Considerations for inclusive health psychology research with LGBTQIA+ participants

At the beginning of 2025, 'medical misogyny' is becoming a popular buzzword in society. This term refers to the negative way that people, particularly women, are treated in terms of sexism or gender bias in the healthcare system. This can manifest as behaviours such as ignoring women's pain or women not being believed when describing their symptoms. 

These behaviours can be particularly seen in gendered health conditions such as endometriosis. Endometriosis is a gynaecological condition found in one-in-10 people assigned female at birth in the UK, which can cause chronic pain and potential infertility. Despite being very common, there has been a monumental lack of endometriosis research, which is reflected in an unknown cause and no known cure. 

Due to stigma related to endometriosis and gender, patients can experience delays to their diagnosis (on average 7.5 years) and care, which can worsen symptoms and have a negative effect on their mental wellbeing.

Recently, there seems to be more interest surrounding endometriosis in popular culture (as seen on the news) and as a result, accounts of endometriosis are being highlighted. However, progress concerning endometriosis is not equal for all. For example, there has been little research into the accounts of people with endometriosis in minority groups, such as individuals from low socioeconomic backgrounds, non-Caucasian people, and people who do not identify as heterosexual. 

My research aims to document and promote LGBTQIA+ patients' experiences of endometriosis, as there has been little exploration into the accounts of people with endometriosis who identify as part of the LGBTQIA+ community. The neglect of the discussion around LGBTQIA+ healthcare experiences in the literature can reflect real-life biases and assumptions that prioritise heterosexual people, compared to LGBTQIA+ people. 

I am specifically interested in the barriers that this patient group experiences when trying to get a diagnosis and this blog post briefly touches on some of the LGBTQIA+ specific considerations I have taken when developing my research, with four core considerations. 

Methodological considerations when studying sexuality and gender minority groups

Specific study of LGBTQIA+ experiences is warranted. Although it is important to ensure that LGBTQIA+ participants remain safe during research, it is also important to ensure that they are not omitted from the narrative of healthcare research. To ensure this kind of work is conducted ethically, these are four key considerations I have when conducting my own research with an LGBTQIA+ sample.

1.        The importance of nuanced and thoughtful ethics 

As with all research, emphasis should be placed on ethical considerations such as confidentiality, anonymity, withdrawal rights, and consent. But like many other minority groups, there are additional design elements to consider within your research and the impact that findings may have on the LGBTQIA+ population. I think that, not only are ethics a legitimate tool to safeguard everyone involved in a research project, but they are also a genuine opportunity to ensure that research is LGBTQIA+ inclusive from the outset.

2.        Challenging biases and assumptions 

A concept that can affect LGBTQIA+ inclusivity is heterosexist bias. Heterosexism describes the belief that heterosexuality is the norm which can lead to the lack of acknowledgement of other sexual identities. As researchers we must consider how systematic heteronormativity may be ingrained into ourselves and thus, our projects. This is important to reflect on from the conception of a research idea, as, if the foundations of a research project (such as the theory or design) are based on heteronormative assumptions, then the findings will reflect this bias. 

A way to address this is to ensure that the language we are using in our studies is inclusive. This can be achieved through ensuring a range of gender identities and sexual orientations are included as options in demographic data. Or better yet, some research allows individuals to self-define their sexual and gender identities. This has been suggested as a way to empower participants to use their own terms to define themselves rather than having the constraints of someone else's (the researcher's) classification of these concepts.

3.        Working with, not on 

At the centre of feminist approaches is this concept of empowerment, and creative and participatory methods are often used to promote this. These methods aim to empower disadvantaged populations and aspire for social change. They encourage collaboration, break down the barriers to participation, and broaden who can be involved in knowledge production. 

So far, in research centring LGBTQIA+ experiences of endometriosis has been omitted. Therefore, when contemplating what methods to use in my project to help centre LGBTQIA+ voices, creative and participatory techniques seem fitting. By listening to your participants when designing research, both the participants and researchers benefit. Such methods allow for co-creation and co-ownership of knowledge ensuring that we highlight the voices of who our research is about and for. Consequently, if you are interested in research with LGBTQIA+ participants, I signpost you on to The LGBT Foundation, which provides resources concerning ethical guidance and demographic monitoring.

4.        Capturing intersectionality  

Furthermore, in the same way that not all experiences of endometriosis are the same, not all LGBTQIA+ endometriosis patients experience the same challenges. Therefore, when conducting research with this population, I think it is a priority to avoid the over-simplification of LGBTQIA+ individuals and their experiences being grouped under one umbrella. 

Indeed, the endometriosis journey and specific barriers for cisgender lesbians may differ from those of trans men. This clustering is especially true when we consider intersectionality. Certain journals already champion this way of thinking. For example, the journal Psychology & Sexuality highlights that they don't consider work for publication that 'aggregates LGBTQ+ experiences, not attending to diversity within'. 

Looking towards equality for LGBTQIA+ health outcomes

As society continues to develop and the world of LGBTQIA+ research continues to grow, these ethical considerations will be in a constant state of flux and will be dependent on the context of where and when this research takes place. Therefore, I expect that our appraisal of how to conduct this kind of research will also evolve, and I look forward to seeing how it develops. I hope that my research will not only highlight the need for academic work into LGBTQIA+ endometriosis experiences (and the wider implication of LGBTQIA+ narratives in health) but also have a practical impact by reducing health inequalities for this group.

When I began research in this area it became apparent that health inequalities are pronounced when gendered health conditions concern minority groups. LGBTQIA+ people still face discrimination and experience health disparities as a result of health inequalities. Therefore, I aim for my research to be emancipatory, anti-discriminatory, and participatory. I believe that this can be done qualitatively and quantitatively, however that is a discussion for another article…