Gender — or do we mean sex?

The use of language when dealing with gender and sex is important: the choice ranges from deliberately political and incendiary, to confusing despite the best of intentions.

The most recent issue of the BJGP¹ illustrates this amply. I was excited to see an issue devoted to ‘Gender’, as an associate in training (AiT) feeling the absence of education in gender medicine. It became increasingly clear that much of the issue was about sex-based topics — important and interesting, but conflated with a more nebulous (and largely undefined) concept of ‘gender’.

Kath Checkland² describes the author of Hags, ‘highlight[ing] the dangers to women of current attempts to downgrade the importance of biological sex’, which is especially pertinent to the paper by Jefferson et al.³ Here, ‘the authors relied on self-identification’ (as well as other clues such as name) when it came to documenting uncertain gender, which they then appear to equate to sex. The distinction between sex and self-identified gender is of course vital to drawing any conclusions about discrimination; biology and gender incongruence may impact this, but for entirely different reasons.

The linguistic confusion continues in the ‘gender’ space. Brown et al⁴ specifically acknowledge difficulties with conducting research because of coding complications and state the ‘intention to balance inclusivity and specificity’; even they slip from ‘transmasculine’ and ‘transfeminine’, to ‘transgender men’ in the discussion — are such men in the former or latter category?

The difficulties with language are not specific to general practice, or to this journal. The laudable aim to make language inclusive may result in health-related harms⁵ such as confusion for non-English speakers or for those with learning difficulties — confusion experienced by Hannah Milton⁶ in this issue.

As Bewley et al have previously argued elsewhere: ‘Ambiguous data collection methods that conflate sex and gender risk erroneous research findings, poor service planning, and lower quality medical practice.’⁷ And this extends to discussing sex-based experience of all kinds, whether it is discrimination, health care, or cultural experience.

So a plea to the BJGP to highlight the need for clarity in sex and gender, not to add to the confusion.