Missing from the Conversation: Sexual Risk Factors Across Young People by Gender Identity and Sexual Orientation

Abstract

Objectives: Lesbian, gay, bisexual, and queer/questioning (LGBQ), and transgender/nonbinary (trans/NB) youth experience health disparities. Much research combines gender identity with sexual orientation or siloes them, ignoring intersections. Methods: Logistic regressions with representative data from 2015 Healthy Kids Colorado Survey (n?=?15,970) explores sexual risk. Results: Findings indicate LGBQ and trans/NB youth have differential levels of sexual risk (drugs during sexual interactions, not using condoms) compared to cisgender heterosexual peers. Other identities, mental health, and bullying are also related. Conclusions: There is a need for culturally responsive bullying prevention, mental health support, education, and sexual health services for marginalized populations.     

Who Adopts Queer and Pansexual Sexual Identities?

Some nonheterosexual individuals are eschewing lesbian/gay and bisexual identities for queer and pansexual identities. The present study aimed to examine the sexual and demographic characteristics of nonheterosexual individuals who adopt these labels. A convenience sample of 2,220 nonheterosexual (1,459 lesbian/gay, 413 bisexual, 168 queer, 146 pansexual, and 34 other “write-in”) individuals were recruited for a cross-sectional online survey. In support of our hypotheses, those adopting pansexual identities were younger than those adopting lesbian, gay, and bisexual identities, and those adopting queer and pansexual identities were more likely to be noncisgender than cisgender, and more likely to be cisgender women than men. The majority of pansexual individuals demonstrated sexual orientation indices within the bisexual range, and showed equivalent patterns of sexual attraction, romantic attraction, sexual behavior, and partner gender as bisexual-identified men and women. In contrast, three-quarters of queer men, and more than half of queer women, reported sexual attraction in the homosexual range. This study found that rather than a general movement toward nontraditional sexual identities, queer and pansexual identities appear most appealing to nonheterosexual women and noncisgender individuals. These findings contribute important information regarding who adopts queer and pansexual identities in contemporary sexual minority populations.     

Exploring the diversity of gender and sexual orientation identities in an online sample of transgender individuals

Although the term transgender is increasingly used to refer to those whose gender identity or expression diverges from culturally defined categories of sex and gender, less is known about the self-identities of those who fall within this category. Historically, recruitment of transgender populations has also been limited to specialized clinics and support groups. This study was conducted online, with the aim of exploring the gender identities, sexual orientation identities, and surgery and hormonal statuses of those who identify with a gender identity other than, or in addition to, that associated with their birth sex (n = 292). Genderqueer was the most commonly endorsed gender identity, and pansexual and queer were the most commonly endorsed sexual orientation identities. Participants indentified with a mean of 2.5 current gender identities, 1.4 past gender identities, and 2 past sexual orientation identities. The majority of participants either did not desire or were unsure of their desire to take hormones or undergo sexual reassignment surgery. However, birth sex and age were significant predictors of “bottom” surgery and hormone status/desire, along with several identities and orientations. This study explores explanations and implications for these patterns of identification, along with the potential distinctiveness of this sample.     

Lesbian,gay, bisexual,and transgender families and health

Research consistently demonstrates that family relationships are key determinants of health, but most research on health and families focuses on a heterosexual and cisgender context. Sexual and gender identities often are overlooked or erased in family and health research. We present an overview of the current state of research on LGBT families and health, using a life course approach and pointing to the ways that LGBT people's experiences of families occur within a broader social structural context, with implications for their health and the health of their family members. We focus on parenthood, parent–child ties, intimate relationships, and caregiving. We also identify two theoretical obstacles for studies of LGBT families and health as well as important research areas for moving forward, such as the inclusion of non‐binary and queer identities in our studies of family and health. Incorporation of LGBT and other queer families and family forms into our health research interrogates assumptions within family and health research and offers insight into how to move the field forward.     

