How to ask about sex, gender and sexual orientation

Sex refers to an individual’s biological sexual characteristics; the external genitals, internal reproductive organs, chromosomes and hormones. The terms male, female and intersex refer to biological sex.

Whether to ask about sex, gender or gender modality (see below) depends on the focus of the question. For example, a question on pregnancy risk should include individuals with female reproductive anatomy (assigned female at birth), whereas a question about social experiences should be based on gender/gender identity.

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Source: Health Behaviour in School-aged Children (HBSC) study  

Age range: 11 - 15 years.   

Item wording:  

What sex were you registered at birth?  

• Male 

• Female 

Considerations:  

• This item forms part of a two-item measure with an item on current self-identified gender identity (see section below on gender identity). 

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Source: Born in Bradford Age of Wonder study  

Age range: 12 - 15 years.  

Item wording:  

What is your sex? (The biological sex on your birth certificate. A question on gender identity will follow in the survey.) 

• Female  

• Male  

• Do not wish to answer  

• Wish to enter own response [open text] 

Considerations:  

• Stonewall response 2021 Draft Guidance on Sex, Gender Identity and Sexual Orientation recommends making it clear to non-binary participants that there will be an opportunity to disclose their gender later in the survey e.g. ‘You will have the opportunity to provide more information about your gender in a later question’.
• The ‘Do not wish to answer’ and ‘Wish to enter own response [open text]’ options allow participants who feel uncomfortable answering this question to opt out. ‘Enter own response’ allows individuals to report if they are intersex. 
• Asking about birth certificates may be confusing for some young people who may not know what is recorded on this document.  

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Source: SHINE Scottish Schools Health and Wellbeing survey  

Age range: 12 - 18 years.  

Item wording:  

What sex were you registered at birth?  

• Male  

• Female 

Considerations:  

• There are two versions of the SHINE survey: 1) a version for primary school students aged 10-12 years and 2) a version for secondary school students aged 12-18 years.  
• The version for secondary-aged students has a double item measure on sex registered at birth and gender identity. The version for primary-aged students has a single item on gender identity only. 

Gender refers to the socio-cultural, psychological, and behavioural aspects of being a man, woman, or other gender (e.g. non binary). These aspects map onto gender-specific socialisations, roles, norms, opportunities and inequalities.

Gender identity refers to the label a person uses to describe their own gender (e.g., as a woman, man, agender person etc.).

Gender modality refers to how a person’s gender identity corresponds to the gender they were assigned at birth.

For some study purposes, a single question on gender identity may be sufficient. If it is important to capture gender modality a two step-approach that asks sex at birth and current gender identity enables researchers to identify participants whose gender identity is different from their assigned sex (gender modality). 

There can sometimes be confusion about the term ‘gender identity’. Some young people may not be familiar with the concept. Another option is to avoid the word gender (see example below from the SHINE survey). 

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Source: Health Behaviour in School-aged Children study

Age range: 11 - 15 years. 

Item wording: 

Identities of people are varied: some people identify themselves as boys, others as girls, and there are people who don’t feel represented by either boy or girl.

Please choose the option that best describes you:

• I identify myself as a boy
• I identify myself as a girl 
• I identify myself as neither a boy nor a girl
• Other/s: [open text]

Issues to consider: 

• The ‘other/s’ open text response option provide the opportunity to gender-nonconforming (e.g. genderfluid or genderqueer) adolescents to indicate their preferred identity label. 

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Source: SHINE Scottish Schools Health and Wellbeing survey 

Age range: 12 - 18 years. 

Item wording: 

How would you describe yourself?

• Boy
• Girl
• In another way
• Prefer not to say

Issues to consider:

• Introductory text included before double-item measure on sex and gender identity: Here are two questions on your sex and gender identity. Most people are born as male or female – this is what we call sex. How people feel inside about being a boy or girl, or some other gender – this is what we call gender identity.

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Source: BeeWell survey

Age range: 11-16 years.

Item wording: 

Are you?

