Finding gender-affirming healthcare providers can be difficult. Many providers lack knowledge and training on the needs and experiences, can be discriminatory, and often have no indication when entering the facility that the provider is gender-affirming.
Cisgender has nothing to do with an individual’s sexual orientation. Therefore how do sex and gender differ and where does cisgender fall within the spectrum of gender identities?
Cisgender is a segment of the larger spectrum of gender identities. Also referred to as “cis,” it describes an individual whose gender identity corresponds to the sex they were assigned at birth. Therefore if an individual assigned sex at birth is female and identifies as a girl or a woman they are a cisgender woman.
The term describes how a person sees themselves and helps others communicate more accurately and respectfully.
Although many individuals may identify as cisgender, a cisgender person is not typical nor has qualities or characteristics that inherently differentiate them from a person of other gender identities.
Cisgender women commonly use the pronouns she and her.
A common mistake is using the term cis-gendered.
The proper usage of the term is cisgender.
Sex and Gender Differences
The terms sex and gender are often used interchangeably, however, they are not the same.
Sex is a biological and physiological designation based on an individual’s sex chromosomes and sexual organs.
This includes an individual’s genitals and sex organs.
It also encompasses secondary characteristics – like body size, bone structure, breast size, and facial hair – that are regarded as female or male.
Gender is a social construct that refers to roles and behaviors that society assigns as being masculine or feminine. The construct infers behaviors that are accepted or appropriate based on how an individual behaves, speaks, dresses, sits, etc.
Gender titles include sir, ma’am, mister, or miss.
Pronouns ។ include him, she, he, and her.
តួនាទី include actress, actor, prince, and princess.
Many of these suggest a power hierarchy of who has it and who does not.
Cisgender women often fall victim to these dynamics.
Refers to an individual’s chromosomes and the way that their genes are expressed.
Typically described in terms of male and female characteristics or the sex assigned at birth.
A social construct.
Refers to the social roles, behaviors, and expectations considered and/or deemed appropriate for men and women.
Historically defined as masculine and feminine, however, definitions can change as society changes.
Gender Identities Glossary
Today, gender is viewed as a spectrum where an individual might identify as one gender, more than one gender, or no gender. The definitions are often subtle and can often overlap, co-exist, and/or change. Gender identities include:
An individual whose gender identity matches their assigned sex at birth.
An individual whose gender identity does not align with their assigned sex at birth.
An individual who feels their gender identity cannot be defined.
An individual who experiences a partial, but not full/complete connection to a particular gender.
An individual who feels neither male nor female.
Similar to non-binary but infers refusal of societal expectations.
Non-binary similarities but focuses on abandoning gender labels.
An individual who experiences multiple genders or shifts between genders.
An individual who experiences or expresses more than one gender.
An individual who identifies with all genders.
Third gender is a concept in which individuals are categorized, either by themselves or by society, as neither male nor female, not ការផ្លាស់ប្តូរ.
They are a different gender altogether.
A Native American term describing someone who is male and female or of two spirits simultaneously.
Cis Woman Identity
The terms cis woman or cis female are used to describe individuals who were assigned female at birth and identify as a woman or female. For cisgender woman, this means their gender identity aligns with their primary sex organs and secondary sex traits that include:
Higher pitch voice.
Broadening of hips.
It can also involve cisnormativity – a concept that everyone identifies as the gender they were assigned at birth. This could inform how a cis woman is expected to dress and act. An even more extreme concept is gender essentialism – this is the belief that gender differences are rooted purely in biology and cannot be changed. However, even cisnormativity beauty standards can influence the perceptions of transgender women that end up reinforcing gender stereotypes. (Monteiro D, Poulakis M. 2019)
Cisgender privilege is the concept that individuals who are cisgender receive added benefits compared to individuals who don’t conform to the gender binary norm. This includes cisgender women and men. Privilege happens when a cisgender individual assumes they are the norm and consciously or unconsciously takes action against those who are outside the definition of masculine and feminine. Examples of cisgender privilege include:
Not being denied work and social opportunities because of not fitting into the boy’s or girl’s club.
