Over the last five years there has been a groundswell in the recognition that healthcare for those in the LGBTQ+ community has been, at best, incredibly lacking & the world of physical therapy is no exception. Fortunately, this growing awareness is being followed by tangible efforts to improve the quality of care provided to this population as evidenced by the formation of PT Proud, a Catalyst Group in the APTA, & a growing body of research to address the unique needs of LGBTQ+ patients. Hermann & Wallace is even offering it’s first ever 3 day course solely focused on treating patients who are gender diverse!
However, it is not uncommon for people to feel overwhelmed by all of the changing terminology & fear of accidentally offending someone. Thus, despite good intentions, many providers find themselves avoiding education & discussion of this topic altogether. The problem with this is that every clinician will inevitably encounter someone who is LGBTQ+ & merely “treating everyone the same'' may inadvertently end up causing harm. This is especially pertinent to pelvic health practitioners as we work on highly personal & vulnerable areas of the body. There are countless reasons why it is worthwhile endeavor to & your knowledge on this topic which is discussed more thoroughly in a blogpost I wrote a few years ago (here), but this post will focus more on practical takeaways that you can implement in your practice.
As mentioned earlier, the terminology can be intimidating; let's break them below into two categories: gender and sexual minorities:
Sex - biological characteristics of chromosomes & anatomy (ie. male, female, intersex)
Gender - societal & cultural categorization based on one’s sex (ie. man, woman, non-binary)
Cisgender - one who identifies with the gender assigned to them at birth
Intersex- someone born with aspects of both male & female anatomy (i.e. externa vulva & internal testes)
Transgender - one whose gender does not match the sex they were born with (may be abbreviated trans; this includes people who are non-binary)
AFAB- assigned female at birth
AMAB- assigned male at birth
Transwoman/MTF - assigned male at birth & identifies female
Transman/FTM - assigned female at birth & identifies male
Non-binary- one who identifies as neither male nor female; may use gender neutral pronouns (they/them)
Top surgery - breast removal (typically FTM) or augmentation (typically MTF)*
Bottom surgery - reassigning one’s genitalia to the anatomy they identify with
Gender identity - the gender that someone associates with internally
Gender expression - the external gender that someone conveys through appearance & behavior
*Non-binary folks may also undergo various gender affirmation surgeries & /or take hormones.
Sexual orientation - the gender(s) that one is attracted to. (Transgender is not a sexual orientation.)
Lesbian- a woman attracted to other women
Gay- a man attracted to other men
Bisexual- a person attracted to both men & women
Pansexual- someone attracted to people regardless of their gender identity
Asexual- a person who is not sexually attracted to others; may still experience romantic attraction
Queer- an umbrella term that applies to all LGBTQ+ people; used as a sexual orientation when other labels are not accurate; may be perceived as a derogatory slur, especially among older individuals
There can be many combinations of the terms above. Someone could identify internally as male, but live outwardly as a woman for a variety of reasons including safety, cost of transition, etc. Also, gender & sexual orientation do not always pair up in a heteronormative fashion. A person could be cisgender & bisexual (a woman AFAB attracted to both men & women) or transgender & lesbian (a transwoman AMAB attracted to women). Furthermore, not all people who are transgender have surgery or undergo hormone therapy, but this does not change their gender identity. Some helpful visuals to understand these ideas are the Gender Unicorn (here) & the Genderbread Person (here).
Now that you have some context to work with, what else can you do to put patients at ease?
-Consider having a rainbow flag in the waiting room to let patients know they are in a safe space.
-Wear a small pin indicating that you are an ally.
-Have inclusive intake forms with a blank space to enter gender rather than a checkbox for male or female.
-If applicable, know where gender neutral bathrooms are located & inform patients.
Ultimately, the best method to providing compassionate & competent care is to minimize your assumptions. There are many things you can do in your day-to-day interactions with patients to convey that you are trying to open up your world view. For example, if you find yourself assuming someone’s gender identity based on their name or appearance, I’d challenge you to practice using the gender neutral they/them pronoun until you learn how they identify. If you are unsure, it is okay to privately ask them! This is far less triggering than misgendering someone. Another common microaggression is assuming a patient’s partner’s gender based on heteronormative values. Try using the terms “spouse” or “partner” when talking to a patient about their loved one(s). It may seem banal to you, but your LGBTQ+ patients will notice.
Disclaimer: I can only represent the part of the community that I identify with. The views expressed are my informed opinions & may not be generalizable to all LGBTQ+ persons. I am thankful to be given a platform to address a topic that is so rarely discussed, but if I have made any errors or misrepresentations, please correct me!