“Your Gender is Valid”: Microaffirmations in the Romantic Relationships of Transgender Individuals

Microaffirmations are small, interpersonal interactions that communicate validation for an identity. The present study focuses on transgender microaffirmations received from romantic partners. Participants included 339 self-identified transgender adults in a romantic relationship (currently or within the past 5 years). Participants were recruited via social media and snowball sampling and took an online survey detailing their experiences in romantic relationships. Participant responses were analyzed via thematic analysis, resulting in seven relationship-salient themes: (1) acknowledging and using cisgender privilege, (2) centering on partner’s identity, (3) affirming gender(less) presentation, (4) helping partner process identity, (5) seeking permission, (6) using affirming language, and (7) acknowledging milestones. Findings emphasize the importance of positive aspects of romantic relationships. Implications for working with transgender clients are discussed.     

Gender Category and Gender Status: A Critical Distinction

Gender has been of explicit analytical interest in sociology for decades. Despite its centrality to the field, “gender” eludes conceptual specificity in significant ways, such as lacking distinction between gender category (identification as a man, woman, nonbinary, etc.) and gender status (the state of being cisgender or not). I contend that the cisgender status is a rich site of interpersonal and institutional power that has been understudied. This work forwards the concepts of gender category and status as analytical tools to help explore key elements of gender interaction and structure, such as cisness. I argue cisness must be teased out via the express distinction between gender category and status, and I provide empirical evidence from 75 interviews with various gendered actors (i.e., cisgender men, cisgender women, transgender men, transgender women, nonbinary individuals) to demonstrate the applied purchase of my findings.     

Differences in Sexual Orientation Diversity and Sexual Fluidity in Attractions Among Gender Minority Adults in Massachusetts

This study characterized sexual orientation identities and sexual fluidity in attractions in a community-based sample of self-identified transgender and gender-nonconforming adults in Massachusetts. Participants were recruited in 2013 using bimodel methods (online and in person) to complete a one-time, Web-based quantitative survey that included questions about sexual orientation identity and sexual fluidity. Multivariable logistic regression models estimated adjusted risk ratios (aRRs) and 95% confidence intervals (95% CIs) to examine the correlates of self-reported changes in attractions ever in lifetime among the whole sample (n = 452) and after transition among those who reported social gender transition (n = 205). The sample endorsed diverse sexual orientation identities: 42.7% queer, 19.0% other nonbinary, 15.7% bisexual, 12.2% straight, and 10.4% gay/lesbian. Overall, 58.2% reported having experienced changes in sexual attractions in their lifetime. In adjusted models, trans masculine individuals were more likely than trans feminine individuals to report sexual fluidity in their lifetime (aRR = 1.69; 95% CI = 1.34, 2.12). Among those who transitioned, 64.6% reported a change in attractions posttransition, and trans masculine individuals were less likely than trans feminine individuals to report sexual fluidity (aRR = 0.44; 95% CI = 0.28, 0.69). Heterogeneity of sexual orientation identities and sexual fluidity in attractions are the norm rather than the exception among gender minority people.     

Bathrooms,Boundaries, and Emotional Burdens: Cisgendering Interactions Through the Interpretation of Transgender Experience

Building on findings demonstrating that social institutions may cisgender realities by creating and enforcing binary notions of gender rooted in cisgender experience, this study examines the ways cisgender people reinforce cisnormative gender binaries in their ongoing interactions. Utilizing interviews with 99 cisgender people, I show how respondents react to a vignette about a gender nonconforming person seeking to use a public bathroom by “cisgendering interactions,” which I define as the process whereby people reassert binary understandings of gender to make sense of transgender experience while placing an unequal emotional burden on transgender and gender nonconforming people to mend the interactional disruption of the gender panic. Additionally, my analysis extends transgender scholarship by demonstrating some ways cisgender people make sense of transgender people in public spaces. In conclusion, I draw out insights for understanding (1) the ways people cisgender their realities in the face of conflicting stimuli, (2) the ways in which emotions are a mechanism of inequality reproduction, and (3) the consequences these actions have for the perpetuation of gender inequality.     

