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LGBTQIA2S+ Key Terms and Definitions for Nurses and Healthcare Providers

by Angelique Geehan

Nurses can use this glossary of terms to help improve their ability to communicate with LGBTQIA2S+ patients and their families. Excellent nursing care requires practitioners to learn about their patients, so while knowing terms does not guarantee excellence, it can help build toward that.

LGBTQIA2S+ Key Terms and Definitions for Nurses and Healthcare Providers

Nurses hold a tremendous amount of power to affect the quality of care patients receive, not just through direct work with the patients but also as advocates in clinical settings and beyond.

While excellence in nursing requires more than just awareness of terms like those in this glossary, a nurse's knowledge of relevant terms can reflect their competence. That, in turn, can help establish trust with patients that can lead to patients feeling safe.

Affirming healthcare environments can be safer ones. They allow patients to disclose facts about their medical histories and ask questions regarding treatment that can greatly affect care. Safer, more affirming relationships between patients and care providers can reduce misdiagnosis, underdiagnosis, and overdiagnosis.

The glossary below provides an introductory guide to language use for healthcare professionals.

The Importance of Conscious Language

Learning and using accurate and appropriate terminology — intentionally, consciously — can help create more affirming environments for everyone: Not just the patients, but also the nurses themselves, their colleagues, and nurses' families and communities.

Anyone may hold stigmatized identities, sometimes in ways that are not evident to nurses, or that are kept concealed until patients feel safe enough to reveal those identities. Sometimes, patients reveal information that makes them more vulnerable to harm because they feel they have no other options.

It can be vital for nurses to embrace cultural and intellectual humility to integrate the needs and concerns of LGBTQIA2S+ people into clinical and community practice.


LGBTQIA2S+ Experiences with Healthcare Providers

Those who are part of groups that have been historically subject to discrimination and misunderstanding, like the LGBTQIA2S+ community, do not always need their healthcare team to be aware of all the vocabulary they may use.

Some of the terms that community members use themselves, as reclamation, are also slurs when used by those not part of the community. Therefore, nurses should not just copy what patients say without asking about the terms. Many of these terms and concepts are continuously discussed within the community, and understandings shift to accommodate new knowledge.

We are aware that patients appreciate when nurses demonstrate open-mindedness, a willingness and ability to learn, and a commitment to creating an affirming healthcare space. When possible, they seek out practitioners who treat them as experts in their own lives and believe their experiences.

Sadly, many are accustomed, instead, to having poorly informed practitioners about LGBTQIA2S+ issues. Ill-informed practitioner experiences can be so harmful that patients avoid care, not just with them but also with other practitioners.

How to Use the Glossary Below

We hope this glossary can offer nurses a foundation for building trust with their patients. However, we believe that no glossary can hope to be complete, updated, and reflect all the terms and meanings that a nurse would need to know.

Besides, we do not believe that patients would be best served by nurses who memorize the definitions. Rather, we suggest that while working to avoid mistakes, nurses prepare to learn from the mistakes they may inevitably make, appreciate those who call attention to slips, and be ready to take advantage of opportunities to repair or mitigate any harmful effects.

We recommend that those using this guide question it, as we would encourage you to do with any information source — even inviting patients to question you when you are a source of information for them.

We hope this may be part of a series of tools to help nurses and healthcare providers bridge gaps of understanding between care providers and marginalized communities so that you can offer the best possible nursing care without the interference of historical prejudices.

Navigating Mistakes with Sensitivity

Mistakes are inevitable. Nurses can work to prevent them by being open to new information from patients, colleagues, continuing education opportunities, and resources like this glossary.

There are also ways to minimize the negative effects of any mistake. To do this, acknowledge the mistake, apologize as appropriate, and thank the source of feedback for sharing information that will improve the healthcare experience for all involved. Furthermore, make any changes necessary to minimize the chance of the mistake reoccurring. Invite the patient, with their consent, to be a part of any actions taken to address the error and its effects.

It may help to let patients know that you are aware of the possibility of mistakes and invite their input, knowing that it may take time for a patient to have enough experiences with you to trust that you will keep any commitments you may make. This sets up an environment where feedback is welcome, making it less disruptive or awkward to address any slips and errors.

For mistakes involving language use, like using incorrect pronouns, nurses should take care to keep the apology and appreciation brief. This can help reduce the likelihood that the patient ends up feeling obligated to console or comfort you, the person who erred. For severe or significant mistakes, we recommend consulting with the patient, advocates for people with identities that the patient shares, and colleagues to determine appropriate follow-up actions.


Acknowledgment: Definitions and connotations can vary across communities and situations as well as shift over time, so we suggest you use this list as a starting point for conversations that will allow you to access broader and more nuanced understandings of the topics addressed, not as a way to judge others who are not familiar with these terms or use them differently. We prioritized terms we deemed relevant to the nursing and patient care environments and will strive to keep this list updated. Suggestions for updates or feedback on the terms and definitions within this glossary can be sent to contact@support.nursejournal.org.


Glossary of LGBTQIA2S+ Terms for Nurses

Term Definition
Ableism / ablism The belief that disabled people, people with disabilities (depending on the community, some prefer "identity-first language" and some prefer "person-first language"), and anyone perceived to have a disability are inferior to able-bodied and able-minded people; that disabilities are "wrong," "unfortunate," or deserving of pity and should be "cured" or "fixed."

This kind of prejudice can be obvious or subtle, presenting itself when people blame a patient or their family for having done something "to deserve" what is perceived as a disability, even if the disabled person values their own characteristics as they are.

