Begin Removing Barriers

BARRIERS TO CULTURALLY COMPETENT CARE

REMOVING BARRIERS: LEARNING THE VOCABULARY Many women feel forced to lie about or hide their relationships with their female partners in order to access medical services and maintain the support of their families, cultural or religious communities. It is important to ask questions and listen to your patient. Use the words they use to describe themselves and significant others. Sexuality is compromised of many factors, in addition to a person’s biological sex, that influence lifestyle choices that can affect a patient’s health. Mary-Helen Mautner 1944 - 1989

Gender vs. Sex

Gender refers to the roles and responsibilities that society assigns to males and females. Gender roles are learned and may change over time. They may vary widely within and between cultures and from one individual to another. Sex is a biological distinction between males and females. It refers to whether a person is male, female, or intersex, and is dependent on the form of the external genitalia.

Sexual Identity vs. Sexual Behavior

Sexual identity, or sexual orientation, is a concept that seeks to classify people according to their attraction to a particular sex. The three sexual orientations commonly recognized are homosexual (same sex), heterosexual (opposite sex) and bisexual (either sex). Sexual orientation describes erotic and/or sensual desires, and practices. Sexual orientation does not define sexual behavior.

Sexual behaviors are the specific activities one engages in, which can change over time. A woman may or may not express her sexual orientation in her behaviors. A woman may be attracted to both genders (bisexual) but only engage in sexual behaviors with one gender. In the healthcare setting, sexual behavior has implications for prevention and treatment of sexually transmitted infections (STIs), Pap test frequency and the need for contraception.

“Women who Partner with Women” (WPW)

This is an umbrella term used to be inclusive of women who may or may not identify as lesbians. Rarely used by a woman to describe herself, it accurately describes behavior, which is very important in the context of health care.

Gender Identity

Gender identity refers to an individual’s concept of themselves as “male” or “female”. It is not dependent on a patient’s biological sex or their sexual orientation. Gender identity can be viewed along a continuum and outward appearances may fall anywhere on that continuum: a feminine-looking female, a masculine-looking female, or an apparent male who has female genitalia. The outward gender presentation is separate from sexual orientation and behavior. Clinicians should be cautious of any assumptions made on appearances only.

Transgender

Transgender is an umbrella term used to describe people who have gender identities, expressions, or behaviors not traditionally associated with the sex they were assigned at birth. Transgender people are often described by their “gender vector”: male-to-female (MTF) or female-to-male (FTM). Transgender people who seek out surgery or hormone treatment to alter their physical anatomies or secondary sex characteristics are called transsexuals. Transgender individuals may have a heterosexual, homosexual, or bisexual orientation.

Understanding Sex, Gender Identity, Sexual Orientation and Sexual Behavior as a Continuum

Each individual can fall at any point along each continuum. Here are examples of three different lesbian women and the variances seen in terms of sex, gender, orientation and behavior:

 

WOMAN #1 CONTINUUM Biological/Assigned Sex Male................~Female Gender Identity: This person identifies more: Masculine........~Feminine Sexual Orientation: This person is attracted to: Female~............Male Sexual Behavior: This person’s sex partners are: Female~............Male WOMAN #2 CONTINUUM Biological/Assigned Sex Male................~Female Gender Identity: This person identifies more: Masculine....~....Feminine Sexual Orientation: This person is attracted to: Female...~.........Male Sexual Behavior: This person’s sex partners are: Female......~......Male WOMAN #3 CONTINUUM Biological/Assigned Sex Male........~........Female Gender Identity: This person identifies more: Masculine........~Feminine Sexual Orientation: This person is attracted to: Female...~.........Male Sexual Behavior: This person’s sex partners are: Female~............Male

REMOVING BARRIERS: SENSITIVE CONVERSATIONS Due to experiences with heterosexist prejudice and discrimination, lesbians and WPW are often quite sensitive to any signal that indicates the provider is not familiar or comfortable with same gender relationships and sexual behavior. Using appropriate language is one way to demonstrate your willingness to provide culturally competent health care. The terms “lesbian, gay, or bisexual,” are preferred over “homosexual.” The word homosexual, although clinically correct, may imply anti-gay and lesbian attitudes. “Partner” is a term you can use with all patients, as opposed to the terms “friend,” “lover,” or “roommate.” “Sexual orientation” is preferred over “sexual preference” because it suggests the inherent nature of sexual identity.