Lesbian, gay and bisexual (LGB) people: introduction

These pages describe some issues around defining the Lesbian, Gay and Bisexual (LGB) population in Scotland. These terms are used to describe sexual orientation and refer to whether an individual is predominantly attracted to someone of the same sex or of both the same sex and opposite sex. This should be distinguished from definitions based on sexual behaviour.

We do not understand the health needs of LGB people living in Scotland well. However, there is evidence of discrimination and mental health issues. Our ScotPHO section on health issues for LGB people provides more information. The main obstacle to better routine health information about LGB people is that they are not separately identified in routine health surveys or in most population based research studies. 

Defining the LGB population

"An ethnic group or ethnicity is a population of human beings whose members identify with each other, usually on the basis of a presumed common genealogy or ancestry." (Smith, 1987, see Key references).

Like ethnicity, sexual orientation is a self-defined identity. Classification is based on commonly accepted terms that allow appropriate use for research or policy. While an individual's self-identification with an ethnic group is based on assumed common cultural or ancestral connections, in the case of the LGB population it is based on assumed common experience, although this experience will vary in its details from individual to individual. Components of this common experience include 'coming out' and experiences of discrimination.

'Coming out' includes both the process by which someone who is LGB comes to accept their non-heterosexual sexual orientation and the continuing disclosure of that sexual orientation. Due to the general assumption that all people will be heterosexual, people who are LGB must correct and challenge this assumption when it is encountered.

The lack of information about people who are LGB is a cause for concern. There is evidence from surveys that the LGB population suffer discrimination including verbal harassment and physical violence (King et al, 2003; Bell and Morgan, 2003, see key references). Discrimination, in the forms of heterosexism and homophobia, can lead to a fear of disclosure of non-heterosexual sexual orientation, even at times when it may be pertinent. This fear of disclosure means that LGB people variously practice concealment of their sexual orientation in different settings.

The experience of heterosexual people is significantly different. They do not need to explain or define their sexual orientation to others, as it coincides with social expectations. They do not experience heterosexism negatively or homophobia unless perceived to be LGB. 

Identity and behaviour

The process of coming out experienced by self-identified LGB people is a mental and social process, not one of sexual behaviour. For example, someone can recognise and accept that they are predominantly or exclusively gay without ever having engaged in any sexual activity. Similarly, the majority of people who are heterosexual accept that they are so without having to engage in sexual activity, and typically do not question the assumption that they are heterosexual.

Sexual behaviour and sexual attraction are not necessarily congruous with self-identified sexual orientation. Sexual behaviour varies between individuals in self-identified sexual orientation groups and particular sexual acts are not exclusive to any particular group. 

Health issues

There is some evidence that the population have poorer mental health an association between discrimination and psychological distress has been identified (King et al, 2003; Bell and Morgan, 2003; Warner et al, 2004, see key references) Better information on the health of LGB people is urgently needed to inform and support strategies to improve their health. Population based health surveys should be encouraged in future to collect information about the self-identified sexual orientation of respondents.