14.5.1 What do we mean by “Sexual Orientation?”

Sexual Orientation is an umbrella term that is used to refer to patterns of attraction—sexual, romantic, or both. Under this umbrella, individuals may assort themselves into categories such as gay, heterosexual, bisexual, pansexual, or asexual.

14.5.1.1 “Queer,” “Bisexual,” “Pansexual,” “Polyamorous,” “Asexual”

Queer as an identity term refers to a noncategorical sexual identity; it is also used as a catch-all term for all LGBTQ (lesbian, gay, bisexual, transgender, queer) individuals. The term was historically used in a derogatory way, but was reclaimed as a self-referential term in the 1990s United States. Although many individuals identify as queer today, some still feel personally insulted by it and disapprove of its use.

Bisexual is typically defined as a sexual orientation marked by attraction to either men or women. This has been problematized as a binary approach to sexuality, which excludes individuals who do not identify as men or women. Pansexual is a sexual identity marked by sexual attraction to people of any gender or sexuality.

Polyamorous (poly, for short) or non monogamous relationships are open or nonexclusive; individuals may have multiple consensual and individually-negotiated sexual and/or romantic relationships at once (Klesse, 2006).

Asexual is an identity marked by a lack of or rare sexual attraction, or low or absent interest in sexual activity, abbreviated to “ace” (Decker, 2014). Asexuals distinguish between sexual and romantic attraction, delineating various sub-identities included under an ace umbrella. https://core.ac.uk/download/pdf/268096211.pdf

You’ll find an excellent overview of terms at: https://pflag.org/glossary/

You’ll note from the definitions the use of qualifiers such as “may,” and “often.” This pattern should serve as a clue that sexual orientation is complicated, and our understanding of the diversity of presentations is quickly changing.

You can also check out this helpful Ally’s Guide to Terminology here.

14.5.2 Is sexual orientation influenced by the environment?

Several studies have found correlations between same-sex sexual preferences and environmental conditions. In this case the “environment” can be the uterine environment, and refer to conditions during fetal development, or the environment can refer to conditions after birth.

The literature on post-birth experiences, and their impacts on sexual orientation, is challenging for many reasons, but largely because it is so difficult to disentangle the impact of a tolerant environment on someone’s inclination to express their homosexuality. For example, there has been work suggesting that children of gay parents are more likely to grow up expressing same-sex sexual preferences (Gartrell et al., 2018). Is this because growing up in a gay family actually influences an individual’s sexuality, or because a family that is accepting of homosexuality creates a safe space for a gay or bisexual individual to express their sexuality?

Somewhat more compelling is the work on the prenatal environment and homosexuality. According to many of these studies, differential exposure to prenatal hormones, specifically testosterone, influences sexuality later in life. Research continues to explore links between the timing and intensity of hormone exposure in utero, particularly testosterone, and sexual orientation in adulthood.

Like many aspects of human development, the cause of a person’s sexual orientation is a complex and personal process. We may never understand the exact scientific or sociocultural factors that drive the process of sexual orientation development. However, only asking “when did you know you were gay?” without also asking “when did you know you were straight?” is more likely to lead to bias in research findings and the way we think about variances in how each of us develops.

14.5.3 Coming Out

The benefit and buffering effects of coming out have been well established in the literature (Stirratt et al., 2007; Cass, 1984; Troiden, 1989). Meyer’s LGBTQ Minority Stress model (see Frost, click here for more) connects minority identification with positive outcomes in terms of coping and social support resources necessary to address minority stress, but it also highlights how minority identification is related to minority stressors within the individual such as expectations of rejection, concealment, and internalized homophobia. In addition, identification and community connectedness can increase visibility, which may increase vulnerability to things like employment discrimination, harassment, and violence (Meyer, 2003).

Review this resource on the coming out process by the University of Washington.

Realize that it may not always be safe to come out to others due to concerns around physical or emotional safety, loss of housing, unsafe living situations, among other difficult situations. Every individual must weigh the pros and cons of coming out because the people around us may not always react in supportive ways.