Ableism affects the LGBTQIA2S+ community in some specific ways. For example, some may consider LGBTQIA2S+ people as disabled, such as when being LGBTQIA2S+ is considered "sick" or an illness or condition that requires the person be "cured" by force. See "conversion therapy."
Agender Not having a gender.

An agender person does not perceive themselves as having a gender. This identity is sometimes included under the transgender umbrella, sometimes considered a nonbinary gender, and may be claimed alone or with other genders.
Affirmed gender A patient's gender(s), regardless of the gender assigned to them at birth.

This phrase is relevant to patient care because many cultures assign genders at or before birth, so it is possible for someone to be assigned a gender they later realize is incorrect. In these cases, an affirmed gender is one (or more) that they have chosen for themselves.
Ally Someone who chooses to fight alongside others, with the implication that they are not from the same group; for example, straight people working as allies of people who are not straight.

Where anti-oppression work is concerned, it can be considered presumptuous for someone outside the group presumably benefitting from the allyship to designate themselves an ally, rather than be recognized as one.
Anatomic(al) inventory A list of the anatomy and physiology a patient has, has had, and/or what they want.

Among many benefits, this can help improve data collection and integrity. It can also reduce unnecessary procedures for all genders (e.g., not requiring pregnancy tests for a patient without a uterus) based on assumptions made because of a binary sex or gender marker in a patient's record.
Androgynous Neither masculine nor feminine, or having both masculine and feminine traits; can describe people, an aesthetic, or the objects people use to craft their presentation; often refers to presentation regardless of gender.

Patients who identify as androgynous might present themselves in any number of ways and can be of any gender, including cisgenders (woman or man).
Asexual Literally, "without sex."

  1. To describe relationships, it can mean that partners are not sexually active for any number of reasons.
  2. When used as an orientation, it includes an ever-increasing number of subcategories of identity, some of which can be combined, and many of which involve conditional and/or variable attraction and/or desire for sex. It is usually the "A" in LGBTQIA2S+. See also "demisexual."

For some, being "ace" means having a complete lack of desire for any sexual activity, including masturbation; for others, it means having a lack of sexual attraction to others or low desire for sexual activity, sometimes both.

Nurses should note that asexuality differs from celibacy, where individuals abstain from sex, making celibacy a condition, status, experience, or choice, rather than an identity. It may also be useful to adopt an understanding of sexuality and orientation in which even "allosexual" people (who have attraction for others) are not expected to experience a consistent state of sexual attraction or desire over the course of their lifetimes.
BDSM Stands for bondage, discipline, domination, submission, sadism, and masochism; also referred to as "kink;" refers to many different practices, some of which involve giving and receiving sensation (such as physical impact or restraint), intentionally shifting power or control in interpersonal interactions, managing risk in ways that may transgress social norms, and more; may involve sexual or erotic interaction but also frequently does not; see also "kink."

Many people include elements of BDSM in their relationships without identifying as part of the BDSM community. The term is included here because, while BDSM can be and is practiced by people of all genders and orientations including cisgender straight people, it is for some an element of their sexuality and/or expression that is not considered "straight." Also, the histories of the LGBTQIA2S+ community and what are now called BDSM communities are intertwined. For instance, sometimes influential people in one community were also a part of the other, and sometimes they were pushed together because of how mainstream societies stigmatized and fetishized the people who are a part of both communities.

Also, the groups share some cultural expressions, including fashion and aesthetics, terminology (as in "top" and "bottom"), and desired experiences (e.g., body modification which has been considered normal or transgressive over time in different situations and to different extents).
Bigender Having two genders.
Biphobia The disapproval, invalidation, erasure, hatred, or fear of bisexuality

It can be important for nurses to affirm bisexuality as its own full identity, not as a place of questioning "on the way" to "real" or "full" straightness or gayness.

Bisexual people can be monogamous or nonmonogamous. Please note that when operating outside the presumptions of monogamy and heterosexuality as normal and ideal, sexual orientation and preferred relationship structure can be separated as elements of identity.
Binding The wrapping or compression of parts of the body, usually the upper front torso, breast, or chest, to alter the body's appearance and/or the sensations an individual may receive from their body.

For some, binding can help relieve gender dysphoria. Nurses whose patients bind should keep informed about both the risks of binding and how to mitigate them.
Bisexual An orientation in which someone can experience attraction to someone of the same and a different gender as their own; the "B" in LGBTQIA2S+ stands for "bisexual."

Those who do not acknowledge that more than two genders exist may perceive "bisexual" to indicate a potential attraction to both men and women.

Orientation does not predetermine a person's relationship structure — bisexual people, as with people of any orientation, can be monogamous, nonmonogamous, or shift over the course of a lifetime.
Bottom Usually the person perceived as receiving an action or sensation, such as being penetrated during sexual activity.

This may be applied differently depending on other associations people may have with sex-related roles, like oral sex.

Though common stereotypes of bottoms may present them as submissive, someone can occupy this role separate from any power dynamic — to be specific, bottoms can also be dominant, power-neutral, or switch roles with partners.
Bottom surgery Any procedure in which a patient's genitals are altered.

It is often part of a medical transition. Bottom surgery is sometimes required as part of changing a birth certificate to correct a gender marker.
Cisgender Describes patients whose affirmed gender is the same as the one assigned to them at birth.
Closeted Having an element of one's identity that is kept private, or "in the closet," for comfort, convenience, safety, and/or survival, for the person or those they are close to; applies to statuses and identities outside the LGBTQIA2S+ community as well, for example, being closeted about having HIV+ status.

