Melissa's Memos Pride Issue

In This Issue:

1. Sexual Behavior, Definitions of Sex, and the Role of Self Partner Context Among LGB Adults

2. Chronic Health Conditions and Key Health Indicators Among LGB Older Adults

3. Queer Aging


Social Media Posts

Book Review


Quote of the Week

            “We consistently hear from our fans and friends how hard it is to find culturally competent health care and that should not be the case in 2017.

 - Tegan and Sara Quin,


Tegan and Sara Foundation founders

Queer Health Access



1.     Sexual Behavior, Definitions of Sex, and the Role of Self-Partner Context Among Lesbian, Gay, and Bisexual Adults

In this article, Sexual Behavior, Definitions of Sex, and the Role of Self-Partner Context Among Lesbian, Gay, and Bisexual Adults members of the Department of Psychology at the University of Utah, Sewell, McGarrity, and Straassberg wanted to research sexual minority groups to better understand the LGB groups' definition of sex. They believed that prior research involving heterosexual individuals had a ‘gold standard’ of what constituted as having sex, but did not see the data for LGB persons. The focal question in search of an answer was, “Do Lesbian, Gay, and Bisexual adults have a common gold standard of what is considered having sex like heterosexual adults?”

“This research is important because the way individuals define sex can influence the behaviors in which they choose to engage, the way they judge their own behavior and that of others, their categorizations of what is appropriate or inappropriate within a relationship, and possibly health-related judgments, such the level of sexually transmitted disease […] [HIV] risk[.]”

            The research team conducted two separate studies over two years with sexual minority groups recruited at the local Pride Festival.

            -Study 1 was a dichotomous (Yes/No) questionnaire with various acts listed for participants (N=329) to decide if they think the act is or is not having sex. The researchers did not find any correlation on the definition of ‘having sex’ between different age or racial groups.

            -The following year, Study 2 was conducted with volunteers at the local Pride Festival, but with an expansion from a dichotomous survey to a Likert-type scale that consisted of a 4-point ranking. Participants (N=393) judged whether the behaviors from Study 1 constituted as “having sex” by marking either numbers 1= Definitely not sex, 2= Probably not sex, 3 = Probably sex, or 4 = Definitely sex. In addition to this format upgrade, Study 2 “utilized a between-subjects design to assess differences in definitions of sex when judging one’s own behavior compared with that of a partner outside of the relationship.” To collect data about both self behavior and how one would consider a partner’s behavior, half of the participants were given one while the remaining half answered the other point of view.

            -Results: The research findings were not far from their hypotheses as well as previous research for heterosexual individuals. Despite the difference in Study 1 and Study 2 answer choice options (dichotomous of Likert-type scale) they both yielded similar results. Insertion of any type, such as penile-anal, or double-ended dildo for women, was the one commonly agreed upon an act that no one participant marked as ‘not having sex.’ In the minority groups researched, amongst gay men, penile-anal intercourse is regarded as the gold standard in “having sex.” In the samples of women, there was no one act that was considered across the board as ‘having sex.’ The results found of the individuals who answered if particular behaviors were deemed as ‘having sex’ was more often times marked Probably Sex and Definitely Sex.

            -Discussion/Personal Takeaway.: While this research provides a decent insight into an under-researched sexual minority group, there are some shortcomings. The main focus referred to as the gold standard, of what each member of the LGB believes to be ‘having sex’ focuses on some type of intercourse. The intent of this is to understand the sexual behavior hierarchies of every group, one cannot help but wonder if any sexual contact should be considered as sex when it comes to managing health.



Sewell, Kelsey K., et al. “Sexual Behavior, Definitions of Sex, and the Role of Self-Partner Context Among Lesbian, Gay, and Bisexual Adults.” The Journal of Sex Research, vol. 54, no. 7, 2016, pp. 825–831., doi:10.1080/00224499.2016.1249331.

2. Chronic Health Conditions and Key Health Indicators Among Lesbian, Gay, and Bisexual Older US Adults, 2013-2014

            In the article Chronic Health Conditions and Key Health Indicators Among Lesbian, Gay, and Bisexual Older US Adults, 2013-2014, researchers reviewed National Health Interview Survey (NHIS) data to compare health disparities in sexual minority groups. National Institutes of Health had identified sexual minorities as part of health-disparate populations. The researchers wanted to  seek out questions of “Do health disparities observed in general sexual minority adult population persist or diminish at older ages?”

            The study’s intent was to examine the extent to which sexual orientation and gender are related to health disparities like: chronic health conditions, general health outcomes, health behaviors, health care access, and preventatives health care for older sexual minority persons (50 years old+).

            The disadvantages of health in sexual minority (LGB) adults has risen significantly in recent years. Evidenced based on national data has shown that LGB adults have higher rates of certain chronic health conditions compared to heterosexual adults like arthritis and cancer. Rates of disability and mental distress were higher among LGB older adults.

            In addition, excessive drinking and smoking have been reported in sexual minority women with less likelihood of insurance, financial setbacks, and healthcare access hindrances. Compared to their heterosexual counterparts, these women are more likely to have a heart attack, stroke, chronic condition, and overall poor health. Cardiovascular disease and obesity were also higher among older sexual minority women. Sexual minority older men were more likely to report having angina pectoris or cancer.