Not having to have sexual orientation questioned.
Not being denied healthcare due to provider discomfort.
Not fearing that civil rights or legal protections will be taken.
Not worrying about being bullied.
Not having to worry about attracting questioning looks in public.
Not being challenged or questioned about the clothes being worn.
Not being demeaned or mocked because of pronoun use.
Moleiro, C., & Pinto, N. (2015). Sexual orientation and gender identity: review of concepts, controversies and their relation to psychopathology classification systems. Frontiers in Psychology, 6, 1511. doi.org/10.3389/fpsyg.2015.01511
Gender identity is a wide spectrum. Can learning the language used to describe various gender identities and non-binary pronouns help explain the difference between gender expression and help in inclusivity?
Non-binary is a term used that describes individuals who do not identify exclusively as male or female. The term addresses various gender identities and expressions that are outside of the traditional gender binary system, which categorizes individuals as either male or female.
Non-binary individuals are those whose gender identity and/or expression fall outside of the traditional binary categories of a man or woman. (Human Rights Campaign. (n.d.))
Some non-binary individuals identify as a blend of male and female; others identify as a gender different from male or female; some do not identify with any gender.
The term “non-binary” can also be “enby”/phonetic pronunciation of the letters NB for non-binary, although not every non-binary individual uses this term.
McCave, EL, Aptaker, D., Hartmann, KD, & Zucconi, R. (2019)។ ការលើកកម្ពស់ការអនុវត្តការថែទាំសុខភាពអ្នកប្តូរភេទដែលមានការបញ្ជាក់នៅក្នុងមន្ទីរពេទ្យ៖ ការក្លែងធ្វើអ្នកជំងឺតាមស្តង់ដារ IPE សម្រាប់អ្នកសិក្សាផ្នែកថែទាំសុខភាពដែលបានបញ្ចប់ការសិក្សា។ MedEdPORTAL, 15, 10861 ។ doi.org/10.15766/mep_2374-8265.10861
Morris, M., Cooper, RL, Ramesh, A., Tabatabai, M., Arcury, TA, Shinn, M., Im, W., Juarez, P., & Matthews-Juarez, P. (2019) ។ ការបណ្តុះបណ្តាលដើម្បីកាត់បន្ថយភាពលំអៀងទាក់ទងនឹង LGBTQ ក្នុងចំណោមនិស្សិតពេទ្យ ពេទ្យគិលានុបដ្ឋាយិកា និងទន្តបណ្ឌិត និងអ្នកផ្តល់សេវា៖ ការពិនិត្យឡើងវិញជាប្រព័ន្ធ។ BMC Med Educ, 19(1), 325 ។ doi.org/10.1186/s12909-019-1727-3
Sherman, ADF, Cimino, AN, Clark, KD, Smith, K., Klepper, M., & Bower, KM (2021)។ ការអប់រំសុខភាព LGBTQ+ សម្រាប់គិលានុបដ្ឋាយិកា៖ វិធីសាស្រ្តប្រកបដោយភាពច្នៃប្រឌិតក្នុងការកែលម្អកម្មវិធីសិក្សាគិលានុបដ្ឋាយិកា។ គិលានុបដ្ឋាយិកា Educ ថ្ងៃនេះ, 97, 104698 ។ doi.org/10.1016/j.nedt.2020.104698
Gender is a concept with many facets. Everyone has a gender expression. Can learning about gender expression help healthcare professionals provide better and more effective treatment plans for the LGBTQ+ community?
Gender expression refers to the ways that individuals present their gender identity and themselves. This can be clothing, haircuts, behaviors, etc. For many, there can be confusion between what society expects from their gender and how these individuals choose to present themselves. Gender expression is constructed from the culture that surrounds it, meaning that there may be a shared social expectation about gender. It can also mean that the same feminine hair or clothing style in one setting could be seen as masculine in another.
