psychiatric Association (APA) decided that homosexuality did not fit the criteria of mental disorder. However, until 1987, the APA continued to include a diagnostic category for individuals who were unhappy with their sexual orientation, which supported the development of conversion therapies. 7
Book Code: CT24CME
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