An individual may be closeted to some but not others; someone who is extremely closeted may be considered "stealth."

People may choose to stay closeted about identities that are subject to violence, stigma, and harm, as has recently been the case for many people in the LGBTQIA2S+ community. For instance, the idiom "having a skeleton in your closet" indicates guilt or criminality — hence the goal of many advocacy and liberation organizations is to be communities where identities are not associated with shame and religious sin, so that people of any identity can be safely "out and proud."

People who have closeted identities can also experience stress from navigating their personal safety and that of their friends and family. Members of the LGBTQIA2S+ community have been subject to violence and death, being rejected from their families and other communities, and other harm for being "out" but also for "tricking" others about their identity when they choose to stay closeted.

Nurses should take extreme care to protect the privacy of any individual and seek explicit, informed consent from their patients before sharing information with other care providers. This can take the form of going over medical records and correspondence with patients before those are made available to anyone else — insurance companies, social service agencies, family members, and partners — and explaining options and consequences for certain patient responses.
Coming out Revealing an identity to others that had previously been kept private.

When identities are presumed (for example, many people assume someone's gender by looking at them or assume everyone is straight), individuals with identities that are stigmatized, marginalized, or erased may have to "come out" repeatedly, such as to every new provider or others with whom they interact. This can increase any stress they are already experiencing because of that identity.

Coming out can be ordinary and/or celebratory. It can also represent self-acceptance, affirmation by others in the individual's social circle, defiance and resistance to oppression, and other elements connected with improved mental health and resilience to stress and trauma.

Some members of the LGBTQIA2S+ community may never "come out" and yet not be closeted.
Conversion therapy Programs or procedures intended to "cure," "fix," or "convert" people who are gay, lesbian, bisexual, queer, transgender, and gender nonconforming so that they will be "straight;" often associated with religious beliefs, especially Christianity and Islam.

Conversion therapy has been banned in different jurisdictions because it is often traumatic and deadly. Nurses who encounter patients who have experienced conversion therapy should work to be particularly sensitive to their patients' mental and emotional health needs, especially during interviews, tests, and other procedures.
Cross-dresser Someone who dresses as the "opposite" gender, regardless of their gender or lack of gender, gender status (cis, trans, nonbinary, questioning, or more), and orientation; anyone dressing in ways associated with a gender other than their own.

Anyone of any gender and gender status (cis, trans, or any other) might cross-dress. "Drag" is a kind of cross-dressing. Please note that cross-dressing does not determine one's orientation.

Although some community members have reclaimed the term, nurses should avoid the term "transvestite" except upon explicit request by their patients.
Cultural (mis)appropriation A complex concept that involves power dynamics and historical patterns of colonization or imperialism.

Generally, it can occur when someone from a group that is more favored benefits from the use of cultural expression (e.g., language, fashion, music, etc.) from a more disadvantaged group without permission, without crediting originators, and possibly even profiting in ways that the originators do not. Specifically, with cultural elements, it may be that no one has the authority to grant permission.

For example, people in the queer community, including people who are not Black or of the African diaspora, often communicate with inflections and phrasings taken from what may be called Black English, African American English, African American Vernacular English (AAVE), or Ebonics. They may benefit by receiving social capital or acceptance or having more fun than with their own styles of communication, while Black and African diasporic people typically experience negative consequences for communicating in AAVE, such as being seen as "unprofessional."
Demisexual A subcategory of asexuality; someone who experiences attraction to others and/or desire for sexual activity only when there is an emotional connection between them.
Endearments Any phrase referring to another person with affection, such as "honey," "sweetie," "dear," "mama," and "sugar"

Because many endearments can seem overly personal or even patronizing in clinical environments (and may also have significance to patients that nurses may not be aware of), we recommend nurses avoid using them without explicit permission.

To note, many patients can feel more cared for and respected when nurses use endearments, so our recommendation is not meant to discourage their use completely, but rather to discourage their universal use as a default without patients' (or colleagues') consent.
Family Possibly anyone an LGBTQIA2S+ patient considers close to them.

Often, the biological relatives, legal guardians, and gestational or adoptive parents of people in the LGBTQIA2S+ community reject or refuse to support them without imposing harmful conditions (such as conversion therapy). A "chosen family" can become as or more important than a "bio family."

Nurses can help advocate for their patients by allowing patients to designate whoever they wish as family members or "next of kin" for medical disclosures and other legal and financial records.
Fatphobia Fear, hatred, or discomfort with fatness, usually connected with misperceptions about the connection between health and the amount or distribution of body fat (in dominant cultures in the U.S., this usually means a very little amount of fat).

Please note clinical terms like "morbidly obese" may carry strong negative connotations that interfere with care.

This bias can exist in communities regardless of orientation and gender and adds a layer of stress to anyone who is also subject to discrimination because of other characteristics and identities.

While some patients and colleagues may be committed to body neutrality / acceptance or body positivity, many are not. It can be useful to ask questions and learn whether the patient prefers nurses use alternate phrases like "plus size," "of size," "fluffy," and "larger bodied," or that they use "fat," where the word is neutral or positive and without stigma.
Female A category that includes characteristics associated with sex and reproduction (e.g., internal and external anatomy, hormones, and chromosomes) which can be congenital or developed; not equivalent to "woman."

Though many female human beings are women, not all of them are; also, some women are not female.
Femme Literally, "woman" in French, but used most broadly to refer to members of the LGBTQIA2S+ community of any gender who may present themselves as feminine or embrace femininity.

