TABLE 3.

Recommendations to collect data on sex, gender identity, sexuality, and intersex/differences in sex development (DSD)

Survey questions	Response options
Sex and Gender Identity
(Optional Q0: What is your gender identity)	[free-text]
Q1: Recognizing these are limited options, which of the following categories best describes your current gender identity (please choose one)?	Man, transgender man, cisgender man Woman, transgender woman, cisgender woman Nonbinary, genderqueer, gender fluid, agender [If the respondent is American Indian or Alaskan Native (AIAN)]: Two-spirit I do not feel that my identity fits into one of these categories [Free text]: What words do you use to describe your gender identity?
Q2. What sex were you assigned at birth, on your original birth certificate?	Male Female Third sex/“X”a Prefer not to answer
Q3. Have you ever been diagnosed by a health professional with an intersex condition or a difference in sex development, or were you born with (or developed naturally in puberty) genitals, reproductive organs, or chromosomal patterns that do not fit standard definitions of male or female?	Yes No Don't know Prefer not to answer
Sexuality
Sexual Identity Which of the following best represents how you think of your sexual identity (please choose one)?	Asexual Bisexual Gay Lesbian Pansexual Queer Same-gender loving Straight/heterosexual [If respondent is AIAN:] Two-Spirit I use a different term [free-text] Don't know Prefer not to answer
Sexual Behaviorb During [your lifetime, the past 12 months, etc.], who have you had sexual contact with (select all that apply): Sexual contact includes any touching of intimate body parts of a person upon another (e.g., kissing, anal sex, fingering).	Cisgender women Transgender women Cisgender men Transgender men Two-spirit person Nobody/no sexual contact Nonbinary Person with another gender [free-text] Don't know Prefer not to answer
Sexual Attractionc During [your lifetime, the past 12 months, etc.], who have you been sexually attracted to (select all that apply):	Cisgender women Transgender women Cisgender men Transgender men Two-spirit person Nobody Nonbinary Person with another gender [free-text] Don't know Prefer not to answer

^aA third sex option or “X” is becoming increasingly available on birth certificates for people who do not identify with male or female, such as people who are intersex, have differences in sex development, or are nonbinary. This option is currently only available in 16 states and the District of Columbia, but is increasingly becoming adopted (Movement Advancement Project, n.d.).

^bIn clinical settings, sexual behavior should only be asked or discussed when it is pertinent to the care being rendered and should be followed by a series of questions to determine what types of sex occurred and with what body parts to assess health needs accurately. Sexual abstinence and celibacy are also sexual behaviors; sexual contact should never be assumed.

^cIn clinical settings, sexual attraction should only be asked or discussed when it is pertinent to the care being rendered.