What’s sexual orientation got to do with it? LGBTQI reproductive health

Co-authored by Monica McLemore, PhD, MPH, RN, assistant professor at the University of California San Francisco, and Candace W. Burton, PhD, RN, AFN-BC, AGN-BC, FNAP assistant professor at Virginia Commonwealth University.

In 2002, the first ever, Gay, Lesbian, Bisexual, Transgender, Queer and Intersex Health Summit1 was held in Boulder Colo. This was the first time bisexual people, transgender people, and intersex people were recognized on a national level at a professional conference, included funding for travel and panels/workshops specific to bisexual, transgender and intersex issues. Additionally, it was one of the first conferences exclusively devoted to health and not centered on illness and/or risk behaviors; several panels discussed the reproductive health needs of LGBTQI individuals. Much that was discussed at that conference, specifically that health care provider assumptions about gender identity, sexual orientation and behaviors can create missed opportunities to provide clients/patients with support and education, remains true today.

Amid conflicting sexual and reproductive health information2 and political discussion of what constitutes comprehensive reproductive health care3 we believe revisiting best practices in reproductive health for LGBTQI individuals is warranted.

This post aims to offer powerful tools to educate the public and decrease reproductive stigma. Understanding basic concepts necessary to provide quality reproductive health care is essential for all health care professionals working with individuals of reproductive age. As discussed in our previous blog post4, gender identity is fluid; however, sexual orientation (defined by the Human Rights Campaign5) is “an individual’s physical and/or emotional attraction to the same and/or opposite gender,” could be distinct from gender identity or expression and can also be distinct from sexual behavior. In other words, both sexual orientation and sexual behaviors can also be fluid.

Gender identity ≠ Sexual orientation ≠ Sexual behavior

A few simple considerations can enhance practitioners’ ability to provide comprehensive reproductive health care to individuals irrespective of sexual orientation, behavior and/or gender identity.

First, it is imperative that providers develop sensitivity around these issues. Providing individuals opportunities to tell you how they identify creates a “safe space” that clients can use to make the best reproductive health care decisions for themselves and their partners. Simply asking: Do you have sex with men, women or both? of all clients/patients should be routine practice and eliminates assumptions about sexual orientation and gender identity/expression.

Asking direct questions such as do you or your partner(s) need contraceptives or birth control to prevent pregnancy? or do you want to become pregnant in the next 12 months? removes assumptions about the reproductive potentials of the gender fluid and individuals with diverse sexual behaviors.

Relatedly, it is important to be aware that assumptions about monogamy are often just as problematic in reproductive health care provision as assumptions about anything else. Again, a straightforward inquiry about the nature of a client’s relationships can help guide recommendations about contraception and other reproductive health needs. We often ask: “Are you in a defined relationship with anyone? With more than one person?” Asking all clients if they are having sex with multiple partners (and if their partners are having sex with multiple partners) should be default to avoid missed opportunities to provide comprehensive reproductive health care to individuals involved in multiple or polygamous sexual relationships or polyamorous relationships.

In all cases, revising expectations about the needs of sexual minority, gender fluid, transgender, and polyamorous individuals creates an inclusive and welcoming reproductive health practice. Doing so promotes safe and effective practices for both providers and clients.



  1. https://storify.com/MLive/author-tweets-sex-ed-course-at-east-lansing-school
  1. http://www.scotusblog.com/case-files/cases/sebelius-v-hobby-lobby-stores-inc/
  1. http://lavenderhealth.org
  1. http://www.hrc.org/resources/entry/sexual-orientation-and-gender-identity-terminology-and-definitions

About monashattell

Mona Shattell is Associate Dean for Research and Faculty Development in the College of Science and Health, and Professor in the School of Nursing at DePaul University. The College of Science and Health at DePaul University is comprised of 8 departments (health sciences, psychology, STEM studies, biology, chemistry, physics, environmental science, and mathematics), 1 school (nursing), and 4 centers (STEM Center, Quantitative Reasoning Center, Center for Family and Community Services, and the Center for Community Research). The college currently has 150 full-time faculty members, 2700 undergraduate students and 725 graduate students, and $15 million in research funding. In her role as Associate Dean for Research, Dr. Shattell promotes research in all departments, schools, and centers in the college; she enhances the culture and capacity of the college to support scientific inquiry, supports and mentors tenure-track and non-tenure-track faculty, and promotes student research. In addition to her position as Associate Dean, she also serves as the PI of mental health services research teams and as board member for several community non-profit mental health advocacy organizations. She is Associate Editor of Advances in Nursing Science and Issues in Mental Health Nursing, a regular blogger for the Huffington Post, and the author of more than 100 journal articles and book chapters. She has participated in several fellowship programs: she is a former Public Voices Fellow with the OpEd Project, which is a media fellowship program that develops thought leaders from traditionally underrepresented groups; she participated in the Sigma Theta Tau International Mentored Leadership Development Program, and post-doctoral K30 Clinical Research Training Program through NHLBI. She is active in a number of professional organizations and is a Fellow of the American Academy of Nursing. She is also a member of the American Nurses Association, the American Psychiatric Nurses Association, the Southern Nursing Research Society, Midwest Nursing Research Society, Sigma Theta Tau International, and the International Academy of Nursing Editors. She serves on numerous community boards of mental health-related service and advocacy organizations. Prior to joining the faculty at DePaul University, she was tenured Associate Professor at the University of North Carolina at Greensboro, Assistant Professor at the University of Alabama at Birmingham, and Lecturer at the University of North Carolina at Charlotte. She received a PhD in nursing from the University of Tennessee Knoxville, a Master of Science degree in nursing from Syracuse University, and a Bachelor of Science degree in nursing, also from Syracuse University.
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