This word has a great deal of historic and cultural connections. For instance, it can have specific meanings in the lesbian and gay communities as a counterpart for "butch" (a masculine expression), in response to gender binary roles. Additionally, it has been combined with other terms to make new identities, such as "stem" (a blending of "femme" and "stud," a reclamatory identity from Black lesbian communities) and "futch," or a femme butch.

Nurses may find it useful to know these terms but would be advised to clarify what patients wish to have entered in medical histories or how they wish to be described to others. Nurses should get specific consent from patients before using these terms to refer to them.
Fetishization A specific kind of objectification (treating a person as an object or dehumanizing them) in which a person is specifically — perhaps only — valued for some aspect of their existence, whether that is a body part, identity, characteristic, or ability.

People in the LGBTQIA2S+ community are frequently fetishized for their identities and subject to negativity and violence if they do not appear "grateful" that someone "is paying attention to" them. The contradiction in which they are seen as unworthy of attention but also the object of a person's attention is part of the complexity of this concept.

"Tokenization" is related, though perhaps a less intense form of objectification. Nurses may encounter this when someone who is a part of an underrepresented group is valued for the trait that is underrepresented, rather than as a whole person who has other traits and attributes. The person who is being tokenized bears a "burden of representation" for all others who share that one characteristic, even when they may have no other shared needs, preferences, and experiences.
Gay Used sometimes to describe anyone in the LGBTQ+ community and the community in general; the "G" in LGBTQIA2S+ stands for "gay;" see also "homosexual."

It is most narrowly used within a gender binary to refer to men who are interested in romantic or sexual interactions with other men and sometimes women who are interested in romantic or sexual interactions with other women. See also "lesbian."

To maintain credibility and convey respect for others, nurses should avoid using "gay" as a slur or slang in casual conversation (e.g., "that's so gay" to mean weak or effeminate). Please note that some members of the gay community may use the term in a reclamatory way or out of internalized homophobia.
Gender An aspect of a person's social identity (or a "social construct"), including expectations for behavior, appearance, role, and more.

These expectations change over time, geography, culture, and a person's age, race, ethnicity, disability, and any other category of identity.

To reflect an accurate and multicultural understanding that recognizes more than two genders or no gender, nurses should consider using phrases such as "all genders" or "all or no genders" and avoid using "both genders" or "opposite genders."
Gender affirmation / confirmation / (re)assignment surgery and/or therapy Any surgical and/or therapeutic procedure patients undergo with the intention of changing their bodies to reflect their gender identity.

Not all trans people seek these procedures and treatments, and some cis people may seek them, though they may not be recognized as "confirming gender" (e.g., estrogen replacement therapy for osteoporosis).

The idea that there is a fixed set of procedures or changes that "complete" a transformation can be harmful. It may be more important to understand completion as specific to a patient's desired outcome.
Gender binary Concept that defines gender as being limited to two options — "man" and "woman" — and typically views these options as "opposites" (i.e., "binary").
Gender dysphoria Psychological distress of varying intensities specific to the experience of gender, usually but not exclusively because the patient was assigned an incorrect sex and gender at birth and has lived for some time or is living as that incorrect gender.

Nurses should ask about gender dysphoria rather than assume based on their gender assignment status. Some cisgender people experience it, and some transgender people never experience it.

Some patients with body or gender dysphoria (different from dysmorphia, though they may be comorbid) may report feeling they have been "born in the wrong body." Gender dysphoria can be associated with body parts like genitals but also with traits such as height, body fat distribution, and hand or foot size.

The opposite may be "gender euphoria," which patients may feel if they have access to gender-affirming spaces and care.
Gender essentialism A belief that gender is binary and determined by unchangeable biological (physical, physiological, and psychological) characteristics like genitals, chromosomes, or hormones that apply to all human beings.

Nurses who strictly adhere to this framework may face challenges to offering appropriate care or treatment because the framework does not permit complete and accurate scientific and medical information about their patients.

For example, it does not acknowledge known natural variations in reproductive, endocrine, and other systems, and it must account for surgeries, body alterations, traumas, or other changes that have affected those systems as exceptions to an understanding of "normal" (sometimes a result of implicit / subconscious / unconscious bias).

These beliefs, in connection with expectations that people comply with fixed binary gender roles, can limit and cause harm to people of all genders, not just trans, agender, nonbinary, and other gender nonconforming people.
Gender expansive Describes people or settings in which concepts of gender are not limited to a gender binary.
Gender expression How a patient chooses to present, or express, their gender; may include clothing, behavior, hairstyle, vocal inflection, and any other characteristic others can perceive.
Gender fluid / genderfluid Having gender that can change.

Some genderfluid individuals follow a gender binary and shift between being men and women, but gender fluidity can include any gender, including a lack of gender (agender). Variations in gender can occur predictably, in patterns, or at random; rapidly or over long periods of time; and in response to different situations or interactions with others, among other factors.
Gender identity A person's gender; how someone perceives gender; see also "gender."
Gender neutral A place, object, or concept that does not have a gender or where gender is not relevant (e.g., gender-neutral restrooms or toilets are intended for anyone to use, regardless of gender).

It may also describe anyone who does not have a gender identity preference for themselves. They may possibly be "agender."
Gender (binary) nonconforming Not following or aligning with traditional binary gender roles.

A patient can be of any identity, even ones not included in the LGBTQIA2S+ community, and still not conform to the gender binary. For example, those who believe in a gender binary may not trust "male nurses" or "female doctors" because they incorrectly believe sex and gender dictate skill sets that limit people to specific roles in society (in this case, that only men should be doctors and only women should be nurses).

