Questions about sex and gender: some thoughts on a way forward for the profession.

Dr Robin Ion @robmarki & Dr Elaine Maxwell @maxwele2

Talking about sex and gender

Sex and gender are important factors in healthcare and for nurses (Ion et al 2021). Despite this, many have observed a recent reluctance to discuss them in a professional context, including in the academic journals. This is not the result of a new-found coyness, or re-emergence of Victorian attitudes. Rather it appears to be a consequence of the sex and gender culture war which is raging across the West.

This relative professional and academic silence is not mirrored on social media platforms, such as Twitter. Here using anonymity and drawing on the dark art of sub-tweeting, nurses can express anger and frustration, make veiled personal attacks, as well as ask genuine questions and challenge ideas – in relative safety. The upshot is a polarised community where two sides appear to be locked in a twentieth style century war of attrition

A platform for discussion

EBN recently sought to address an example of this. Observing the Twitter response to a nurse who had been invited to write on the issue, the editor issued an invitation for nurses to anonymously post questions about sex and gender on Padlet, to be addressed in an editorial. We found the experience, which was also framed as an ‘experiment’, both helpful and thought-provoking.

An online’ experiment’

The ‘experiment’ shed a light on a significant concern for all professionals: how to talk about highly contested issues in a way which doesn’t cause personal distress, result in professional censure, personal attack, or social ostracism.  In this case, how to engage all nurses (not simply activists) in discussing the concepts of sex and gender, and their practice implications.

The posts on Padlet illuminate divisions in opinion.  One group of respondents are concerned about a conflict between the sex-based rights of adult biological women and the gender based rights of adult trans women, others do not accept that such a conflict exists.

The second divide arises between those who see significant risks around the management of children and young people with gender dysphoria and, in particular, any subsequent medical or surgical interventions supporting transition. Set against this are those who see transition as potentially life -saving.

We recognise the good intent of all respondents. The strength of feeling expressed on both sides comes as no surprise, given the debates across society. However, we are disappointed that a profession such as nursing has not addressed the differences of opinion openly. Exhortations to #bekind do not resolve the differences, nor do they acknowledge the challenges that nurses have in day to day practice managing a caseload of people with different needs and competing rights.

Its’ good to talk: let’s choose to do it

We have observed increasingly polarised opinion, with emotional rather than evidence-based comment, leaving no space where professional nurses can come together to debate and move practice forward in a way that is mindful of everyone’s rights.

As Cass (2022) noted in her interim report, the current discussion around sex and gender is everybody’s business and as a profession we cannot shy away from a topic, simply because it is difficult.

We can choose to talk to each other in good faith to properly explore areas of difference and common ground. In doing this we must draw on evidence as well as lived experience. We can also choose to stop insulting each other. We can make the decision to check our language for hyperbole. Put simply, disagreement is not ‘hate’, not every person who advocates for trans people is an ‘ activist’ and not every person who disagrees with gender ideology is a ‘bigoted transphobe ‘. Continuing with this language will not help trans people regardless of whether we see ourselves as ‘allies’ or ‘gender critical’.

There is also something else that must be done. Our leaders in in practice and academia, including the professoriate and academic journals, need to acknowledge what’s happening. They have a part to play in role modelling professional and respectful discourse.

The profession has a choice. If things remain the same, sex and gender will continue to be a battleground. There may be winners, but they will not be trans people, nor nurses in clinical practice, or nursing educators.

It really is time to talk. If we choose not to, we must acknowledge that we did know there was a problem. We are grateful to EBN for being brave enough to take the first step.  We implore the rest of the profession to respond.


Cass H. Independent review into gender identity services for children and young people: interim report. 2022.

Ion, R., Patrick, L., Hayter, M. and Jackson, D. (2021), Sex, gender and nursing. J Adv Nurs, 77: e10-e12.







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