Sex, gender and nursing

The aim of this editorial is to raise awareness and provoke discussion about the issues sex gender in nursing. Here, we provide a brief summary complex challenging area. This topic has been subject significant heated debate on social media has, more recently, come fore mainstream throughout sections academia—prompting increasingly polarized discussion. It now an issue where deeply held views are evident—some quite entrenched. We have begun see some spilling over into healthcare environment. that nurses cannot ignore, one nurse clinicians, academics, researchers policy makers urgently need engage with. For many, perhaps even most nurses, interesting, yet unproblematic concepts. Typically, taken refer biological reality which observed at birth distinguishes between male female—normally basis external genitalia, but can also be determined biochemical chromosomal level internal organs. A check recent anatomy physiology texts aimed for example, Peate Nair (2015) will quickly confirm this. Those with knowledge people who identify as intersex rightly point out picture does not account small groups whose organs do conform picture—Dreger's (2017) work provides helpful overview area compelling injustices done time by medical establishment. While existence evidence simple male/female binary all difference, it fundamentally alter sex. In contrast sex, relatively new concept was adopted feminism women's studies 1970s 1980s (Pluckrose Lindsay, 2020) distinguish stereotypical behaviours roles were associated female behaviour—the masculine feminine. Before gender, these generally considered innate Gender theorists reframed them socially constructed ways being, embedded society acted type ‘script’ girl boy children socialized women men played their day-to-day lives. there aspects masculinity femininity (Halpern, 2012), speaking, consensus much what or behaviour outcome expected norms expectations. Until recently notions largely uncontested healthcare, although fact terms sometimes used interchangeably (Stonewall, 2021) resulted confusion. Despite this, remains upon care offered informs format service design delivery (including health services) across world. assume that, while readers feel our lacks detail nuance, accept broadly accurate conforms clinical reality, everyday practice forms foundational blocks education. As noted above, always confusion around difference related, different More however, change how two both viewed used. Put simply, common, and, circles intellectually valid argue sex—once solid indisputable ‘facts’ healthcare—is actuality construction. Proponents view against commonly understood position recorded birth—specifically observation genitalia—in favour states assigned birth. former rooted essentialism—having vagina indicates baby presence penis marks child. latter argues new-born's decided doctor and/or midwife ‘invalid’ criteria. Here extension other biomarkers, incidental identity baby. such they determine any real sense, rather ideological custom practice. Drawing Butler (1990) subsequent theorists, those notion biologically determined, self-identified better marker whether female. effect, conflates gender. self-identification, individual—not others—identifies identity/sex. self-identification subjective experience person determines man woman appear others. words, may outward physical appearance, anatomical physiological characteristics male, sense defines if woman. transgender ‘trans’ applied natal differs from identity. Given conviction immutable so many long, represents paradigm shift its truest sense. These changes created major turbulence number academic disciplines (Brunskill-Evans, 2020), curiously, nursing remained quiet face Perhaps discipline seen impact debates step away. On level, understandable as, times, vicious threats harm—often directed towards women—who sought defend sex-based rights, under threat consequence retreat cases Scottish MSP, Joanna Cherry (Anonymous, UK academic, Kathleen Stock (Grove, illustrative become doubt current emotion anger surrounding topic, launched GC Academia Network (N.D.) personal accounts academics support emergence perceived being orthodoxy. fully acknowledge troubling, believe professional moral responsibility implications discipline. practice, education research profound. At basic take no longer interpreted experience, then widely differentiating setting—biological sex—is workable. surely variable. Suissa Sullivan (2021) noted, collect reliable data sex-related needs, very difficult future demand ensure services fit purpose. practical indeed secondary colleagues should, expect increasing numbers gynaecology wards treated testicular cancer. To uphold dignity, consider language use when describing caring ovaries, womb therefore pregnant give birth, menstruation menopause framed written patient documentation. Screening programmes rethought. Traditional identifying, inviting encouraging routine screening risk developing cancers previously only men, revised (Dahlen, 2020). first steps already taking place services, ‘chestfeeding’ ‘birthing partner’ introduced English NHS Trust inclusionary alternatives breastfeeding ‘pregnant woman’ (BBC, 2021). argued move ‘inclusive language’—other include ‘vulva havers’, ‘menstruators’ ‘cervix havers’—is problematic reduces list body parts (Vigo, There concern vulnerable groups, learning disabilities inequality, struggle understand terminology clear simple. Language thing accommodate developments. require sensitivity skill part planners staff. prepare occur classroom. know normativity (McCann & Brown, 2018; McCann seems likely continuing development needed. highly probable opportunities provided staff delivering material. arising reframing lie ethical problems presents. date, response workers organizations uncritical individuals declared identity, match admirable, insofar should prepared speak up marginalized. However, approach affirmation neglect legal treatment. criticisms puberty blockers young express feelings dysphoria (Pilgrim Entwistle, consent potentially irreversible life changing treatment surgical removal healthy tissue seek transition. share acceptable alternative single safe spaces option request professional. domestic abuse sexual violence predominantly crimes, patients, still sensitive consideration decision-making preferences upheld. Nurses transition subsequently go detransition (Butler Hutchinson, 2020, currently poor. essential profession gives serious thought develop existing base due least, able talk with, help guide struggling make informed choices decisions, last lifetime ongoing intervention. conversations. would tempting think conversations managed someone else specialist knowledge. asked help, community mental equally encounter dysphoric person. Preparation needs classrooms skills labs meet patients nurses. suggest beyond urgent area, adequately inform providing safest highest quality advice, dysphoric, non-binary people. vehemently opposed discrimination marginalization based characteristic. everyone access without fear discriminatory practices experiences. happen, conversation place, often raging, disciplines. profound teach research. Unless active players, best observers confused followers fundamental variables. coming years, hope serve invitation begin exploring legal, relation highlight urgency robust base.