Gender and Sexual Identity

Terms and Definitions

Sex and Sexual Identity

Sex is multifaceted, with at least 9 components: chromosomal sex, gonadal sex, fetal hormonal sex (prenatal hormones produced by the gonads), internal morphologic sex (internal genitalia), external morphologic sex (external genitalia), hypothalamic sex (sex of the brain), sex of assignment and rearing, pubertal hormonal sex, and gender identity and role. Sexual identity is a self-perceived identification distilled from any or all aspects of sexuality and has at least 4 components: sex assigned at birth, gender identity, gender expression, and sexual orientation.

Sex Assigned at Birth

A newborn is assigned a sex before (typically through ultrasound) or at birth based on the external genitalia (natal sex). In case of a disorder of sex development (intersex) , these genitalia may appear ambiguous, and additional components of sex (e.g., chromosomal, gonadal, hormonal sex) are assessed. In consultation with specialists, parents assign the child a sex that they believe is most likely to be consistent with gender identity, which cannot be assessed until later in life (see Chapter 606 ).

Gender Terms

Gender identity refers to a person's basic sense of being a boy/man, girl/woman, or other gender (e.g., transgender, genderqueer, nonbinary, gender fluid). Gender role refers to one's role in society, typically the male or female role. Gender identity needs to be distinguished from gender expression , which refers to characteristics in personality, appearance, and behavior that are, in a given culture and time, considered masculine or feminine. Gender role is about one's presentation as a boy/man or girl/woman, whereas gender expression is about the masculine and/or feminine characteristics one exhibits in a given gender role. Both boys/men, girls/women, and transgender, genderqueer, or nonbinary persons can be masculine and/or feminine to varying degrees; gender identity and gender expression are not necessarily congruent. A child or adolescent might be gender nonconforming , that is, a predominantly feminine boy or a predominantly masculine girl.

Sexual Orientation and Behavior

Sexual orientation refers to attractions, behaviors, fantasies, and emotional attachments toward men, women, or both. Sexual behavior refers to any sensual activity to pleasure oneself or another person sexually.

Transgender

Transgender people are a diverse group of individuals whose gender identity differs from their sex assigned at birth. They include transsexuals (usually referred to as transgender) (who typically live in the other gender role and seek hormonal and/or surgical interventions to modify primary or secondary sex characteristics); cross-dressers (who wear clothing and adopt behaviors associated with the other sex for emotional or sexual gratification and may spend part of the time in the other gender role); drag queens and kings (female and male impersonators); and individuals identifying as genderqueer (differently gendered), nonbinary (neither male nor female, both, or in-between), or gender fluid (not fixed but changing). Transgender individuals may be attracted to men, women, or other transgender persons.

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