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By: Davina Kotulski, Ph.D.
I. LGBT Terminology
Sexual Orientation Terminology is an important part of being a culturally competent clinician when working with LGBT clients. Below you will find several important terms, however, when working with someone from a sexual minority it is best to ask that client how they refer to themselves and how they would like you to refer to them.
A. Sexual orientation- refers to a person’s romantic or sexual attraction (i.e. heterosexual, bisexual, homosexual).
B. Gender orientation- refers to how one identifies themselves with regard to gender (i.e. male, female, both, neither).
C. Homosexuality- a sexual orientation characterized by romantic or sexual desire for members of the same sex. Homosexuality is a clinical term and the words Gay or Lesbian are preferred.
1. Sub-Categories of Homosexuality
a) Lesbian- refers to females with a sexual orientation directed towards females.
b) Gay- refers to either males or females with a sexual orientation directed towards members of their same sex.
D. Heterosexuality- a sexual orientation characterized by romantic or sexual desire for members of the other sex.
E. Bisexuality- a sexual orientation characterized by romantic or sexual desire for members of both sexes. Bisexual refers to persons who are attracted to both males and females. Bisexuality can fall anywhere between the sexual orientations of homosexuality and heterosexuality meaning that an individual who is bisexual may be more attracted to one sex or gender over the other.
Biphobia, which is similar to homophobia, describes a fear people have of individuals with a bisexual sexual orientation. Biphobia stems from the belief that only heterosexuality and homosexuality are genuine orientations and a person who is bisexual is either truly straight, has not fully “come out of the closet,” or is simply a promiscuous individual incapable of monogamous commitment. Bisexual persons may also be the target of homophobia and hate crimes. The military considers bisexuality a reason for discharge under the Don’t Ask, Don’t Tell Policy. Bisexual persons may also be discriminated against by some within the gay community as well, as seen with the term “hasbian” to refer to bisexual lesbians currently with a male partner.
II. Gender Orientation Terminology
A. Transgender- An umbrella term for people whose gender identity and/or gender expression differs from the sex they were assigned at birth. The term may include but is not limited to: transsexuals, cross-dressers, genderqueers, two spirits and other gender-variant or gender non-conforming people. Many transgender people may identify as female-to-male (FTM), male-to-female (MTF), neither or both. Transgender people may or may not choose to alter their bodies hormonally and/or surgically. Gender orientation is completely separate from sexual orientation. Therefore, you should not assume that an MTF will be interested in being with men or that a FTM is attracted to females. Gender orientation and sexual orientation are distinct. It is important to use the descriptive term preferred by the transgender person and to elicit from them who their romantic attachments are with. Never assume.
B. Transsexual- People who desire to have or have achieved a different physical sex from their physical sex at birth. For example, they have felt like a man trapped in a woman’s body or a woman trapped in a man’s body.
C. Transvestite and Cross Dressers- The term was coined by Magnus Hirschfield in 1915 in Berlin to describe a group of people who wore clothes of the opposite sex.
D. Genderqueer- a person who does not fit into the traditional two-gender or gender-binary system. Some people identify a little with both genders, others with no gender at all. Others view gender as a continuum with either gender as poles and themselves somewhere in the middle. Some prefer gender-neutral pronouns or no-pronouns at all and use only their name.
E. Two-Spirit- A contemporary Native American term which refers to a masculine and feminine spirit embodied in one person. It also can refer to LGBTI Native Americans. Some tribes have their own words to refer to the two-spirit person who before Christian influence was a sacred person (i.e. Nadli in Navajo and Wintke in Lakota). Today these terms carry negative connotations like the words “faggot” or “lezzie.” In the past, however Nadli and Wintke had a special place in society, (i.e. baby-naming, marital counseling, etc).
F. LGBTI
Refers to lesbian, gay, bisexual, transgender, and intersexed people. Often shortened ton LGBT or LGB Sometimes includes Q for questioning or queer.
G. Queer
Queer is a word that historically had many negative connotations associated with it. However, it has been adopted by younger LGBTI people and more radical left-leaning political individuals. This term is controversial in the LGBT community and still perceived as a negative term by some. If you use this and you are not “queer” use this term with caution.
III. Physical Sex Terminology
A. Male-XY Chromosome, male secondary sex characteristics.
B. Female- XX Chromosome, female secondary sex characteristics.
C. Intersexed- refers to ambiguous or both male and female sexual characteristics (including hormonal or chromosomal characteristics).
IV. Kinsey Sexual Orientation Scale
Alfred Kinsey was a biologist at the University of Indiana who began studying human sexuality. Kinsey published two important books on male and female human sexuality. In his research, Kinsey found that 10% of the population is homosexual. He also created the Kinsey Scale in 1948 to describe the range of human sexuality.
Kinsey Sexual Orientation Scale
A. Exclusively heterosexual experience
B. Predominately heterosexual experience only incidental homosexual experience
C. Predominately heterosexual experience but more than incidental homosexual experience
D. Equally heterosexual & homosexual experiences
E. Predominately homosexual experience but more than incidental heterosexual experience
F. Predominately homosexual experience only incidental heterosexual experience
G. Exclusively homosexual experience
V. Vivienne Cass and the Homosexual Identity Formation Model
In 1979 Vivienne Cass created an identity formation model to describe the coming out process for sexual minorities, she called it the Homosexual Identity Formation model. The Homosexual Identity Formation (HIF) model is composed of six stages: (a) identity confusion, (b) identity comparison, (c) identity tolerance, (d) identity acceptance, (e) identity pride, and (f) identity synthesis. This model, created by Vivienne Cass (1979, 1990), suggests that individuals who would be labeled by society as “homosexual” begin to experience same-sex erotic feelings and are initially confused by these feelings and their sexual orientation. Cass suggests that as the individual begins to identify these feelings they gradually move through stages in a linear fashion. The stages go from denial of their homosexual feelings through stages of tolerance, acceptance, and then finally integration of these feelings into the whole self. According to Cass a person may become stuck in the first stages and may never fully accept and integrate their sexual orientation with their over all identity.
