This is a piece written by Assistant Director, Anna Swygert, to educate volunteers on important terminology and concepts regarding sexual orientation and gender so that we in Streetlight can be better allies to our LGBTQ+ patients.
It can feel difficult to talk about gender and sexuality. Your experience of the world and your experience of how the world experiences you as it relates to love and attraction is incredibly personal and vulnerable, and it can feel uncomfortable to share this with others, especially when you do not know how another person will react. I was once sharing a story about my then-girlfriend with a 14-year-old patient, and she interrupted me to ask, “Wait…you have a girlfriend. You’re gay?” And as I carefully said yes back, she said, “That’s so cool!” As a queer person, there is a fear in revealing my identity that it will be labeled as a “problem” by someone else, and there is a sense of relief when that identity is not a barrier to relationship but a bridge.
Adolescence is a pivotal time in identity development as teens and young adults figure out who they are and how they connect with other people. We in Streetlight know how much of a privilege it is to walk with folks during this vulnerable and transformative time, and it is especially a privilege to walk with patients navigating their journey of sexuality and gender discernment. We have many patients who identify as LGBTQ+, and to best care for them, we thought it would be appropriate to have a little SOGI 101 to address our comfort level in talking about gender and sexuality in affirming ways.
The phrase “coming out” refers to the process by which one accepts, comes to identify, and shares one’s own sexuality or gender identity with others. Many people remain “closeted” by not revealing to others their queer sexuality or gender identity for many reasons, such as fear for one’s safety, peer or family rejection, or disapproval and/or loss of housing, job, etc. When someone shares their identity, it is a sign of trust. We as a community want to support our patients (and team members!) as best we can, and a great first step is understanding terms and concepts important to the LGBTQ+ community.
The Gender Unicorn
The Gender Unicorn is a tool used to understand the four spectra of gender identity, gender expression, sexual attraction (here labeled “physically attracted to”), and romantic attraction (here labeled “emotionally attracted to”).
These spectra of identity lift up the varied experiences of gender and sexuality.
Gender identity: how I identify
Gender expression: how I look and express myself
Sex assigned at birth: label at birth based on external genital anatomy
Sexual attraction: who am I physically attracted to
Romantic attraction: who I am emotionally or spiritually attracted to
These concepts will be expanded upon, but it is helpful to see these spectrums of identity before learning distinct SOGI terms. Each person can pinpoint where they align on each spectrum, and sometimes, these identifications align with specific identities. The following terms are by no means comprehensive, but they are a great foundation to build competency in understanding SOGI concepts.
Sexual Orientation Terms
| Terms | definitions |
|---|---|
| Sexual orientation | A person’s sexual identity in relation to the gender(s) to which they are attracted; sexual orientation and gender identity develop separately. |
| Queer | An umbrella term encompassing all sexualities except heterosexuality. Historically, queer has been used as a slur or pejorative term. Some individuals or communities have reclaimed the term, while others have not. |
| Gay | A person who is emotionally, romantically, or sexually attracted to their same gender exclusively. Men, women, and non-binary people may use this term |
| Homosexual | A person primarily emotionally, physically, and or sexually attracted to members of the same sex/gender. This term is considered stigmatizing, as historically, this term was used as a way to medicalize one’s sexual orientation and use it as the illness inverse of the “healthy norm” of heterosexual. |
| Heterosexual/Straight | A term for someone experiencing attraction solely to some members of a different gender. |
| Lesbian | A woman who is attracted to other women exclusively. Women and non-binary folks can identify as lesbian, but not all women do. Some women prefer to use the term gay or queer instead, depends on the individual. |
| Bisexual | Person who is sexually attracted to people of their same gender and people of another gender |
| Pansexual | A person whose attraction to others is not based on gender. Pansexual people may refer to themselves as gender-blind, asserting that gender and sex are not determining factors in their romantic or sexual attraction to others |
| Asexual (often shortened to “ace”) | A person who experiences little to no sexual attraction |
| Demisexual | A person who experiences little to no sexual attraction until a strong romantic connection is formed with someone. This term is often situated as part of the asexual spectrum. |
| Questioning | A person who may question their sexuality |
LGBTQ+ terminology is constantly evolving as people put new language to their lived experience, so individuals may use terms differently than those listed, use different variations or combinations of identities (e.g. asexual biromantic; romantically attracted to same and another gender, but experiences little to no sexual attraction), or use identities not listed at all. If you are unfamiliar with someone’s terminology, it is a great opportunity to lean into curiosity and give them the opportunity to share about their experience. Validation is so important.
