Creating an LGBTQ+ inclusive space and understanding Gender!

Written By Sinead Waites - Physiotherapist -

How do we create a space that’s safe for LGBTQ+ folks? What does LGBTQ+ even stand for? What is GENDER?

If these are questions you have had occasion to ponder (or if this is the first time you’ve thought about it), please, step inside…Lets do some demystifying.

First, what does LGBTQ+ stand for? L= Lesbian, G= Gay, B= Bisexual, T= Trans, Q= Queer, + = plus every other label someone may identify with. This acronym can vary, and you might see things like an “I” added which means Intersex. We will explain these terms later down the track.

How do we create a space that is inclusive for people who are LGBTQ+? Well, part of it is upskilling as clinicians so that we aren’t blindly bringing our own biases about sexual orientation and gender when we work with people. Another part is our lovely clients understanding what it means to be inclusive! It’s beyond the scope of this article to comprehensively address this. However, a good starting point is understanding GENDER!

What is gender? What is our old understanding? What is our new understanding?

Most of us who grew up in Australia (and many other places) likely have a good grasp of the old understanding of gender. This goes something like: when someone is born, a doctor will look at the baby’s external genitalia and say “It’s a girl” or “It’s a boy”. And then all the girls grow up to be women, and all the boys grow up to be men. Historically, the assumption was then that all the men marry women, and all the women marry men, and the cycle repeats. If you want to go further you could add in some stereotypes: women are weak, men are strong; women are nurturing, men are aggressive; women wear skirts, men wear pants, etc. Thankfully, a lot has changed but most of us will be familiar with this script.

To explain our contemporary/new understanding of gender I’m going to bring in the Genderbread Person. This version was perfected by Sam Killermann who runs a free online resource for learning about gender and sexuality. I’m going to run through how Sam explains the Genderbread Person.

As we go through it, you can think about how you personally sit on the spectrums of identity, sex, gender, and sexual orientation. 

First, Identity, Sex, Gender, and Sexual orientation are independent of each other. One does not equal the other. For example, just because someone identifies as a man, they are not necessarily attracted to women (as per our old understanding).

• Gender identity: How you, in your head, experience and define your gender, based on how much you align (or don’t align) with what you understand the options for gender to be. It includes personality traits, jobs, hobbies, likes, dislikes, roles, expectations. Some examples:

o   Transgender/Sistergirl/Brotherboy: a gender description for someone who has transitioned (or is transitioning) from living as one gender to another. Or an umbrella term for anyone whose sex assigned at birth and gender identity do not correspond in the expected way. Sistergirl and brotherboy are used in some Aboriginal and Torres Strait Islander communities.

o    Genderqueer/Nonbinary: a gender identity label often used by people who do not identify with the binary of man/woman.

o   Cisgender/cis: a gender description for when someone’s sex assigned at birth and gender identity correspond in the expected way. E.g. the Dr said “It’s a girl” and that person grew up to identify as a girl/woman.

o   Bigender: identifies with 2 genders simultaneously, or at different times.

o   Genderfluid: Experiences shifts between different genders at different times.

-            Sexual attraction/orientation: Who you feel drawn to in a sexual, romantic, and/or other way. Examples:

o   Straight/ heterosexual: a person primarily emotionally, physically, and/or sexually attracted to some people who are not their same sex/gender.

o   Lesbian: women who are primarily attracted romantically, erotically, and/or emotionally to other women. 

o   Gay: experiencing attraction solely (or primarily) to some members of the same gender. Can be used to refer to men who are attracted to other men and women who are attracted to women.

o   Pansexual: a person who experiences sexual, romantic, physical, and/or spiritual attraction for members of all gender identities/expressions.

o   Bisexual: a person who experiences attraction to some men and women; attraction to some people of their gender and another gender. Bisexual attraction does not have to be equally split or indicate a level of interest that is the same across the genders an individual may be attracted to.

o   Demisexual: experiences sexual attraction only after forming a strong emotional bond with someone.

o   Asexual: experiencing little or no sexual attraction to others and/or a lack of interest in sexual relationships/behavior. Asexuality exists on a continuum from people who experience no sexual attraction or have any desire for sex, to those who experience low levels, or sexual attraction only under specific conditions. Many of these different places on the continuum have their own identity labels E.g. demisexual.

