By Ness Cooper
Maintaining a safe, inclusive environment is essential when seeing patients in any medical setting. Some patients may avoid contact with healthcare services if they perceive that interactions will be uncomfortable, hostile, or likely to trigger psychosexual factors. This is particularly true of sexual and reproductive health, given the intimate nature of the care involved, but can apply to any healthcare setting.
To maintain a safe environment requires not just a medical approach but a holistic, person-centred one. This should be applied throughout the patient journey, from booking appointments and providing non-clinical information, through to seeing clinicians and arranging treatment. This includes using appropriate language, such as referring to patients and their bodies using the language that they use. It also means avoiding language that makes normative assumptions about a patient, their lifestyle, or their lived experience. Inclusive language is helpful as it allows patients to have a better understanding of their health and to take autonomy over their sexual and reproductive health needs in a safe and educated way.
The use of gender-affirming language is often associated with the care of transgender and non-binary patients, as part of social affirmation and transition. However, cisgender patients will also expect clinicians to use language that recognises their gender identity and its wider cultural context. Gender identity and expression varies from person to person, and whilst there may be cultural expectations of gender, everyone will have their own internal view of what it means and feels like for them.
Chosen names are important to ask for all individuals. Some may have different names for safeguarding and protection reasons; equally an individual may be more comfortable when you use a name or nickname they prefer. It’s important to ask your patients their name, how they pronounce it, and make a note on your records for future reference.
It’s rare to use someone’s name repeatedly throughout a conversation, and thus we all use pronouns (e.g. he/him, she/her) on an everyday basis. Some individuals use gender neutral pronouns such as they/them, a mix of pronouns (e.g. she/they, they/he), or neo-pronouns (e.g. xe/xem, fae/faer, ey/em, ze/hir). If you’re unsure of a person’s pronouns, it is best not to make assumptions. It is acceptable to use they/them temporarily until there is an opportunity to ask an individual discreetly which pronouns to use. To deal with any mistakes made when using a person’s pronouns, simply apologise briefly, correct the mistake, and move on without dwelling.
When using inclusive and person-centred language such as pronouns, don’t presume the individual’s lifestyle, sexual orientation, or relationship status. With any form of reproductive or sexual health care it’s always best to ask these questions separately and inclusively for all patients. And when taking medical histories and talking about body parts, it’s best practice to ask individuals their preferred terms. There is a wide range of language used both by transgender and cisgender patients. Clarifying things aids communication, avoids confusion and embarrassment on the part of the clinician, and makes the conversation more comfortable for the patient. If it is felt that asking personal questions might be uncomfortable for the patient, it might be useful to explain why the questions are being asked and how they might support the patient’s care.
It should go without saying that care should be patient-centred, and any political views regarding gender and gender affirming care should be left outside of the consulting room.
Whilst some are concerned that responding to gender dysphoria by offering affirmative care and inclusive language may cause harm, it is important to understand that anyone can experience dysphoria, and that dysphoria is appropriately managed by a holistic approach to the cause of the dysphoria.
Dysphoria is when someone’s internal world is dysregulated due to feeling something in their external world not fitting with their identity. Most people will experience some form of dysphoria throughout their life, and this may evolve and change over time. For transgender and non-binary people, this will often be an external factor that clashes with their internal sense of gender.
For example, a transgender man may find that his period causes him dysphoria. Rather than approach his gender as the issue leading to dysphoria, affirmative care helps him look at how to manage his period in gender affirming ways via holistic approaches, ranging from using period products that are less feminine, to more medical approaches if these are mutually felt to be appropriate. The use of mutually agreed and inclusive language can aid successful discussions of such matters and will build trust between patient and clinician.
It’s worth reiterating that inclusive language is important for all individuals seeking reproductive and sexual healthcare, not just LGBTQ+ individuals. This supports our patients in getting the correct care throughout their life, whether they are exploring pregnancy, managing an STI, or experiencing the menopause.
Further resources:
Communication about sexual orientation and gender between clinicians, LGBT+ people facing serious illness and their significant others: a qualitative interview study of experiences, preferences and recommendations
https://qualitysafety.bmj.com/content/32/2/109.abstract
Trans Hub Social Affirmation
https://www.transhub.org.au/social
LGBTQIA+ menopause: room for improvement
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(22)01935-3/fulltext
Providing gender affirming and inclusive care to transgender men experiencing pregnancy
https://www.sciencedirect.com/science/article/abs/pii/S0266613822002984
Reducing sexually transmitted infections NICE guideline [NG221]
https://www.nice.org.uk/guidance/ng221/chapter/Recommendations
HIV Prevention: Delivering safe and acceptable PrEP services to transgender women and men
About the Author
Ness Cooper (she/her/they/them) is a clinical sexologist who works as a therapist in private practice. She has trained extensively in the field of human sexuality qualifying in various areas of sexual health, sex and relationship education, sex and relationship therapy and coaching. She has even trained with the Kinsey Institute for Human Sexuality and is a member of the ISSM and American Board of Sexology.
She acts as a consultant for various industries giving support and advice on sex and relationship matters, from campaigns, copywriting, curriculum, staff training around sexuality and sex including inclusivity, workshops, talks, and academic texts.
Additional credit: This article was reviewed in collaboration with the RCS England Pride in Surgery Forum (PRiSM).