Society tries to regulate expression by making women wear certain kinds of clothes, and men other kinds, in order to participate in school, work, and when in public.
When cultures enforce gender norms it is known as gender policing, which can range from dress codes to physical and emotional punishment.
Creating a safe space for all genders requires awareness of these explicit or implicit gender norms so policing can be prevented. (José A Bauermeister, et al., 2017)
Research has shown that there are increased rates of discrimination against transgender and gender-nonconforming individuals compared with bias against those who are LGBTQ. (Elizabeth Kiebel, et al., 2020)
Gender expression can and does affect access to and quality of health care.
Individuals with a gender expression that is different from what is expected for their assigned sex at birth may experience increased bias and harassment from providers. (Human Rights Watch. 2018)
Minority stress has been shown to play an important role in health imbalances. (I H Meyer. 1995)
Research suggests that gender expression is a part of the minority stress described by cisgender sexual minorities and gender minorities. (Puckett JA, et al., 2016)
The effects of gender expression are different depending on a person’s sex, gender identity, and their setting.
However, doctors do need to know a person’s sex that was assigned at birth to be able to do proper screening tests, like screening for prostate or cervical cancer.
One way to be more affirming is for the doctor to introduce themselves first, using their own pronouns.
Health workers should ask everyone what name they prefer to be called and what pronouns they use.
This simple act invites the patient to share without creating awkward uneasiness.
Each person chooses how to present themselves to the world, and we respect all. We at Injury Medical Chiropractic and Functional Medicine Clinic will work to address the effects of minority stress on health disparities and raise awareness of the ways to continually improve positive experiences for LGTBQ+ individuals seeking inclusive health care for neuromusculoskeletal injuries, conditions, fitness, nutritional, and functional health.
Bauermeister, J. A., Connochie, D., Jadwin-Cakmak, L., & Meanley, S. (2017). Gender Policing During Childhood and the Psychological Well-Being of Young Adult Sexual Minority Men in the United States. American journal of men’s health, 11(3), 693–701. doi.org/10.1177/1557988316680938
Kiebel, E., Bosson, J. K., & Caswell, T. A. (2020). Essentialist Beliefs and Sexual Prejudice Toward Feminine Gay Men. Journal of homosexuality, 67(8), 1097–1117. doi.org/10.1080/00918369.2019.1603492
Human Rights Watch. “You Don’t Want Second Best”—Anti-LGBT Discrimination in US Health Care.
Ayhan, C. H. B., Bilgin, H., Uluman, O. T., Sukut, O., Yilmaz, S., & Buzlu, S. (2020). A Systematic Review of the Discrimination Against Sexual and Gender Minority in Health Care Settings. International journal of health services: planning, administration, evaluation, 50(1), 44–61. doi.org/10.1177/0020731419885093
Meyer I. H. (1995). Minority stress and mental health in gay men. Journal of health and social behavior, 36(1), 38–56.
Puckett, J. A., Maroney, M. R., Levitt, H. M., & Horne, S. G. (2016). Relations between gender expression, minority stress, and mental health in cisgender sexual minority women and men. Psychology of Sexual Orientation and Gender Diversity, 3(4), 489–498. doi.org/10.1037/sgd0000201
Regarding inclusive health care, many healthcare providers must respect their patients and their needs when coming in for a general check-up. Since many individuals in the LGBTQ+ community are already dealing with enough stress, especially young people, it is important to have a calm, safe, and non-judgmental environment promoting safety and inclusion. (Diana & Esposito, 2022) មានមធ្យោបាយជាច្រើនដែលរួមបញ្ចូលការថែទាំសុខភាពអាចផ្តល់លទ្ធផលជាប្រយោជន៍ដល់បុគ្គលនិងអ្នកផ្តល់សេវាថែទាំសុខភាព។ មួយចំនួនអាចរួមបញ្ចូល៖