Some consider being part of the LGBTQIA2S+ community as automatically being nonconforming because the perceived "normal" way of being — binary, cisgender, neurotypical, and heterosexual — is so limiting that any divergence qualifies as not conforming to gender expectations or roles. For others, being gender nonconforming requires more intentional and perceivable deviation from gender binary norms (e.g., more than a binary man having long hair or a binary woman having short hair).

The abbreviation "TGNC" stands for trans and/or gender nonconforming and is used to include noncisgender people.
Gender role Set of expectations a society has about how people should be, internally and in relationship to others, on the basis of their gender.

This can include fixed or fluid ideas of how people of specific genders can, cannot, should, and should not express themselves and the consequences when people defy or go against their society's gender-related expectations to varying extents.
Genderqueer A gender identity that does not conform to the gender binary.

Genderqueer people usually reject fixed and stereotypical beliefs about gender and may express their gender outside of common social norms. The reclamation of "queer" as an identity often carries a tone of political resistance.
Genitals Reproductive organs; can be internal or external; gonads.

Nurses may know terms for genitals as presented in texts, but common terms for genitals may carry such gendered connotations that using them can interfere with care. Nurses may wish to familiarize themselves with alternates like "front hole" and "back hole."

It is also common for many, including nurses, to use inaccurate and colloquial language (such as referring to the vulva as the vagina) rather than accurate or self-defined terms.

Nurses are advised to ask patients how they refer to their own body parts.
Gestational parent / partner An alternative to pregnant or birthing person; parent; does not presume gender (the complement can be "nongestational partner/parent").

Parents, guardians, caregivers, and family members who are in the LGBTQIA2S+ community might use the terms "mother," "father," or similar, but they may also have their own terms. Nurses should ask what patients would like to be called and make note of that for themselves and other staff.
Gray (grey) asexuality / graysexuality An orientation between asexuality and allosexuality; can include demisexuality ("demigraysexual") or other combinations of these identities; see also "asexual."
Heteronormative The belief that it is normal for human beings to be "straight" — that humans exist as only one of two genders with fixed characteristics and who are attracted to and desire sexual activity with those of the "opposite" sex (i.e., that men should only be attracted to women and women should only be attracted to men).

This belief usually maintains that these relationships should also be monogamous — with the connected belief that anything else is wrong, "sinful," "sick," or "perverted."
Heterosexual Someone who exists as a gender within a binary (including both cis and trans people) and who experiences attraction to people of a different gender and sex as their own; also "straight."

Some who identify as heterosexual may have romantic or sexual interest in or activity with people of the same gender or sex as their own.
Homosexual A person who is romatically or sexually interested in people of the same sex or gender as their own; can be a neutral synonym for "gay" and "lesbian."

Please note that, in certain phrasings, "homosexual" can also have a negative connotation because of how some dominant religions and their leaders have stigmatized being gay or "homo" and because of the clinical or scientific connotation the word has. Ideally, nurses would not need to use the word "homosexual" in patient care.

Any time a practitioner might want to ask about someone's sexual orientation, it may be worth pausing to identify whether and why that specific information is needed. If it is needed, convey why and offer how the answers will affect the patient's care, as part of getting fully informed consent.

It may also be the case that sexual orientation itself is not relevant, and instead using an anatomical inventory of the patient and their partner(s) could streamline a conversation. For example, if a nurse were to offer contraception, they could ask if the patient and any partners have sperm or eggs or how the patient would like to manage contraception.
Homophobia Hostility, hate, fear, or marginalization of anyone perceived as "homosexual," including straight people who do not conform to gender roles.

When these negative attitudes are conveyed by a member of the LGBTQIA2S+ community toward another member of the community or toward themselves, the underlying feelings could be described as "internalized homophobia."
Honorifics Titles added to names to convey respect or higher status, such as Ms., Miss, Mrs., Mr., sir, and ma'am.

Many honorifics reflect a binary gender or specific job title. Gender-neutral honorifics include Dr., Mx. (sometimes pronounced "mix" or "mixter"), and ranks in military and law enforcement.

Nurses should ask patients how they wish to be addressed rather than assuming that a patient would feel respected by an honorific.
Human milk feeding / breastfeeding / chestfeeding / bodyfeeding Phrases nurses can include or offer in addition to lactation and infant feeding when involving the feeding, nursing, or pumping of human milk.

"Breastfeeding" alone might be fine for many members of the LGBTQIA2S+ community, but for some, it may not connect or may trigger dysphoria or other negative feelings. Using additional terms includes more families and focuses attention on the people, processes, and physiology involved.
Intersectionality / intersectional feminism The theory, coined by Kimberlé Crenshaw, that states elements of a person's identity, such as class, race, sex, and gender, are interconnected, inseparable, and affect each other, and that people are advantaged and disadvantaged because of how these identities relate to the societies in which they live.
Intersex A category that includes natural variations in characteristics associated with sex and reproduction (e.g., internal and external anatomy, hormones, and chromosomes) which can be congenital or developed; can be ambiguous or have traits otherwise associated with both male and female sex variations; the "I" in LGBTQIA2S+ stands for "intersex."

Though it was once widely used, nurses should never use the term "hermaphrodite," which is often considered a slur. Please note some intersex people use it in a reclamatory way. If nurses encounter the term "hermaphrodite" in medical records, patients may appreciate being able to change the term to ones of their own choosing.

Nurses should avoid comparing the frequency of intersex variations in the general population to the frequency of people being born with red hair, a common comparison, as the comparison is Eurocentric and not useful across racial and ethnic groups.