- Gender expression: How you present your gender and how those presentations are viewed based on social expectations.

o   Includes: style, grooming, clothing, mannerisms, affect, appearance, hair, make-up…

§  Masculinity: refers to the attributes most commonly associated with men in a culture. E.g. strong, aggressive, wears pants.

§  Femininity: refers to the attributes a culture most commonly associates with women. E.g. weak, nurturing, wears skirts.

§  Androgyny: refers to possessing both stereotypical masculine and feminine traits. 

- Biological Sex: Includes: body hair, chest, hip to shoulder ratio, hormones, penis, vulva, chromosomes, voice pitch. Often confused with gender!

o   Sex Assigned At Birth: Female, Male, Intersex- usually based solely on external genitalia (ignoring internal anatomy, biology, and change throughout life).

§  AFAB: Assigned Female At Birth- female external genitalia.

§  AMAB: Assigned Male At Birth- male external genitalia.

§  Traditionally we have pretended Intersex folks don’t exist. Pretending this helped to uphold our old understanding of gender (that there are only males and females, and males can only be men, and females can only be women. However intersex birth frequency is around 1:100. This ratio is much more common than blue eyed redheads (around 1:588).

Hopefully that is all making sense. But if you still have questions, scoot on over to Sam’s website, where there are free/pay-as-you-feel courses. 

Why is it important to create LGBTQ+ safe, inclusive spaces? An Australian cross sectional survey of 928 transgender and nonbinary participants over 18 years old, published in 2021 found that 26% of participants reported discrimination in accessing healthcare. Sixty-three per cent had experienced verbal abuse and 22% of participants had experienced physical assault. Seventy-three per cent of participants had experienced depression and 67% anxiety over their lifetime, compared to the general Australian population aged 16-85 years for any mental disorder over the lifetime of 42.9%. Forty three per cent of transgender and non-binary folks reported attempting suicide at least once in their lifetime, compared to lifetime prevalence of suicide attempts in general Australians population, aged 16-85 years old, of 4.9%.

They concluded that barriers, including widespread discrimination, contribute to health inequity and prevalent mental health conditions with better training for health professionals in the provision of safe, gender-affirming and general health care for trans people urgently required.

This is why its important for clinicians to upskill to create safe inclusive spaces so LGBTQ+ folks can access the health care they need. Understanding your own gender is a good starting place for this.

Creating a safe space at Newcastle Aquatic Physiotherapy is intertwined into our values here.

Our Core Values

Care — We show up with heart. We follow through on our word, we listen deeply, and we treat people with kindness and generosity. Whether it's a client or a teammate, we choose care — in our actions, in our words, and in how we hold space for each other. And that care doesn't have a condition on it. It doesn't matter who you are, where you come from, who you love, or what your body looks like — you deserve to feel genuinely cared for when you walk through our doors. That's not a nice-to-have for us. That's the whole point.

Openness — We stay curious and humble. We know that no-one has all the answers (including us). So we ask questions, we listen to understand, and we keep looking at things from different angles. That's how we grow — together. Part of that openness means recognising that healthcare hasn't always felt safe or accessible for everyone — and we take that seriously. We want to keep learning, keep listening, and keep doing better so that every single person feels genuinely welcome here.

Connection — We've got each other's backs. We're a team, not just in name but in action. We lean on each other, help each other out, and create space where it's safe to be real — even when things are messy or hard. And that same safety? We're committed to creating it for every client too. Because connection only happens when people feel truly seen and safe. We are proud members of the Welcome Here Project, and we mean it — LGBTQ+ people, people of all abilities, all backgrounds, all bodies — you belong here.

Creativity — We think outside the box (because most people don't fit in one). We value fresh ideas, flexible thinking, and the courage to try something new. We experiment, we explore, and we're not afraid to do things differently if it helps someone move forward. Because the truth is — standard approaches don't work for everyone. And we think that's a reason to get creative, not to give up. Everyone deserves access to great healthcare, and if we need to find a new way in to make that happen, that's exactly what we'll do.

The lovely people who come to NAP can also assist in making this an inclusive safe space for everyone. If you are interested, or have further questions, I would highly recommend checking out Sam Killermann’s free resources.