Understanding Sexual Orientation and Gender Identity


This article is part of the month-long focus on LGBTQ mental health and issues. Each month, Life in Balance provides an in-depth look at aspects of mental health, identity, and wellness.

By Dr. Jami Wilder

“He has to be gay. He’s carrying a purse and wearing makeup.”

Last week, while at a Pride event, I heard someone whisper this statement to a friend. There is so much in that statement to examine and discuss that frankly, I could spend the next few months talking about it. However, I think what it highlights for me most today is the way we blur our understanding of sexual orientation and gender identity. We have a tendency to use the terms and their meanings interchangeably. For example, when we see a woman who a masculine presentation, we often make the assumption that she is a lesbian.

The truth is sexual orientation and gender identity are very separate constructs. And they are separate from two other parts of identity that often are overlooked and lumped in – our biological sex and our gender expression. Each of these parts of a person’s identity – biological sex, gender identity, gender expression , and sexual orientation – have some basic commonalities:

1. They are separate from one another (ie. your biological sex does not necessarily determine your gender expression).

2. They can be related to one another (ie. your gender identity may influence your gender expression).

3. They all occur on a continuum and are not binary (ie. sexual orientation is not “gay or straight” only).

That is how they are similar. Let’s break down the difference.

Biological sex:

Biological sex is determined by several biological components. Your anatomy, your chromosomes, and/or you hormones dictate your biological sex. Although there is a social (and often medical) pressure to conform to either “male” or “female,” biological sex does occur on a continuum from FEMALE to INTERSEX to MALE. To learn more about variation in biological sex and intersex experience, visit the Intersex Society of North America.

Gender Identity:

Gender identity is the your psychological sense of self. It is how you think about you; how you interpret your experience of your biological sex and gender expression. It can be the same as what was assigned to you at birth (“I was called a girl at birth. I was treated in all the culture bound ways girls are treated. I feel like a girl.”). Or it can be different from your assigned identity “I was called a girl at birth. I was treated in all the culture bound ways girls are treated. I feel like a boy.”). And, it also occurs on a continuum from WOMAN to GENDERQUEER/TRANSGENDER to MAN.

Gender Expression:

Gender expression is how you present to the world – how you communicate your preferred way of being on a continuum of FEMININITY to ANDROGYNY to MASCULINITY. It is reflected in things like hair style, clothing choices, mannerisms, etc. Your gender expression can be congruent with your gender identity or not. Men who choose more traditionally feminine clothing may identity as a man on the gender identity spectrum, for example.

Sexual Orientation:

Sexual orientation reflects who you are psychologically, romantically, emotionally, spiritually and sexually attracted. It lies on a continuum that includes many variations ranging from homosexual, bisexual, heterosexual, pansexual, asexual, Gray-A, omnisexual, etc. Sexual orientation is NOT only sexual behavior. In fact, man who identifies as heterosexual may have engaged in sexual act with male partners and still identify as heterosexual. Volumes of research have been compiled reflecting the variation of human sexual sexual behavior. to learn more, visit the Kinsey Institute.

So how does this all relate to mental health?

A great deal of psychological distress comes from the conflict caused by trying to fit ourselves into the boxes society (and family and friends) draws around us. When we try to force ourselves into the “appropriate box” in terms of our identity, we often find it to be monumentally uncomfortable. Understanding the world and ourselves in shade of grey instead of black and white allows for the complexity of human experience to be appreciated and accepted. When we can give that to ourselves – acceptance and appreciation – we are on our way to creating psychological wellness.

Jami Wilder, Psy.D., is co-owner of Wilder Therapy and Wellness in Cranston, RI. She is also a postdoctoral fellow at RWU Counseling Center.


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