Even if nurses are educated about intersex people, many healthcare systems and institutions often still reflect a lack of awareness about intersex variations in their forms (such as allowing for only "male" and "female" options when asking about "sex"). Patients in this case have no way to disclose their histories. In these situations, nurses can work to update their workplaces.
Kink A "bend" or "twist" in what is seen as conventional human interactions; see also "BDSM."

Kink activities may involve sexual elements or be an element of sexuality for some, but many kink activities are practiced nonsexually and overlap with widely accepted hobbies and forms of movement and expression.

Rather than delve into a patient's nonsexual kink activities, nurses may find it more useful to discuss specific health concerns related to high-risk activities, as they might with a patient involved in activities like martial arts, extreme sports, and dance.

For sexual activities that do involve kink, taking the histories relevant to general sexual interaction is usually sufficient. For mental health providers, it may be worth determining the sense of agency, fulfilment, and support the patient feels with their partners and peer group, much as they might with patients who are not kinky
Lesbian Commonly understood to be a woman who is sexually or romantically attracted to other women; the "L" in LGBTQIA2S+ stands for "lesbian."

Nurses may find it most useful to ask patients to self-identify and make note of those terms, offer a list of labels and allow patients to choose as many as apply, or use an anatomical inventory if more appropriate. This approach can accommodate language shifting as it has with this term within the LGBTQIA2S+ community. For example, some gay women do not identify as lesbians, some nonbinary people do, and some lesbians do not identify as women.
LGBTQIA2S+ Stands for lesbian, gay, bisexual, transgender, queer, questioning, intersex, asexual, two spirit, and those whose identities are not included in the abbreviation.
Lifestyle Typically implies that members of the LGBTQIA2S+ community are choosing to suffer injustices as their orientation when they could instead "just choose to be straight."

For nursing care, it may not be relevant whether people choose or are born with particular orientations, but we advise nurses to avoid presuming either of the two: That all people can choose their sexual orientation or that all people "are born gay" or any other gender identity or orientation and "cannot choose orientation."
Male A category that includes characteristics associated with sex and reproduction (e.g., internal and external anatomy, hormones, and chromosomes) which can be congenital or developed; not equivalent to "man."

Though many male human beings are men, not all of them are; also, some men are not male.
Men who have sex with men (MSM) / women who have sex with women (WSW) Describes patients by behavior or activity rather than using identity labels; MSM and WSW have sex with individuals of the same sex or gender as themselves and may or may not identify as straight, homosexual, or bisexual.

Similarly, you may also encounter other abbreviations for people with other identities using the initial letters of the relevant labels with "L" in the middle for "loving" or who love," such as MLNB for men who love nonbinary people or WLW for women who love women.
Misgender To perceive someone as a different gender or genders than they actually are.

Misgendering becomes evident when someone communicates in a way that reveals their misperception (e.g., addressing a woman as "Sir" or referring to an agender person as a man).
Monogamy A relationship structure in which two people are committed exclusively to each other; not related to gender and orientation

A monogamous person is someone who desires to have only one partner at a time. Some monogamous people require their partners also be monogamous, and some maintain partners who are nonmonogamous.
Neurodivergent Umbrella term for the expanse of identities often originated as mental health and clinical diagnoses or pathologies that have since been reclaimed as neutral and/or positive; as opposed to "neurotypical."

Common examples include being autistic (nonautistics are "allistic"); having depression, anxiety, dyslexia, or variations of post traumatic stress disorder; and for some being queer.
Nonbinary / non-binary Literally, "not binary."

When referring to gender specifically, "nonbinary" can mean the category of all genders and no gender that are neither of the two binary genders (i.e., man and woman), or it can be a specific gender on its own.

Sometimes written and spoken as "enby," but not consistently as "NB" because the latter represents non-Black in many communities. Where communities involve both identities, separating the use of abbreviations can help with clarity.
Nonmonogamy A category of relationship structures in which people are not committed exclusively to one partner; not related to gender and orientation; for some, but not all, this term is synonymous with "polyamory."

A nonmonogamous person is someone who can have more than one partner at a time, regardless of how many partners they have, including when they are unpartnered or single. Some nonmonogamous people require their partners also be nonmonogamous, and some maintain partners who are monogamous. Some nonmonogamous people also identify as swingers, polyamorous, having open relationships, and other phrasings.

The category can also include structures that specify the genders of the partners involved, specific kinds of commitments, or changes in legal or social status like marriage. Polyandry and polygamy are examples. Some nonmonogamous people specify their preferred relationship structure as "relationship anarchy," "ethical nonmonogamy," and more.

If nurses suspect that the course of care may be affected by specific kinds of exposures, we recommend focusing more on navigating the concerns with your patient(s) than on the labeling of the relationship structures involved.
Outing Revealing anything private about someone without their consent.

For someone who is part of the LGBTQIA2S+ community, being outed about their gender, sexual orientation, or any stigmatized part of their identity could result in the person experiencing mild to serious negative consequences including emotional and physical harm (such as assault and death), loss of access to basic needs and social and familial connections (including removing children from the home and job loss), and more.

Nurses can take an active role in protecting the privacy and safety of their patients by helping them understand who has access to information provided on medical records and asking what patients' own practices are on disclosure.
Pansexual Attracted to or interested in having sex with people of all genders; can be combined with other orientations; not related to an individual's desired relationship structure.
Partner Widely accepted way of referring to people in a relationship and can include any kind of relationship; useful because it does not presume gender, orientation, legal status, or type of relationship.