Also, keep in mind the role of an ally is to not out someone to others. It is up to the individual to tell others about their identity, and we could even cause them physical or emotional harm if we expose them to others. Do not do this without the person’s express and direct permission beforehand.

14.5.3.1 When did you know you were straight? Bias in adolescent romantic relationships

Individuals who identify as nonheterosexual are often asked how or when they knew they were gay. But this question would seem odd if posed in reverse: when did you know you were straight? That’s because heterosexuality is widely accepted as “normal” whereas other sexual orientations are more likely to be thought of as a deviation from the normal. In other words, if someone is not straight, there must be a reason for the difference. This assumption, that heterosexuality is normal, also leads to questions about what causes homosexuality, and subsequently, other sexual orientations. A common question may be “Is homosexuality genetic?” Asking this question is a bit like asking, “Are we born gay? Or straight?”

This question can be problematic for some, because the motivation for asking the question may not be scientific. For example, individuals who have a social problem with homosexuality may be motivated to see sexual orientation as a choice, making homosexuality a characteristic one could choose not to exhibit. And in recent history, eugenicists (individuals who promote selective reproduction among “favored” types of humans) used a presumed genetic basis for homosexuality as an argument in favor of sterilizing gay people. The question can also be problematic because the stated or implied focus is typically on the cause of homosexuality, rather than heterosexuality. But, for now, let’s focus on the biology of homosexuality’s origins. While no serious scientist is claiming that same-sex mating preferences arise in a simple Mendelian fashion, or that there is a single “gay gene,” many have found evidence of a possible genetic basis. Some intriguing data are from the literature on twins. For example, researchers discovered that identical twins (who arise from the same sperm and egg, and have nearly 100 percent identical genetics) are more alike with respect to sexual orientation than are nonidentical twins (who arise from different eggs and sperm) (Roselli, 2018). However, identical twins don’t overlap completely in sexual preferences, a finding that suggests other factors—besides genetics—may be at work.

14.5.4 Sexual exploration and activity

14.5.4.1 Practicing safe sex

A report by the National Center for Health Statistics (NCHS) of data gathered between 2015-2107 found that 42% of female adolescents and 38% of male adolescents have had sexual intercourse by the age of 19. This is a decline from 2017 where it was found that more than half (55%) of male and female adolescents had had sexual intercourse by the end of high school (NCHS, 2020). It was also found that the majority of sexually active adolescents were using birth control methods. For sexually active adolescents, practicing safe sex is not only important for physical health, reducing risk of sexually transmitted diseases and unwanted pregnancies, but emotional health as well and can help adolescents build healthy relationships. The report found that 78% of females and 89% of males aged 15–24 who had their first sexual intercourse before age 20 had used a form of birth control at their first sexual intercourse (NCHS, 2020). For more information on the National Center for Health Statistics report, please visit this link: Sexual Activity and Contraceptive Use Among Teenagers in the United States: 2015-2017.

14.5.4.2 Access to birth control

The most commonly used birth control among adolescents are condoms (97%), withdrawal (65%), and birth control pills (53%) (NCHS, 2020). Birth control that does not require a doctor’s prescription, such as condoms or spermicide, is the most readily available for adolescents as it can be purchased from drugstores. Other forms of birth control, such as prescription birth control, may be available to adolescents without their parents’ consent. Here is a link to adolescents’ access to contraception by state: Minors’ Access to Contraceptive Services.

14.5.5 Teen Pregnancy

14.5.5.1 Teen parents

Birth rates and pregnancy rates for adolescents in the United States have been declining in recent decades.

By 2018 the birth rate and pregnancy rates for adolescents in the United States dropped 72% from the peak in 1991. Although adolescent pregnancy rates have declined since 1991, teenage birth rates in the United States are higher than most developed countries (NCHS, 2020).

14.5.5.2 Risk Factors for Teen Pregnancy

Miller, Benson, and Galbraith (2001) found that parent/child closeness, parental supervision, and parents’ values against teen intercourse (or unprotected intercourse) decreased the risk of adolescent pregnancy. In contrast, residing in disorganized/dangerous neighborhoods, living in a lower SES family, living with a single parent, having older sexually active siblings or pregnant/parenting teenage sisters, early puberty, and being a victim of sexual abuse place adolescents at an increased risk of adolescent pregnancy.