VI. Special Concerns
A. Unique Challenges LGBT Families Face
Marriage Rights-At present same-sex couples in the United States are denied 1,138 federal marriage rights and in most states hundreds of state marriage rights, exceptions include Massachusetts which allows same-sex couples to marry and access all state marriage rights and other states that have civil unions and domestic partnerships which provide some of the state marriage rights. These marriage rights significantly impact a same-sex couple/family’s ability to protect itself, its assets, and its members. A small sample of marriage rights include the ability to provide health care, take family medical and bereavement leave, receive pensions and social security, make medical and burial decisions, file joint taxes, receive discounts or employment benefits as a family or married person, own property as spouses without harsh and unfair tax consequences, and the right to sponsor a spouse for the purposes of immigration.
Partnership Recognition
In the United States marriage for same-sex couples is only recognized in Massachusetts. Reciprocal Beneficiaries in Hawaii, Domestic Partnerships in California and New Jersey, and Civil Unions in Connecticut, and Vermont offer only a minority of the rights that heterosexual couples have access to. Presently Spain, Canada, Belgium, the Netherlands and soon South Africa allow same-sex couples to marry. At least 17 other countries provide many partnership rights including the right to sponsor a partner for the purposes of immigration and many other counties allow LGBT individuals to serve openly in the military and provide partners of LGBT service members spousal benefits. The United States does not.
B. Challenges of LGBT Youth
According to several studies, gay, lesbian, and bisexual youth are 2-3 times more likely than their heterosexual counterparts to attempt suicide (Russell, 2001; Garofalo, 1999; and U.S. Department of Health and Human Services, 1989). Additionally, gay youth are more likely to be bullied and because of that to be at greater risk for depression, anxiety disorders, and school failure (National Mental Health Association, 2002). In his 1999 study on teenagers who are gay or bisexual, Garofalo found “that these young people are more likely to engage in other high risk behaviors: alcohol consumption, drug and tobacco use and sexual activities with multiple partners.” Russell’s study confirmed Garofalo’s findings that gay teens have a higher incidence of depression and substance abuse. According to Russell, these youth are “not having them emotional needs met, so they’re using and abusing substances.” Russell extrapolated from his findings that gay teens are “literally self-medicating.”
Russell, S. (August 2001) Gay and Lesbian Youths At Greater Risk for Suicide, American Journal of Public Health.
Garofalo, R. (May 1999) Archives of Pediatric and Adolescent Medicine.
Gibson, P. (1989) Secretary’s Task Force on Youth Suicide, National Mental Health Association
C. Challenges LGBT Seniors Face
As I note in my book Why You Should Give a Damn about Gay Marriage, LGBT seniors face a unique set of challenges that their non-gay peers do not. LGBT seniors are often not able to live with their partners in retirement homes who do not allow unrelated or unmarried people to share an apartment. Most retirement homes are connected with religious affiliations that are not welcoming to gays. LGBT people are denied spousal benefits such as social security survivor’s benefits, pensions, and healthcare of a deceased spouse, all benefits afforded heterosexual surviving seniors. According to the Pride Senior Network, the Minnesota Board on Aging, and Senior Action in a Gay Environment LGBT seniors suffer poorer medical care because they are 1) less likely to go to a physician for fear of having to explain who they are who their partner’s are because they don’t want to get substandard medical care, 2) there is documented proof that physicians express a bias and make disparaging remarks about LGBT patients, and 3) LGBT people have been neglected or received sub-standard care by homophobic physicians (Kotulski, 2004).
D. HIV/AIDS
HIV/AIDS was first thought of as a “gay disease,” some called it the “gay plague” and attributed it to God’s punishment for homosexual behavior. In the U.S., the disease was noticed when gay men in the largest metropolitan areas were coming down with opportunistic infections like Kaposi’s Sarcoma (KS), a rare form of cancer that tended to occur in older people, and Pneumocystis carinii pneumonia (PCP), a rare lung infection.
People knew very little about the disease and many, including a doctor for the CDC, thought that only homosexuals were at risk for the disease. The disease had many different names in the early eighties GRID, (gay-related immune deficiency), AID (acquired immunodeficiency disease) and then finally it was defined and designated as AIDS (Acquired Immune Deficiency Syndrome). It was at this point that the transmission through sexual contact was identified. Then, gradually people began to learn of transmissions via blood. There continued to be much misinformation about the spread of AIDS. Many people thought it could be transmitted through handshakes, kissing, or simply touching an infected person.
According to the CDC Website “Nearly 25 years after the first report of a handful of cases of a nameless deadly disease among gay men in New York and Los Angeles, there are still over 1 million persons living with HIV in the United States. About one-fourth of those with HIV have not yet been diagnosed and are unaware of their infection. The “new” syndrome discovered 25 years ago has become one of the deadliest epidemics in human history, killing more than 25 million people around the world, including more than 500,000 Americans.” https://www.cdc.gov/hiv/spotlight.htm