            The researchers utilized data collected from 2013-2014 versions of the NHIS. These were household surveys in reference to individual’s health. Participants ranked their health as good or poor. Within older sexual minority adults, the possible limitations “in activities of daily living (ADLs) and instrumental ADLs (IADLs) were assessed by asking […] because of a physical, mental, or emotional problems, needed help with personal care and routine needs.” Consideration of participants access to healthcare was judged if they have health insurance and a main source of care. The researchers also conducted a series of logistic and linear regressions as appropriate, controlling for socioeconomic covariates (age, race/ethnicity, income, and education) that have been found to be associated with health disparities.

            Their results found that in comparison to heterosexual older women and men, the sexual minority older women and men surveyed both had higher household incomes, educational attainment levels, and typically had higher employment rates. The sexual minority older women reported having experienced a stroke, a heart attack, asthma, arthritis, low back or neck pain, and a weakened immune system and higher number of chronic conditions, but were less likely to have diabetes. Sexual minority women reported poorer overall health, disability, and mental distress, and were less likely to report ADL limitations.

            Similarly, sexual minority older men stated more issues with angina pectoris,  low back or neck pain, cancer, and a weakened immune system. They were less likely to be obese than their heterosexual male counterparts, but likely to be current smokers and engage in excessive drinking. Sexual minority older men were more likely to report a disability, ADL and IADL limitations, and mental distress. Preventative care was more common in sexual minority older men (flu shot, HIV test within last year).

            Of the older sexual minority groups researched, bisexual people are theorized to experience “elevated stress and social isolation, in part as a result of marginalization within lesbian and gay communities as well as society in general.” This may play a part in the findings of the older bisexual men and women.

            The overall findings of the 2013-2014 data collected research, sexual minority adults showed a much higher likelihood of chronic health conditions and other healthcare disparities. These findings are important to establish for at-risk groups in order to curate proper and necessary preventative efforts.

            While this information provides insight into some of the self-reported data by older sexual minority group (LGB) adults, data regarding gender identity and expression does fall short in the NHIS.


Fredriksen-Goldsen, Karen I., et al. “Chronic Health Conditions and Key Health Indicators Among Lesbian, Gay, and Bisexual Older US Adults, 2013–2014.” American Journal of Public Health, vol. 107, no. 8, 2017, pp. 1332–1338., doi:10.2105/ajph.2017.303922.


3. Queer Aging: Implications for Social Work Practice with Lesbian, Gay, Bisexual, Transgender, and Queer Older Adults

            Queer Aging discusses an interesting point of view in regard to social work practice with lesbian, gay, bisexual, transgender, and queer older adults. The author expresses the importance of the social workers intentional/unintentional adding to the setbacks older LGBTQ+ adults experience.

            The social work profession has rapidly increased its awareness and inclusion of sexual orientation and gender identity that extends to the wellbeing of the LGBTQ+ older adults. Fabbre expands on Fredriksen-Goldsen and colleagues proposed practice competencies to update and challenge social workers self-awareness and understanding of structural forces that influence their context for practice. This updated practice is referred to as ‘critical reflectivity.’

            With aging LGBTQ+ adults, incorporating their perspectives is to recognize the heteronormativity, heterosexism, and transphobia and to strengthen one’s capacity to curb these social forces in practice.

            Critical reflectivity pushes the social worker to combat heteronormativity, heterosexism, and transphobia, by being self-aware and self-recognizing their position and contribution of these social forces. Kondrat (1999) proposed a reconceptualization of practitioner self-awareness based on a critical examination of the self as “inextricably immersed in society’s structures both as agent and product” (p. 464).

            Fabbre expresses the importance of understanding systemic issues and oppression that aging LGBTQ+ older adults experience and recognizing how individuals have lived with this and begin to create new social norms. 


             Fabbre, Vanessa. “Queer Aging: Implications for Social Work Practice with Lesbian, Gay, Bisexual, Transgender, and Queer Older Adults.” Social Work, vol. 62, no. 1, 2016, pp. 73–76., doi:10.1093/sw/sww076.



Book Review

Publisher: Oxford University Press; 1 edition (June 10, 2014)

Paperback: 676 pages


Trans Bodies Trans Selves provided an amazing resource for myself as a therapist and as an educator. I have recommended this book to new clinicians and interns who have questions about transgender topics. The book covers health, biology, psychology, history, culture, and politics. It presents personal stories from the perspective of transgender identifying individuals, family members, professionals and community leaders. The visuals included are well done and informative. I personally gained an understanding of the mechanics of “tucking” after reading the book. The explanation of Sexual Reassignment Surgery was comprehensive and informative. It presents information that I can use with clients during sessions when discussing surgery options. Trans Bodies Trans Selves has taught me and my clinical team so much about working with members of the transgender community and their needs. I feel that this book should be a part of every clinical and medical professional’s library. The only downfall I found with the book was that it was awkward to handle due to size.


Author Bio: Laura Erickson-Schroth, MD, MA, is a psychiatry resident at New York University Medical Center. She is a board member of GLMA: Health Professionals Advancing LGBT Equality, as well as the Association of Gay and Lesbian Psychiatrists. She is a founding member of the Gender and Family Network of New York City, a group for service providers interested in the health of gender non-conforming children and adolescents.

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