Self-Reported Gender Identity and Sexuality in an Online Sample of Cisgender,Transgender, and Gender-Diverse Individuals: An Exploratory Study

The relations between self-reported aspects of gender identity and sexuality were studied in an online sample of cisgender (n = 4,954), transgender (n = 406), and gender-diverse (n = 744) groups. Aspects of gender identity and sexual fantasies, attraction, behavior, and romantic relations were assessed using the Multi-gender Identity Questionnaire (Multi-GIQ) and a sexuality questionnaire. Results show a wide spectrum of gender experiences and sexual attractions within each group, an overlap among the groups, and very weak relations between atypical gender identity and atypical sexuality. At the group level, aspects of gender identity and sexuality were mainly predicted by gender and sex-gender configuration, with little contribution of sex assigned at birth. A principal component analysis (PCA) revealed that measures of gender identity and of sexuality were independent, the structure of sexuality was mostly related to gender, whereas the structure of gender identity was mostly related to sex-gender configuration. The results of both approaches suggest that measures of gender identity could roughly be divided into three classes: one including feeling as a man and feeling as a woman; a second including measures of nonbinary and “trans” feelings; and a third including feeling as a “real” woman and feeling as a “real” man. Our study adds to current scientific data that challenge dichotomous conventions within gender identity and sexuality research. Possible social and clinical implications are discussed.     

Clinical and Supervisory Considerations for Transgender Therapists: Implications for Working with Clients

Transgender therapists have unique and valuable perspectives into how gender organizes the therapeutic process. Currently, in the MFT field, there is discussion of the cisgender therapist's experience in the therapy room, but no known articles on the transgender therapist's experience. This article provides insight into the experiences of transgender therapists around issues of self‐disclosure, social locations of both therapist and client, and clinical supervision. Drawing from our clinical experiences as transmen, we highlight special considerations for working with cisgender, queer, and transgender clients. Implications for supervision of transgender therapists are also discussed. As more gender diverse students seek MFT training, there is an urgent need to acknowledge their perspectives. This article is a call for beginning conversations in this direction.     

Our Story: The Parent and LGBTQ Child Relational Process

This study explores the parent-lesbian, gay, bisexual, transgender, and queer (LGBTQ) child relational process, before and after the child discloses his or her sexual orientation and/or gender identity to his or her parent(s). Eleven parent-adult child dyads were interviewed in this grounded theory study. Participants included children representing the full LGBTQ spectrum and their parents. Results indicate that parent-child dyads experience a relational process occurring in five sequential phases, the last one continuing indefinitely. Parent-LGBTQ child close relationships manifest societal beliefs regarding LGBTQ identities. Dyad members share an evolving relational identity and construct a shared narrative that shifts in response to familial life events and broader societal changes.     

Transgender experiences and transphobia in higher education

While categories like “campus climate” highlight variation across institutions, trans people's experiences also vary within an institutional context. By studying trans people's experiences in higher education, however, we can better understand and respond to the differentiated and changing needs of transgender people in other arenas. In this paper, I review key qualitative and quantitative findings along several themes: (a) disclosing trans identities, (b) trans communities, and (c) resources and career‐level support. Specifically, I use the concept of microclimates to explain how trans people encounter various forms of support and discrimination on campus. For example, someone might receive support from particular individuals, such as an advisor, or spaces, like a gender studies classroom, but not others. Researchers also report both similarities and differences between binary and nonbinary trans people, as well as between transgender men and transgender women, suggesting that there is no universal trans experience, nor a one‐size‐fits‐all approach to supporting trans students and faculty members. Challenging interpersonal and systemic transphobia requires context‐specific interventions.     