Gender Identity Terms
| terms | definition |
|---|---|
| Sex (or sex assigned at birth) | An assignment that is made at birth, usually male or female, typically on the basis of external genital anatomy but sometimes internal gonads, chromosomes, or hormone levels . |
| Gender identity | A person’s deep internal sense of being female, male, a combination of both, somewhere in between, or neither, resulting from a multifaceted interaction of biological traits, environmental factors, self-understanding, and cultural expectations. |
| Gender expression | The external way a person expresses their gender, such as with clothing, hair, mannerisms, activities, or social roles |
| Gender perception | The way others interpret a person’s gender expression |
| Gender diverse | A term that is used to describe people with gender behaviors, appearances, or identities that are incongruent with those culturally assigned to their birth sex. |
| Transgender | A subset of gender-diverse people whose gender identity does not match their assigned sex and generally remains persistent, consistent, and insistent over time. |
| Cisgender | A term used to describe a person who identifies and expresses a gender that is consistent with the culturally defined norms of the sex they were assigned at birth. |
| Non-binary | A term describing a person who does not identify exclusively as a man or a woman. Non-binary people may identify as being both a man and a woman, somewhere in between, or as falling completely outside these categories. |
| Agender | A term that is used to describe a person who does not identify as having a particular gender |
| Genderfluid | A term describing a person who does not identify with a single fixed gender or has a fluid or unfixed gender identity. |
| Intersex | A term that is used to describe a person born with a variety of differences in their sex traits and reproductive anatomy, including differences in genitalia, chromosomes, gonads, internal sex organs, hormone production, hormone response, and/or secondary sex traits. |
| Gender dysphoria | A clinical symptom that is characterized by a sense of alienation to some or all of the physical characteristics or social roles of one’s assigned gender; also, gender dysphoria is the psychiatric diagnosis in the DSM-5, which has focus on the distress that stems from the incongruence between one’s expressed or experienced (affirmed) gender and the gender assigned at birth. |
| Deadnaming | The use of the birth name or other former name of a transgender or non-binary person without their consent. |
| Misgendering | Referring to a person using a pronoun or form of address that does not correctly reflect their gender. |
Someone’s gender identity can often come into play when we are talking to or about one another – this is where preferred names and preferred pronouns enter the conversation. Preferred names are the names that someone prefers to go by, while pronouns are terms used to substitute a person’s name when they are being referred to in the third-person. Such pronouns include:
- He/him/his
- She/her/hers
- They/them/theirs
- Ze/zir
- Xe/xem
For both name and pronouns, it is easy enough to ask. I always ask, “What is the name you like to go by?” and I try to ask most patients their preferred pronouns. A person’s gender identity should not be assumed based on their pronouns (e.g., not all people that use they/them pronouns identify as non-binary), and their specific gender identity is not crucial information for us – we simply want to know how they want to be known so we can best validate them.
AND, it’s okay to make a mistake. No one expects you to get it right immediately. It can be especially difficult if you have a long-standing relationship with someone and have only used different pronouns for them. But if you do make a mistake, correct yourself and move on. If someone corrects you, thank them and move on. If someone is correcting you, it is because they believe you will try to use the correct name and pronouns for them. And be okay with correcting others! If you notice someone using the incorrect pronouns or name of someone else, you can interrupt them with the correct name/pronoun. This helps take the burden off the individual.
A caveat – working in pediatrics can make this trickier. Because we work with patients and their families, it can sometimes be difficult to know how to refer to someone if you are unsure of their “closetedness” with other people in their life. Some patients are not yet out to their families. Some patients prefer to not tell their medical providers their preferred pronouns or gender identity for fear that it will impact their medical care. Try to follow their lead, and when they are alone, ask direct questions about when you should use which terminology. We want people to feel safe, and sometimes that means remaining closeted, unfortunately.
At its foundation, affirming care is the desire to honor and validate our patients’ lived experiences, and thank you all for having the humility and compassion to learn from and with our LGBTQ+ patients.
Resources
For more information on sexuality and gender, the following organizations provide a wealth of resources on LGBTQ+ affairs.
Human Rights Campaign
The Human Rights Campaign (HRC) is the largest LGBTQ political lobbying organization within the United States. HRC provides educational resources on terminology, community organizations, and advocacy on sexual orientation and gender inclusivity.
Center for Excellence on LGBTQ+ Behavioral Health Equity
The Center of Excellence on LGBTQ+ Behavioral Health Equity resources behavioral health practitioners to support those identifying as lesbian, gay, bisexual, transgender, queer, questioning, intersex, two-spirit, and other diverse sexual orientations, gender identities, and expressions. They hope to address meantal health disparities effecting LGBTQ+ people across all stages of life.
The Trevor Project 
The Trevor Project addresses mental health concerns of LGBTQ+ youth by providing emergency crisis support, as well as participating in ongoing research and educational opportunities. They offer free, confidential and secure 24/7 service managed by crisis counselors who are trained to answer calls, chats, or texts from LGBTQ young people who are struggling with issues such as coming out, LGBTQ identity, depression, and suicide.
References
Terms compiled from the following resources.
“Glossary of Terms.” Human Rights Campaign. Retrieved on October 4, 2022, from https://www.hrc.org/resources/glossary-of-terms
Key terms and concepts in understanding gender diversity and sexual orientation among students. American Psychological Association. Retrieved October 4, 2022, from https://www.apa.org/pi/lgbt/programs/safe-supportive/lgbt/key-terms.pdf
LGBTQIA+ glossary of terms for health care teams ” LGBTQIA+ Health Education Center. Health Resources and Services Administration of the U.S. Department of Health and Human Services. Retrieved October 4, 2022 from https://www.lgbtqiahealtheducation.org/publication/lgbtqia-glossary-of-terms-for-health-care-teams/
Rafferty, J., Committee on Psychosocial Aspects of Child and Family Health, Committee on Adolescence: Section on Lesbian, Gay, Bisexual, and Transgender Health and Wellness (2018) Ensuring comprehensive care and support for transgender and gender-diverse children and adolescents, Journal of Pediatrics 142(2). https://doi.org/10.1542/peds.2018-2162
Written by Anna Swygert, Streetlight Assistant Director (2022)