14.5.5.3 Consequences of Teen Pregnancy

After the child is born life can be difficult for a teenage mother. Only 40% of teenagers who have children before age 18 graduate from high school. Without a high school degree her job prospects are limited and economic independence is difficult. Teen mothers are more likely to live in poverty, and more than 75% of all unmarried teen mother receive public assistance within 5 years of the birth of their first child. Approximately, 64% of children born to an unmarried teenage high-school dropout live in poverty. Further, a child born to a teenage mother is 50% more likely to repeat a grade in school and is more likely to perform poorly on standardized tests and drop out before finishing high school (March of Dimes, 2012).

Research analyzing the age that men father their first child and how far they complete their education have been summarized by the Pew Research Center (2015) and reflect the research for females. Among dads ages 22 to 44, 70% of those with less than a high school diploma say they fathered their first child before the age of 25. In comparison, less than half (45%) of fathers with some college experience became dads by that age. Additionally, becoming a young father occurs much less for those with a bachelor’s degree or higher as just 14% had their first child prior to age 25. Like men, women with more education are likely to be older when they become mothers.

14.5.5.4 Educational programs

Comprehensive sex education in middle schools and high schools is critical in allowing adolescents to make educated, informed, and responsible decisions about their sexual health. Due to education and increased use of contraception, the pregnancy rates and birth rates have declined to a historic low for adolescents in the United States (CDC, 2019). Educational programs offer education tools on contraception, sexually transmitted diseases, information about understanding consent and sexual assault, and helping adolescents set life goals around if or when they want to have children (Planned Parenthood, 2017). Educational programs such as these have been found to delay sexual activity, and lower pregnancy and birth rates among adolescents (Planned Parenthood, 2017). For more information regarding educational programs, please visit this link: Planned Parenthood.

14.5.6 Intimate Partner Violence

Intimate Partner Violence (IPV) can include physical violence, sexual violence, stalking, and physical aggression by a current or former intimate partner (CDC, 2021). IPV not only affects adult partners but is a prevalent issue in adolescent intimate couples as well and is also referred to as Teen Dating Violence (TDV). A survey which was conducted in 2019 and asked U.S. high school students about their dating experience in the previous 12 months, found that about 1 in 12 adolescents who were dating experienced physical dating violence and about 1 in 12 experienced sexual dating violence (CDC, 2019). Female students reported higher rates of experiencing sexual and physical dating violence than male students. Students who identified as LGBTQ – gay, lesbian, bisexual, queer, and transexual students – reported experiencing higher rates of dating violence than students who identified as heterosexual (CDC, 2019).

Even though this is a prevalent issue in adolescent dating, it is not discussed enough, and adolescents are often afraid of letting others know about the violence they have endured. It is important to be aware of this issue and to provide support for survivors of violence as the consequences of violence in adolescent intimate relationships include depression, anti-social behavior, substance abuse, and thoughts of suicide. Being in a violent intimate relationship during adolescence may also lead to continuing to be in violent relationships throughout adulthood (CDC, 2019).

For more information about teen dating violence and ways to prevent it, please visit this link: CDC Teen Dating Violence.