A Two-Question Method for Assessing Gender Categories in the Social and Medical Sciences

Three studies (N = 990) assessed the statistical reliability of two methods of determining gender identity that can capture transgender spectrum identities (i.e., current gender identities different from birth-assigned gender categories). Study 1 evaluated a single question with four response options (female, male, transgender, other) on university students. The missing data rate was higher than the valid response rates for transgender and other options using this method. Study 2 evaluated a method of asking two separate questions (i.e., one for current identity and another for birth-assigned category), with response options specific to each. Results showed no missing data and two times the transgender spectrum response rate compared to Study 1. Study 3 showed that the two-question method also worked in community samples, producing near-zero missing data. The two-question method also identified cisgender identities (same birth-assigned and current gender identity), making it a dynamic and desirable measurement tool for the social and medical sciences.     

Associations of Bisexual-Specific Minority Stress and Health Among Cisgender and Transgender Adults with Bisexual Orientation

Among sexual minorities, bisexuals are at the greatest risk for poor health due in part to prejudice and stigma. This research examined associations of bisexual-specific minority stress and health among cisgender (non-transgender) and transgender adults with bisexual orientation. Participants were 488 adults (378 cisgender women, 49 cisgender men, 61 transgender individuals), age 18 to 66 years, with bisexual orientation based on identity and/or attractions to multiple genders. Participants completed an online survey. Hierarchical linear regression analyses were conducted with sexual minority stress and bisexual-specific minority stress as the predictors and physical health, measured by the 36-Item Short Form Survey (SF-36), as the outcome. Models controlled for demographic variables. Moderation analyses were conducted to test for gender differences. Greater bisexual-specific minority stress significantly predicted poorer overall physical health (β = ?0.16), greater pain (β = ?0.16), and poorer general health (β = ?0.25) above and beyond the effects of sexual minority stress. Gender moderated the association between bisexual-specific minority stress and health, such that bisexual-specific minority stress predicted overall physical health and role limitations for transgender individuals but not for cisgender women. Addressing bisexual-specific minority stress is necessary to improve the health and well-being of bisexual individuals.     

Momentary Desire for Sexual Intercourse and Momentary Emotional Intimacy Associated With Perceived Relationship Quality and Physical Intimacy in Heterosexual Emerging Adult Couples

Sexual desire and emotional intimacy are central to relationships, yet little is known about how these feelings vary within and between partners or relate to dyad functioning. We explored magnitude and stability of momentary sexual desire and emotional intimacy in relation to quality and functioning of heterosexual relationships. After reporting perceived relationship quality and physical intimacy enjoyment, members of 18 emerging adult heterosexual couples reported momentary partner-specific sexual desire and emotional intimacy several times a day for two weeks (2,224 reports). Mean and mean squared successive difference (MSSD) characterized magnitude and stability, respectively, of the momentary states. Regression models of relationship outcomes examined influence of the male versus female partner having greater or more stable desire and intimacy. Sexual desire and emotional intimacy magnitude and stability were associated with relationship quality and physical intimacy enjoyment differently for men versus women. Gender-specific differences between partners also predicted relationship outcomes. Men particularly perceived higher relationship quality and enjoyed physical intimacy more when they had higher and more stable sexual desire and their female partners had more stable emotional intimacy. Partner differences in momentary sexual desire and emotional intimacy may contribute to understanding quality and functioning of heterosexual relationships.     

Foreclosing Fluidity at the Intersection of Gender and Sexual Normativities

Binary gender and sexuality are socially constructed, but they structure thought at such a deep level that even those critical of sexism and homophobia can unwittingly reproduce them, with consequences felt most profoundly by those whose gender/sexual identity defy binary logic. This article outlines a generic pattern in the reproduction of inequality we call foreclosing fluidity, the symbolic or material removal of fluid possibilities from sexual and gender experience and categorization. Based on 115 responses from people who are both sexually and gender fluid and a reading of existing sociologies of gender and sexualities from a fluid standpoint, we demonstrate how lesbian/gay/straight, cisgender, and transgender women and men—regardless of intentions—may foreclose fluidity by mobilizing cisnormative, transnormative, heteronormative, and/or homonormative beliefs and practices. Examining patterns of foreclosing fluidity may provide insight into (1) the further incorporation of fluid people and standpoints into symbolic interactionism, and (2) the reproduction and persistence of sexual and gender inequalities.     

