Supporting LGBTQIA+ Patients

Sexual Orientation and Gender Identity (SOGI)

Collection and utilization of Sexual Orientation and Gender Identity (SOGI) data can improve member experience and help providers deliver affirmative and quality care, especially for members part of the LGBTQIA+ community. On this page we will explore what SOGI data is and how to talk about it with your patients.

What is SOGI and why is it important?

Sexual Orientation and Gender Identity, or SOGI, is an inclusive term that applies to everyone. While this information can be particularly helpful in providing quality healthcare to the LGBTQIA+ community, it also helps us provide a more inclusive and affirmative experience for all members. Collection of SOGI data shows members that providers and HPSM are making an effort to recognize and affirm their identity.

What is sexual orientation?

Sexual orientation is a person's identity in relation to the gender or genders to which they are sexually attracted, which can change over time. There are many different types of sexual orientation including but not limited to:

• Lesbian: A woman who has a significant attraction, primarily to members of the same gender, or who identifies as a member of the lesbian community.
• Gay: One who has significant sexual attractions primarily to members of the same gender or sex, or who identifies as a member of the gay community. Typically associated with men.
• Bisexual: The potential to be sexually attracted to people of more than one sex and/or gender, not necessarily at the same time, not necessarily in the same way, and not necessarily to the same degree.
  
• Queer: Reclaimed derogatory slang by many who reject gender and sexual binaries. Also used as a political identity by many who want to dismantle oppressive systems in society.
  
• Asexual: Umbrella term for those to tend not to have a sexual desire towards others; asexuals may experience romantic attractions and engage in sexual behavior.
  
• Pansexual: One who can feel an attraction to anyone, including individuals who do not identify as a specific gender. Pansexual people may describe their attraction as focusing on personality rather than gender.
  

This list is not exhaustive.

Why is gender identity different from sexual orientation?

Gender identity is the personal sense of one's own gender. Gender identity can correlate with a person's sex assigned at both or can differ from it. Here are terms that are important to know regarding gender identity.

• Gender expression “How I look and express myself”: Gender expression, or gender presentation, is a person's behavior, mannerisms, interests, and appearance that are socially associated with gender. This can range from masculine, to feminine, to androgenous.
• Sex assigned at birth: Sex assigned at birth is the label at birth based on external genital anatomy. This is either Male or Female.
• Cisgender: Umbrella term for those whose gender expression and gender identity are congruent with the sex assigned to them at birth, and whose gender is validated by the dominant culture.
• Intersex: A general term used for a variety of bodies in which a person is born with reproductive or sexual anatomy that does not fit into the sex binary.
• Non-Binary: “Non-binary” is generally used as an umbrella for various gender nonconforming identities and is most often used by those who do not strictly identify as "male" and "female."
• Transgender: Umbrella term for those whose gender expression or identity is not congruent with the sex assigned at birth and/or whose gender is not validated by the dominant culture.

Learn more at the San Mateo Pride Center’s ABC’s of LGBT+.

Tips When Your Patient is LGBTQIA+

These tips are intended to support providers in offering inclusive, supportive care to LGBTQIA+ patients. These suggestions are informed by the National LGBTQIA+ Health Education Center.

Refrain from making assumptions about a person’s sexual orientation or gender identity based on appearance 

Making assumptions about a patient’s sexual orientation can put them on the spot to “come out” to you. Use neutral language when asking questions and take your lead from the individual person. Ask patients how they would like to be addressed, what name they would like to be called and which pronoun is appropriate. Some ways to ask this are “What is your current gender identity?” Or “What is your current sexual orientation?”

Revising intake forms can support this process by ensuring that providers and clinic staff have accurate information on a patient’s current sexual orientation, gender identities and pronouns. Health care providers can also make it their protocol to use gender-neutral language with patients in the exam room or at the front desk, ask for their pronouns and implement “bedside” inclusivity.

Note: Providers should facilitate disclosure of sexual orientation and gender identity, but be aware that disclosure or “coming out” is an individual process and it’s not always easy. You can help create a safe environment by asking for information pertinent to medical care only, as you would with any other patient.

Listen to and reflect patients’ choice of language when they describe their own sexual orientation and gender identity

Ensure that all clinic staff are trained to reflect a patient’s choice of gender identity or sexual orientation when addressing the patient. Reflecting a patient’s choice of language also includes how they refer to their relationship or partner. Referring to a significant other as a “husband,” “wife” or “partner” after the patient has used such language can contribute to a welcoming environment.

If you make a mistake, acknowledge it and apologize. For example, you could say, “I’m sorry I didn’t get that right. I meant to say       .” Or if you need help recalling, you could say “Can you please tell me again so I can make sure that I have the correct information?” 

Ensure cultural competency from check-in to check-out

A patient’s health care experience goes beyond the examination room. It’s important to make sure that their whole experience is positive. This includes providing gender-neutral bathrooms and making all administrative processes identity-affirming. Health care providers should consider requiring all clinic staff to participate in annual trainings that explain LGBTQIA+ health disparities and affirming communication. San Mateo Pride Center can be a resource for training and resources.

Provide welcoming visual cues

Entering a health care facility, patients look for signs and clues of diversity and openness to LGBTQIA+ identities. Assess the physical environment of your building with attention to what kind of messages may be communicated to patients. Once clinic staff are trained on supporting patients with affirming and supportive language, consider providing visual cues that your office is a welcoming space. This could include brochures and educational materials addressing LGBTQIA+ health concerns, publicly posting a nondiscrimination statement and displaying posters from LGBTQIA+ or HIV/AIDS nonprofit organizations. 

Stay up to date with the latest LGBTQIA+ health research and be knowledgeable about the needs of LGBTQIA+ patients

Partner with your patients to understand their health care priorities and offer up-to-date information on topics like hormone replacement therapy or how patients can live with HIV/AIDS. This can take the burden of educating their providers off of patients’ shoulders. 

Take routine and inclusive sexual health histories for all adolescent and adult patients 

Taking a routine history of sexual health should be part of the comprehensive history for all adolescent and adult patients. Start the conversation by stating that you ask all patients these questions in order to provide appropriate care. This opening helps to normalize the conversation. Asking inclusive questions that avoid assumptions (such as “Are you in a relationship?” and “What is the gender or genders of your sexual partners?”) invites patients to feel more comfortable disclosing sexual behavior and any related questions or concerns.