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A heterosexual bias in healthcare delivery is pervasive, and it may not be perceived by the primary care clinician. However, it can be blatantly clear to the lesbian, gay, bisexual, and transgender (LGBT) patient as early as the initial interaction within the clinical setting.

LGBT patients often cannot complete the most basic informational questions that appear as check boxes on initial visit intake forms, such as sex (male or female) or marital status. Although the healthcare provider may be unbiased and open-minded, prejudice is well-ingrained in the healthcare system in subtle and overt ways.1-4 Policies and practices in health care that assume and/or favor heterosexuality may leave LGBT patients feeling judged and demeaned, and LGBT patients receive suboptimal health care as a result.5-7

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Sexuality is a human dimension that can only be described on a continuum and often cannot be defined by a specific category. In health care, terms used to define a person’s sexuality include lesbian (L), gay (G), bisexual (B), and transgender (T).8

Which of the following best describes your experience with LGBT patients during the past 5 years?

In the medical literature, lesbians are often referred to as women who have sex with women (WSW). Gay men are often referred to as men who have sex with men (MSM).9 The terms lesbian and gay are used to refer to people who are attracted to members of the same sex, and the term bisexual describes people who are attracted to members of either sex.10,11

The term transgender is used to describe people who do not identify with their biologically assigned sex at birth. Transsexual refers to transgender persons who have undergone sex reassignment surgical procedures.8

At times, the acronym LGBT includes the letter Q (LGBTQ). Q denotes the term queer, which is an umbrella category that some have used to refer to the entire LGBT community. The term may be used to describe those who are on a continuum of gender, gender presentation, or sexuality that may not fit within societal “norms.” Q also denotes the term questioning, which indicates a person is in the process of understanding his or her sexual orientation.9,12 It should be taken into consideration that not all LGBT people identify as queer, and the term may also be used by some as a political or activist identifier.

Other terms to understand include intersex and gender dysphoria. The term intersex refers to a person whose reproductive organs and/or chromosomes do not fit into usual patterns (eg, those with Klinefelter syndrome).13 Gender dysphoria is distress associated with one’s sex that was assigned at birth because it is inconsistent with the individual’s perceived and preferred gender identity.14 It is important to recognize that gender dysphoria is not a mental illness but considered gender nonconformity. The World Professional Association of Transgender Health stresses that gender nonconformity is a matter of diversity not pathology.15

Sexual orientation and health

According to the Centers for Disease Control and Prevention (CDC) National Health Statistics Report: Sexual Orientation and Health Among US Adults, 96% of adults aged between 19 and 64 years identify themselves as heterosexual, 1.6% identify as gay or lesbian, 0.7% identify as a bisexual, and 1.1 % indicate “something else” or gave no answer.16 However in 2011, a CDC report from a survey of 13,495 men and women between the years 2006 and 2008 revealed that 12% of women aged between 25 and 44 years had sexual contact with another woman, and 6% of men revealed they had sexual contact with another man.17 These numbers indicate sexual orientation is more accurately described as fluid rather than a set of discrete categories.