14.5.7 What is gender identity?

From birth, children are assigned a gender and are socialized to conform to certain gender roles based on their biological sex. “Sex,” refers to physical or physiological differences between males, females, and intersex persons, including both their primary and secondary sex characteristics. “Gender,” on the other hand, refers to social or cultural distinctions associated with a given sex. When babies are born, they are assigned a gender based on their biological sex—male babies are assigned as boys, female babies are assigned as girls, and intersex babies are born with sex characteristics that do not fit the typical definitions for male or female bodies, and are usually relegated into one gender category or another. Scholars generally regard gender as a social construct, meaning that it doesn’t exist naturally but is instead a concept that is created by cultural and societal norms. From birth, children are socialized to conform to certain gender roles based on their biological sex and the gender to which they are assigned. A person’s subjective experience of their own gender and how it develops, or gender identity, is a topic of much debate. It is the extent to which one identifies with a particular gender; it is a person’s individual sense and subjective experience of being a man, a woman, or other gender. It is often shaped early in life and consists primarily of the acceptance (or nonacceptance) of one’s membership into a gender category. In most societies, there is a basic division between gender attributes assigned to males and females. In all societies, however, some individuals do not identify with some (or all) of the aspects of gender that are assigned to their biological sex. Those that identify with the gender that corresponds to the sex assigned to them at birth (for example, they are assigned female at birth and continue to identify as a girl, and later a woman) are called cisgender. In many Western cultures, individuals who identify with a gender that is different from their biological sex (for example, they are assigned female at birth but feel inwardly that they are a boy or a gender other than a girl) are called transgender. Some transgender individuals, if they have access to resources and medical care, choose to alter their bodies through medical interventions such as surgery and hormonal therapy so that their physical being is better aligned with their gender identity.

14.5.7.1 Gender identities

Sex and gender are often confused for one another and are used interchangeably in many circumstances; however, these are distinct concepts. Sex depends on chromosomes, genetics, hormones, hormone receptors, gonads, and epigenetic factors, and secondary sex characteristics continue to unfold during puberty and throughout our lifespans impacting the way that our physical bodies look and feel. Female, intersex, and male bodies exist on a continuum of possibilities. Gender, on the other hand, is a social construct based on gender roles, expectations around behavior, stereotypes concerning vague concepts like femininity and masculinity, and personal internalization of what gender means to each individual person. All of these factors, through socialization, work to influence the way each individual person internalizes concepts around gender.

When we feel a sense of harmony in our gender, we are said to have gender congruence. It takes the form of naming our gender such that it matches our internal sense of who we are, expressing ourselves through our clothing and activities, and being seen consistently by other people as we see ourselves. Congruence does not happen overnight but occurs throughout life as we explore, grow, and gain insight into ourselves. It is a simple process for some and complex for others, though all of us have a fundamental need to obtain gender congruence.

When a person moves from the traditional binary view of gender to transgender, agender, or nonbinary, they are said to “transition” and find congruence in their gender. Genderspectrum.org adds, “What people see as a “Transition” is actually an alignment in one or more dimensions of the individual’s gender as they seek congruence across those dimensions. A transition is taking place, but it is often other people (parents and other family members, support professionals, employers, etc.) who are transitioning in how they see the individual’s gender, and not the person themselves. For the person, these changes are often less of a transition and more of an evolution.” Harmony is sought in various ways to include:

• Social – Changing one’s clothes, hairstyle, and name and/or pronouns.
• Hormonal – Using hormone blockers or hormone therapy to bring about physical, mental, and/or emotional alignment.
• Surgical – When gender-related physical traits are added, removed, or modified.
• Legal – Changing one’s birth certificate or driver’s license.

14.5.7.2 The Language of Gender

• Agender – When someone does not identify with a gender.
• Cisgender – When a person’s gender identity matches their assigned sex at birth.
• FtM – When a person is assigned a female sex at birth but whose gender identity is boy/man.
• Gender dysphoria – When a person is unhappy or dissatisfied with their gender and can occur in relation to any dimension of gender. The person may experience mild discomfort to unbearable distress. This is classified as a mental health diagnosis and this diagnosis must be given to an individual in most states if they wish to receive hormone and other gender-affirming treatments. Not all transgender or nonbinary people may experience gender dysphoria and some cisgender people may experience this.
• Genderfluid – When a person’s gender changes over time; they view gender as dynamic and changing.
• Gender role – All the activities, functions, and behaviors that are expected of males and females in a gender binary society.
• Genderqueer – Someone who may not identify with conventional gender identities, roles, expectations, or expressions.
• MtF – When a person is assigned a male sex at birth but whose gender identity is girl/woman.
• Non–binary – When a gender identity is not exclusively masculine or feminine.
• Transgender – An umbrella term that denotes when a person’s gender identity differs from their assigned sex.