For example, partners can be work colleagues, spouses, significant others, teammates in a sport, companions in specific activities, and so on.

Nurses can use the flexibility of the term to begin a conversation with patients to determine any details relevant to patient care as appropriate.
Polyamorous Having the ability to have more than one romantic and/or sexual partner; separate from gender and orientation; see also "nonmonogamy."

For some, polyamory is the same as nonmonogamy. For others, it is a category of nonmonogamy, and others view them as two different categories.
Polygender, pangender Literally, "multiple gender" and "all gender."

Though specific people may phrase and apply these understandings differently from each other, pangender people may describe their gender as not limited to any specific categories or as being all genders at once.
Pronouns Words used to replace nouns.

"It" should never be used to refer to people unless requested; referring to people using "it" can carry baggage because of how the pronoun has been used to alienate and dehumanize in the past, as with those in the LGBTQIA2S+ community.

Common singular pronouns include she/her/hers and he/him/his, they/them/theirs, xie/xir/xem, elle (pronounced "eh-yeh" as in the Spanish), and siya.

Nurses who are uncertain of a patient's pronouns can ask what pronouns they should use. If that is not an option, nurses can default to using a patient's name or they/them/theirs, keeping in mind that for some, even this option may be misgendering.

Patients may also appreciate if nurses ask how patients would like pronoun misuse to be handled when the patient is present and absent. For example, if other staff use incorrect pronouns, would the patient want the nurse to correct them, and if so, how.

Please note that using the phrase "preferred pronouns" can reflect an inaccurate understanding that people may want different pronouns in different situations. While being able to consent to pronoun usage can protect someone's privacy, the phrasing may also risk trivializing someone's identity as a preference rather than a fact.
QTPOC Stands for queer and/or trans people of color; a related term is QTBIPOC which stands for for queer and/or trans Black, Indigenous, and other people of color.

Not all community members who have these identities support the use of these abbreviations, but they are widely used.

QTIPOC (queer, trans, and/or intersex people of color) is a variation more common outside the United States.
Queer Term that has been reclaimed as it originated as a slur for being different from a heterosexual, cisgender norm; could refer to gender identity, sexual orientation, or both and often used by those who resist norms and the status quo; the "Q" in LGBTQIA2S+ stands for "queer."

Some patients still consider it a slur and hold negative feelings about other members of their communities using it.

Nurses are advised to use it only if they identify as queer themselves or only at the specific request of a queer patient.
Questioning A state of being unsure and seeking answers about one's gender and/or orientation; the "Q" in LGBTQIA2S+ can also stand for "questioning" in addition to "queer."

It is sometimes used as an orientation label (e.g., someone in the process of questioning any element of their identity).
Same gender loving Umbrella phrase, coined by African American activist Cleo Manago, that includes homosexual and bisexual people of any gender as a way to center Black and African diasporic people and cultures.

Some patients may use SGL in addition to other orientations, and some may use it exclusively.
Sex 1. Category relating to potential reproductive characteristics, for which variations may be male, female, and intersex; different from gender.

Nurses are advised to avoid perceiving people in different sex categories as "opposites." Nurses may find it more accurate to use phrasings like "other sexes" or "all sexes."

2. Can also refer to sexual activities

Nurses may find that their colleagues and patients have a wide range of perceptions about what constitutes sex and sexual activity. It may be more practical to have exploratory conversations that discuss specific concerns, opportunities to manage health and risk, and previous or desired behaviors and activities.
Sex assigned / assumed / presumed at birth In the United States, as in many other countries, healthcare workers often presume a baby's sex at or before birth based on the appearance of gential organs and based on the awareness of only two options, male and female. Please note sex and gender are not the same though historically they have been viewed as such.

Some babies may later be identified as intersex, as intersex people may have external genitals that appear binary. Sometimes, babies with ambiguous genitals are categorized as intersex, and efforts are underway to prevent unnecessary surgeries to modify babies' genitals to appear less ambiguous.

Also, typically, when a sex label is assigned, the gender is presumed (i.e., female = girl and male = boy). However, a concept of gender cannot realistically be developed by the child until they have the awareness to form a social identity and express and present gender.

Gender presentation is frequently imposed by parents and other members of the child's social group without children given the opportunity to explore, then affirm the gender assigned to them, or select a different gender or genders.

Because of the routine presumption of gender on the basis of sex, nurses may encounter patients and colleagues who conflate the two. Clarifying the use of terms may be useful, if doing so would be beneficial to the care team and patient's family. However, it is also possible that doing so may create conflict which could interfere with care outcomes. Nurses are advised to proceed carefully and work toward systemic change rather than commit to a fixed idea of correct and incorrect in individual interactions.
Sexual orientation A pattern of sexual attraction toward others; common orientation labels include straight, gay, heterosexual, homosexual, lesbian, bisexual, queer, pansexual, and asexual.

Nurses should avoid referring to this category as "sexual preference," which homophobic, biphobic, and queerphobic people have used to imply that orientation is always a (wrong) choice and can/should be changed.
Sex work Any occupation in which an individual exchanges access to their body, specifically in sexual or eroticized contexts, for something of value to them, usually money.

Community members often disagree about whose work is included and preferred terms for themselves. Some terms that carry social stigma, like "whore," "slut," and "prostitute" have been reclaimed by sex workers themselves and should not be used by those outside the community unless explicitly requested.

Nurses should be cautious about applying any beliefs about sex work without confirming with their patients; some perceptions may apply for some individuals, but not all. Making assumptions without confirming a patient's reality may prevent care providers from being able to offer optimal support.

