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, PhD, RN, FAAN is professor and chair of the department of community, systems, and mental health nursing in the College of Nursing at Rush University in Chicago. She is the Editor of the Journal of Psychosocial Nursing and Mental Health Services, and the author of more than 100 journal articles and book chapters. Her published work focuses on therapeutic relationships, various environments of care, and the mental and physical health of truckers. Dr. Shattell is an active social media user, content developer, and public thought leader. She has published op-eds in the New York Times, The Atlantic, The Hill, Health Affairs Blog, Huffington Post, PBS, and others. 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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