LGBT+ Inclusivity in Surveys and Questionnaires

Despite progress being made on multiple issues involving the LGBT+ community, it continues to surprise me that in something as straightforward (no pun intended) as a survey, we still have a long way to go. And that is no clearer to me than at the doctor's office.
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When was the last time you took a survey or filled out a form where you had to specify your sex, gender or sexuality? Do you recall how many options were given for each of these three questions? As of late, I've become more vigilant whenever a questionnaire comes over my email or across my desk. Despite progress being made on multiple issues involving the LGBT+ community, it continues to surprise me that in something as straightforward (no pun intended) as a survey, we still have a long way to go.

I recently took part in a survey from in which I was asked my gender and only given two options, "male" or "female," which really frustrated me. I then reached out to fellow activists to see what their experiences in this matter have been like. I was overwhelmed by stories of the lack of inclusion on forms they've been given to fill out from various institutions, including LGBT+ groups themselves.

One friend who is transgender and bisexual discovered that their statewide LGBT group was asking people to self-identify on its website donation page, and it was only possible to select one identity when the options given were "lesbian," "gay," "bisexual," "transgender," "ally" and "other." For my friend, marking "other" didn't seem right, and they would have preferred the ability to choose multiple identities. "I really want there to be more bi/trans* visibility," they told me, "especially since many people think trans* people are either all gay or all straight (depending on who you ask) and, of course, no one thinks a trans* person could be bisexual despite bisexuality being the largest sexual orientation group among trans* people."

Other LGBT+-specific surveys that one would think would attempt to be extremely inclusive leave certain identities out as well. For example, one survey received by BiNet USA that claimed to be about "Sexual Minority Men's Gender Attitudes and Wellbeing" ended up having a pretty narrow focus on gay men, despite being promoted as a study that included bisexual, genderqueer and transgender men too.

For transgender individuals, the issue is quite frustrating, especially considering that surveys and questionnaires often mistakenly include "transgender" in questions related to sexual orientation, despite the fact that being transgender is a question of gender identity, not sexual orientation, and isn't linked to any one sexual orientation. Transgender people can be asexual, heterosexual, bisexual, non-monosexual, gay, lesbian or any other sexuality. Along the same lines, we have surveyors asking people to identify their sex, offering the options of "female," "male," "female-to-male" or "male-to-female"; the problem with these options for transgender individuals is that choosing the "FTM" or "MTF" options, as opposed to just "male" or "female," is akin to saying that transgender people are not "real" men and women. This is a problem.

Another issue with websites and forms that ask you to identify is confusion around the terms "sex" and "gender." The majority of the time, you will be asked for your gender and be given two options: "man" or "woman." For some, neither of those options describes them; for others, there is a deeper story than choosing one or the other. Sex and gender can be completely different for some. For my transgender friends, having an "other" option for gender beyond the man/woman binary would be a move in the right direction. If a survey maker wants to be even more inclusive, that person could expand the options to include "third-gender," "gender-neutral," "genderqueer" or "none," among other labels, and the survey taker could have the ability to choose more than one gender identity. For sex, options should include "male," "female" and "intersex" at the very least. Considering that there are so many different genders and gender expressions, as well as multiple variances between gender and sex, those conducting surveys could even have a fill-in-the-blank option for such identifying questions, so that the survey taker could properly write in the best term.

In my research on this topic, I was astounded to see instances in which individuals felt unrepresented by such questions on forms given to them directly by their own doctor's office. A physician should be more than aware of the fact that the gender binary is not a binary at all, and that allowing a patient only two possible answers when asking about their gender is unrealistic. To date, there have been many studies focusing on the lack of adequate treatment that members of the LGBT+ community receive as a result of a lack of understanding or inappropriate questioning, leading to overall poorer health outcomes, on average.

Activist Denise Ingram told me, "For me this is problematic in all sorts of ways, but the main two issues are 1) it is a binary, and 2) they don't want to know my gender (they should); what they want to know is my sex. Both those things seem essential to your ability to be my doctor."

Along the same line of thought, incorrectly conflating "sex" with "gender" and making assumptions about someone's sexuality as a result can lead to other problems as well, especially in a doctor's office. Gender and gender expression do not necessarily equate to any one sexual orientation or another, as was mentioned earlier regarding transgender people and the possibility of them being any sexuality. However, many questionnaires, including those given by physicians, do not address this reality.

We still live in a heteronormative and cissexist society, and that is no clearer to me than at the doctor's office. When I fill out their forms and identify as female, my doctors always assume that that means that I am heterosexual, so they ask me if I am on birth control. I have never once been asked if I engage in sexual activities with more than one sex or gender, so if I feel like my doctor should know, I am the one who has to awkwardly mention it. For those of us who would be considered a gender identity or sexual orientation minority, that can be a difficult subject to broach if right off the bat you feel like your physician or gynecologist doesn't understand you and your needs.

In fact, if doctors are making assumptions about a patient's gender, sex and sexuality without verifying with the patient, mistakes are just waiting to happen. For example, if a doctor makes assumptions about the sex practices of a man in a relationship with a woman without considering the possibility that one or both partners could be bisexual, that doctor could leave out important information that could affect the health of his patient and the patient's sexual partners; if he withholds contraception advice that could help the patient practice safe sex with partners of different genders, that could lead to STD contraction.

The more I look into this matter, the more instances of non-inclusivity I end up finding. The fact is that with the vast number of genders, sexes and sexualities that are possible, labeling becomes virtually impossible, and asking someone to identify by a handful of terms may not get across the full picture of a person. Much clearer questions should be asked on surveys and questionnaires, especially in the medical field, if accurate data is to be collected, and for all people to receive the best medical care possible.

This is likely just the beginning of a much larger conversation.

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