Common stereotypes or beliefs include that sex work is only done for survival, only women engage in sex work, sex work is only a result of human trafficking, and sex workers would prefer other occupations if they had more choices.

People who advocate for women's rights but do not include sex workers in their advocacy may be labeled "SWERFs," which stands for sex worker exclusionary radical feminists.
Stealth 1. Describes a trans person who exists as their correct gender(s) without disclosing their previous gender history, with the implication that the person can "pass" as cisgender.

This concept exists because of the default belief that cisgender is normal, and anyone who is not cisgender must declare their gender.

2. Also a term for a consent violation that amounts to sexual assault.

It is a practice regardless of gender and orientation in which someone using a barrier (usually a condom) removes it during penetrative sex without their partner knowing.
Straight See "heterosexual."

Nurses may find it useful to ask patients to self-label and describe their sexual activity, rather than assume a patient's sexual orientation.
TERF Stands for trans exclusionary radical feminist.

This label applies to those who advocate for women's rights but excludes trans people. For instance, they might believe trans women are not (biological) women.
Top Usually the person perceived as initiating or giving the action or sensation involved in a sexual interaction (e.g., the person penetrating during penetrative intercourse).

This understanding can be complex and somewhat inconsistent, especially when considering activities that can be associated with domination, like oral sex.

Though common stereotypes of tops may present them as dominant, someone can occupy this role in an interaction separate from any power dynamic — to be specific, tops can also be submissive, power-neutral, or switch roles with partners.
Top surgery Surgical alterations to the upper torso or chest, whether to remove breast or mammary tissue or to augment breasts.
Trans man / transgender man A man who was assigned an incorrect gender at birth.

Some trans men exist within a gender binary, and some claim additional gender identities.

Nurses are recommended to ask each man how to best support him as a patient, as they would a patient of any gender.
Trans woman / transgender woman A woman who was assigned an incorrect gender at birth.

Some trans women exist within a gender binary, and some claim additional gender identities.

Nurses are recommended to ask each woman how to best support her as a patient, as they would a patient of any gender.
Transgender Describes someone who was assigned an incorrect gender at birth; the "T" in LGBTQIA2S+ stands for "transgender."

Generally, this term refers to anyone who is not cisgender, including people who are agender and other nonbinary genders. However, some understand this term to mean only people of binary genders.

Nurses should use this word as an adjective, as in the "transgender community" or a "transgender advocate." We recommend not using the word "transgendered." This can imply a lack of agency for the person and suggest the identity is of the past and not current. Also, used as a noun (as in "a patient who is a transgender") it can create the impression that the speaker or writer is dehumanizing the person. This general rule applies to other identity terms too.
Transition A process during which a transgender person changes one or more aspects of themselves (e.g., their name, pronouns, physiology through surgery or hormone treatment, legal documentation, etc.)

Outdated phrasing includes "cross-sex" therapy.

Nurses may also find different attitudes toward phrases like "FTM" and "MTF" (for "female-to-male" and "male-to-female"). These may conflate sex and gender depending on the elements of transition involved (whether they involve sex characteristics and to what extent those are connected to gender for the patient).

"FTF" and "MTM" can be useful rephrasings, where the person's sex is affirmed and constant while aspects of their identity are altered, but "gender affirming" might be more useful.
Transphobia / transantagonism Fear, hatred, stigmatization, or erasure of transgender people whether active or passive.

Transphobia often leads to harassment, violence (both individual and institutionalized), and a lack of intervention or appropriate protections for transgender people.
Transracial Refers to adoption "across" or "outside" one racial category; not someone who decides they "feel like" or "should be" of a different race than they or their biological parents are.

Nurses may encounter this term not only because families in the LGBTQIA2S+ community sometimes adopt transracially, but also because some undermine the idea of gender as a social construct that can be self-identified by comparing it to the construct of race, which cannot be changed because of an individual's preferences (though it can change in different cultural settings).
Transsexual An outdated term for a transgender person, an individual who lives as a different sex than they were assigned at birth.

While still proudly used by some in the LGBTQIA2S+ community, nurses should default to "transgender."
Two Spirit Umbrella term intended to describe an individual of a nation, band, tribe, community, or culture indigenous to Turtle Island (North America) who exists outside the gender binary imposed by European settlers; the "2S" in LGBTQIA2S+ stands for "two spirit"

Identifying people as having two or more spirits is not exclusive to Turtle Island communities, but the use of this phrase in English is generally meant to refer to them. However, sometimes it is simplified as being an Indigenous, First Nations, or Native American person who possesses both femininine and masculine spirits.

Please note it is not considered the same as being gay and/or transgender, but the identities may be linked for specific people. Also, not all people claim a two spirit identity.

Nurses should take care to honor the specific genders and orientations of the cultures of their patients rather than potentially allow this phrase to erase them.


Related Resources


Written by:

A queer Asian gender-binary nonconforming parent, Angelique Geehan founded Interchange, a consulting group that offers anti-oppression support through materials and process assessments, staff training, and community building. Geehan works to support and repair the connections people have to themselves and their families, communities, and cultural practices.

She organizes as a part of National Perinatal Association's Health Equity Workgroup, the Health and Healing Justice Committee of the National Queer and Trans Asian and Pacific Islander Alliance, the Houston Community Accountability and Transformative Justice Collective, the Taking Care Study Group, QTPOC+ Family Circle, and Batalá Houston.

Geehan is a paid member of our Healthcare Review Partner Network. Learn more about our review partners.


Featured Image: Juanmonino / E+ / Getty Images

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