It is June, so it is officially Pride Month! Pride Month is a time to forward the inclusion and representation of the 2SLGBTQIA+ (Two Spirit, lesbian, gay, bisexual, transgender, queer/questioning, intersex and asexual/aromantic) community, and for people to celebrate who they are. Here at TARGet Kids! (TK!), we are committed to equity, diversity, and acceptance all year round, and are not limited to one month of the year. We understand the importance of gender and sexual identity in child and adolescent development, and hope to continue to amplify queer voices and perspectives, especially in paediatric health research.
Gender versus Sex
Gender is a social construct and is referred to as a person’s identity of being male, female, a combination of both, or neither. (Giordano, 2019). Sex, or more specifically, sex assigned at birth, describes the complex medical identification of male, female, or intersex based on physiological factors, including chromosomal observations, hormones, and internal and external reproductive structures (Freeman & Ayala López, 2018).
Some people prefer to label their gender, or not at all, and that’s okay too! Examples of gender identities are as follows:
Cisgender: A person whose gender aligns with their sex assigned at birth.
Transgender: A person whose gender does not align with their sex assigned at birth.
Agender: A person who does not have a gender, or is gender-neutral.
Gender fluid: A person whose gender changes along one’s lifespan.
Non-binary: A person who does not identify exclusively within the gender binary, or as solely male or female (Giordano, 2019).
Gender Dysphoria and Expression
Gender dysphoria describes the uncomfortability or unease that one may potentially experience regarding the conflicting nature of one’s sex assigned at birth and their gender identity (Ervin et al., 2023; Giordano, 2019). On the other hand, gender expression refers to the way in which one decides to present appearance-wise, behaviourally, or with one’s name, amongst other variables. This may or may not align with their gender identity.
Sexual Orientation and Romantic Orientation
Sexual and romantic orientation often come hand-in-hand, but the terms refer to different types of attraction and can be independent of one another (Diamond, 2003). Sexual orientation describes one’s sexual attraction to a specific gender, genders, or none at all. The same can be said for romantic orientation, but with romantic attraction (Li et al., 2022).
Some examples of sexual or romantic orientations are as follows:
Lesbian: This term describes someone who identifies as a woman, feminine-presenting, or non-binary who is attracted to other people who also identify as a woman, feminine-presenting, or non-binary.
Gay: This term describes someone who identifies as a man, masculine-presenting, or non-binary who is attracted to other people who also identify as a man, masculine-presenting, or non-binary.
Bisexual/Biromantic: These two labels describe either a sexual or romantic attraction to two or more genders.
Pansexual/Panromantic: These two labels describe either a sexual or romantic attraction to others, regardless of gender considerations.
Asexual/Aromantic: These two labels describe either a lack of sexual or romantic attraction one experiences.
Queer: Queer is an overarching term for being a part of the 2SLGBTQIA+ community.
Questioning: This refers to someone who is in the process of figuring out their preferences and attraction to others with regards to gender and/or gender expression (Ervin et al., 2023; Hayfield & Křížová, 2021).
Two Spirit
Being Two Spirit is a term used within an Indigenous framework and understanding of gender which describes an intersectional approach to sex, gender, sexuality and romantic attraction outside the confines of a Westernised lens (Dykhuizen et al., 2022). Although Two Spirit may be defined differently depending on the Indigenous culture and tribe, Two Spirit people were important contributors in their communities and were highly esteemed. Today, Two Spirit people face oppression and experience disparities, particularly in health, as a result of colonisation. Efforts are needed to lessen knowledge gaps, as well as achieve a more comprehensive and holistic approach to supporting Two Spirit people in their wellbeing (Dykhuizen et al., 2022). Understanding the interrelatedness of physical, mental, emotional and spiritual health, as well as integrating Indigenous teachings of balance and healing will help to improve the livelihood of the Two Spirit community.
Significance of Gender and Sexuality in Paediatric Healthcare
Gender and sexual minority youth are at risk of health disparities, including mental, social, emotional and physical health problems, and these issues are only exacerbated by barriers in healthcare and other social determinants, like religion and ethnicity (Hafeez et al., 2017; Mayer et al., 2008). Therefore, efforts are needed to address these health concerns within the field of research and paediatric care.
Efforts can be as simple as paediatricians having a confidential discussion regarding gender and sexuality at regular health assessments which, in turn, allows adolescents to feel more comfortable disclosing their identities and build rapport with healthcare professionals (Lau et al., 2021). As a result of this conversation, healthcare professionals are able to improve care by adopting a more collaborative, supportive, and gender-affirming approach for their patients and subsequent families. Another way to support children exploring their identities, particularly transgender youth, can be as simple as providing educational resources to learn more about gender, sexuality, coping skills, and resilience (Boskey, 2014; Harrison, 2003).
By acknowledging and validating the experiences of 2SLGBTQIA+ children in a culturally-sensitive way, gaps in accessibility and representation may be bridged, as well as improve the quality of life of developing queer youth (Craig et al., 2021; Boskey, 2014).
TARGet Kids! Goals
In collaboration with adolescent health researchers, our current healthy youth catalyst grant will examine the relationship between screen use and sexual health behaviours and risks in Canadian adolescents and utilize youth participatory action research methods to identify potentially modifiable risk factors (Principal Investigators: Drs. Alene Toulany and Ashley Vandermorris).
TK! has been diligent in including biological sex in its data collection and research findings. Currently, we are actively reviewing our tools for gender identity to enhance inclusivity in our surveys. It is essential to acknowledge that while our research necessitates considering sex as a biological variable, we recognize the distinction between sex and gender identity. These two aspects have diverse impacts on physical and mental health, and overall well-being. Our commitment is to conduct research that does not undermine gender identity but rather supports the comprehensive biopsychosocial needs of all children and families.
2SLGBTQIA+ Children’s Books Recommendations
Phoenix Gets Greater by Marty Wilson-Trudeau (Author)
What Makes a Baby? by Cory Silverberg (Author), Fiona Smyth (Illustrator)
Sex Is a Funny Word: A Book about Bodies, Feelings, and YOU by Cory Silverberg (Author), Fiona Smyth (Illustrator)
My Shadow is Pink by Scott Stuart (Author)
Love Makes a Family by Sophie Beer (Author)