One from: 

• Girl (including trans girl)
• Boy (including trans boy)
• Non-binary
• I describe myself in another way
• Not sure

Issues to consider: On its own this question does not permit analysis of how experiences differ between cis and trans young people. In the BeeWell survey, the question is followed by a specific question on trans status. (see section below).

 

The inclusion of a separate question on transgender status will gather information on whether or not a respondent identifies with a trans or gender non-conforming status. Not all transgender or other gender minority individuals will identify as trans. 

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Source: BeeWell survey

Age range: 11-16 years.

Item wording: 

Some young people are transgender. This means that their gender is different to the one they were assigned at birth (e.g. someone who was assigned male at birth but is a girl, or someone who is non-binary and is not a girl or a boy). Do you consider yourself to be transgender?

One from: 

• Yes
• No
• I describe myself in another way (e.g. gender fluid)
• Not sure

Issues to consider:

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Sexual orientation (identity and attraction)

Sexual identity (how we think about ourselves as a sexual person), sexual attraction (who we are sexually attracted to) and sexual behaviour (how we have sex and who with) are all dimensions of sexual orientation. These are not necessarily aligned in individuals. For instance, some men and women report recent same-sex behaviour but identify as heterosexual (Geary & Tanton, 2018).  This means that each of these dimensions captures different populations.  A study focused on STI transmission will most likely want to capture behaviour while a study interested in stigma and discrimination will likely want to capture identity. 

Multiple item measures that measure at least two aspects of sexual orientation are considered best practice (Jones, 2019). 

For adolescents, items measuring self-described sexual identity and sexual attraction are recommended. If there is only space for one item, a single question on sexual attraction is most relevant for all ages, including younger groups without sexual experience and young people who may not yet have a clear sense of their sexual identity (Jones, 2019).

Including ‘unsure’, ‘questioning’ ‘other – please describe’ open text response options allows participants to express uncertainty they may feel about their developing identity and feelings. 

The categories that people use to describe their identities vary widely over time and context and are constantly evolving. See Stonewall’s list of LGBTQ+ for a list of up to date terms in the UK. 
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Here are some examples of questions in existing surveys. They all have limitations to consider. Note that best practice is constantly evolving.

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Sexual identity

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Source: BeeWell survey

Study description: 
Age range: 11-16 years. 

Item wording: 

What best describes you? 

• Bi/pansexual
• Gay/lesbian
• Heterosexual/straight
• I describe myself in another way
• Not sure

Issues to consider: 

• ‘I describe myself in another way’ preferable language to ‘other’ category
• No open text option for ‘I describe myself in another way’
• Putting heterosexual/straight in the middle rather than first helps ‘balance out’ majority and minority identities and feels inclusive, but cognitive testing for the Equally Safe study (see below) found that with this order some heterosexual participants didn’t understand the question (as they did not recognise the first options and did not continue reading the list). 

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Sexual attraction

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Source: Equally Safe at School Survey

Age range: 11 - 16 years. 

Item wording: 

Are you attracted to...? 

• Girls
• Boys
• Both girls and boys
• I am not attracted to anyone
• Unsure
• I prefer not to say 

Issues to consider: 

• ‘I am not attracted to anyone’ option is inclusive of asexual young people and young people who do not/ have not yet experienced attraction
• Limitation it that ‘both girls and boys’ excludes attraction to non-binary individuals.
• Recommendation: to include a ‘non-binary’ or ‘any gender’ option for individuals who are attracted to people with non-binary gender identities 

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Source: Health Behaviour in School-aged Children study 

Age range: 11 - 16 years. 

Item wording: 

When you daydream about sex, do you dream about: 

• Girls or women
• Boys or men
• Both
• I don’t daydream about sex

Issues to consider:

• This item measures the gender of partner(s) in sexual fantasy
• ‘I don’t daydream about sex’ option is inclusive of young people who do not experience sexual fantasies
• A limitation is that young people may still feel attraction to others without daydreaming about sex.
• Recommendation: to include additional ‘non-binary’ or ‘any gender’ response option for individuals who are attracted to people with non-binary gender identities

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Sexual behaviour 

There are many different aspects of adolescent sexual behaviour that can be measured. For a full list of sexual behaviour measures that have been validated with adolescents, visit our measure finder.

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