______________________________________________ Intercultural Competence and Patient-Centered Care
Coming-out process : A process by which an individual, in the face of societal stigma, moves from denial to acknowledg- ing his/her sexual orientation. Successful resolution leads to self-acceptance. Coming out is a lifelong process for lesbian, gay, bisexual, and transgender persons and their families and friends as they begin to tell others at work, in school, at church, and in their communities. Gay : The umbrella term for GSM persons, although it most specifically refers to men who are attracted to and love men. It is equally acceptable and more accurate to refer to gay women as “lesbians.” Gender and sexual minorities (GSM) : A term meant to encompass lesbian, gay, bisexual, trans, queer/questioning, intersex/intergender, asexual/ally (LGBTQIA) people as well as less well-recognized groups, including aromantic, two-spirited, and gender-fluid persons. Heterosexism : An institutional and societal reinforcement of heterosexuality as the privileged and powerful norm. Heterosexuality : Erotic feelings, attitudes, values, attraction, arousal, and/or physical contact with partners of the opposite gender. Homophobia : A negative attitude or fear of non-straight sexuality or GSM individuals. This may be internalized in the form of negative feelings toward oneself and self-hatred. Called “internalized homophobia,” it may be manifested by fear of discovery, denial, or discomfort with being LGBTQIA, low self-esteem, or aggression against other lesbians and gay men. Homosexuality : The “persistent sexual and emotional attrac- tion to members of one’s own gender” as part of the continuum of sexual expression. Typically not used to describe people. LGBTQIA : An acronym used to refer to the lesbian, gay, bisexual, transgender/transsexual, queer/questioning, inter- sex/intergender, asexual/ally community. In some cases, the acronym may be shortened for ease of use or lengthened for inclusivity. Members of this group may also be referred to as gender and sexual minorities (GSM). Queer : An umbrella term to describe persons with a spectrum of identities and orientations that are outside of the hetero- normative standard. Sexual identity : The inner sense of oneself as a sexual being, including how one identifies in terms of gender and sexual orientation. Sexual orientation : An enduring emotional, romantic, sexual, and/or affectionate attraction to another person. Individuals may experience this attraction to someone of the same gender, the opposite gender, both genders, or gender nonconforming. Transgender : An umbrella term describing a number of dis- tinct gender positions and identities including: crossdressing, transsexual, nonbinary, and intersex.
on women than men. Much of the research into women’s health has focused on the perinatal period, which limits our knowledge of how mental illness affects women’s lives. There is also some evidence that women’s pain is less likely to be taken seriously and controlled than male patients. A series of four studies found a relative gender-pain exaggeration bias, wherein perceivers believe women, relative to men, to be emotionally dramatizing and therefore more likely to exag- gerate versus downplay their pain [147]. This bias may lead perceivers to interpret women’s, relative to men’s, pain reports as overstatements, inauthentic, or dramatized. Providing gender-sensitive care to women involves overcoming the limitations imposed by the dominant medical model in women’s health. This requires theoretical bases that do not reduce women’s health and illness experience into a disease. This philosophy incorporates explanations of health and empowers women to effectively and adequately deal with their situations. The major components incorporated into the development of sensitive care include: • Gender is a central feature. • Women’s own voices and experiences are reflected. • Diversities and complexities are incorporated into women’s experiences. • Theorists reflect about underlying androcentric and ethnocentric assumptions. • Sociopolitical contexts and constraints of women’s experiences are considered. • Guidelines for practice with specific groups of women are provided. GENDER AND SEXUAL MINORITIES The gender and sexual minority (GSM) population is a diverse group that can be defined as a subculture. It includes homo- sexual men, lesbian women, bisexual persons, transgender individuals, and those questioning their sexual identity, among others. The GSM population is diverse, representing all ages and all socioeconomic, ethnic, educational, and religious back- grounds. The population has been described as “hidden and invisible,” “marginalized,” and “stigmatized.” As a result, the unique health and safety needs of the population have often been overlooked or ignored. Clear definitions of the concepts related to sexual identity will be helpful. The following is a glossary of terms used in discussions of this group [71; 72; 73; 74; 75; 76]: Asexual/aromantic : An individual who does not experience sexual attraction. There is considerable diversity in individuals’ desire (or lack thereof) for romantic or other relationships. Bisexual : An adjective that refers to people who relate sexually and affectionately to both women and men.
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