Seeking Connection Versus Avoiding Disappointment: An Experimental Manipulation of Approach and Avoidance Sexual Goals and the Implications for Desire and Satisfaction

Previous correlational research has demonstrated an association between people’s reasons for having sex (i.e., their sexual goals) and their sexual desire and sexual and relationship satisfaction. Across two studies of people in romantic relationships (N = 396) we extend previous research and demonstrate, for the first time, that manipulating the salience of approach sexual goals (i.e., engaging in sex to pursue positive outcomes, such as enhanced intimacy) compared to avoidance sexual goals (i.e., engaging in sex to avert negative outcomes, such as a partner’s disappointment) or a control condition leads people to feel higher sexual desire for their romantic partners and to report higher sexual and relationship satisfaction. In addition, in Study 2 we demonstrate that focusing on approach sexual goals over the course of a week leads people to report more satisfying sexual experiences during that week, as well as higher desire and overall relationship satisfaction, compared to a control group. The current findings advance approach–avoidance theory by providing evidence that it is possible to manipulate people’s sexual goals and, in turn, impact their feelings of desire and satisfaction. Results are promising for the development of interventions to promote sexual and relational well-being.     

Evidence of Diverse Identities in a Large National Sample of Sexual and Gender Minority Adolescents

Adolescence is a time of identity exploration, and preliminary evidence indicates the ways adolescents are describing their sexual and gender identities (SOGI) are changing. A nuanced understanding of SOGI is necessary for valid assessment in developmental research. Current measures do not capture the diversity of emerging identities among young people. Our study analyzed a national sample of 17,112 sexual and gender minority adolescents (13–17 years) to better understand how identity labels are reported across sexual, gender, and ethnoracial minorities. Adolescents reported 26 distinct SOGI categories; 24% of adolescents utilized nontraditional SOGI labels, such as pansexual and nonbinary. These identifications varied significantly as a function of ethnoracial identity. Results have implications for how scholars conceptualize and measure SOGI among adolescents.     

Shame in the Clinical Process with LGBTQ Clients

This commentary integrates the literature on the social and psychological dynamics of shame and discusses its relevance to the clinical process, especially with lesbian, gay, bisexual, and transgender and queer clients. It is argued that engagements with shame, especially where sexual desire, sexual orientation, or gender identity is a foremost consideration or conflict, may be the most important factor in producing and maintaining the therapeutic alliance. Shame, a social emotion, is considered in the light of work done in sociology, psychology, neuroscience, and psychoanalysis. Future directions for clinical research are suggested.     

Absent in theory,invisible in practice: Queering HBSE for a more inclusive social work profession

A sound theoretical foundation is a necessary element of social work education that prepares students to confront the challenges of practice with critical knowledge of the human experience. Queer theory is a strength-based framework for understanding sexual and gender identities that fall outside of the current social norms, and offers a highly relevant and useful pathway for the education of social work practitioners. Despite its utility for enhancing understanding and acceptance of gender and sexual minority (SGM) people, it is underutilized in social work compared with other disciplines. Additionally, this study reports on the gender and sexual identities of social work students and their endorsement of help-seeking behaviors related to issues of gender and sexual nonconformity. These empirical-based perspectives undergird the tenets of queer theory and support its application in research endeavors aimed at better understanding the human experience. A theoretical and empirical-based argument is made for the queering of HBSE to strengthen both explicit and implicit curricula in social work education. This study expands on the limited usage of queer theory within social work and directly challenges the normative and binary nature of sexual and gender identity evident within the professional literature and implications for education and research are offered.