Language matters.

It frames how we think about diseases, ideas, identities, and people. Language can welcome individuals, or isolate them. Most people avoid offensive language, but even “non-offensive” language can be exclusionary, confusing, or promote false ideas.

If you read our blogs regularly, you may have noticed that we use some terms you don’t necessarily hear often. Here are eight terms we purposefully substitute for others, and why.

1. People with vaginas/People with penises instead of women/men

When we talk about birth control, gynecological care, and (sometimes) sex, we often avoid using the terms “girl,” “woman,” “boy,” or “man.” This is because we’re usually giving medical advice that relates to people not based on their gender identity, but based on their physiological characteristics.  We serve many transgender and gender-questioning young people at the Center, and isolating them would not only be incompatible with our ethos of inclusive and non-judgmental care, but also potentially damaging to patients.

Because many people are transgender, non-binary, or another gender, there are plenty of men with vaginas, women with penises, and people who don’t identify with being either a man or a woman. Saying, “women need to get a Pap smear every 3 years once they turn 21” ignores and erases the many men who have vaginas and need Pap smears too. It’s also just incorrect, since women who have penises certainly don’t need Pap smears.

If we’re discussing gender norms or stereotypes, however, we’ll usually use “girl,” boy,” etc. This is because those stereotypes don’t apply to everyone with a vagina (for example): they apply to women.

2. Internal condom instead of female condom

“Internal condom” is trans-inclusive, while “female condom” is not. Internal condoms are for anyone with a vagina, not just (or only) women. “Internal” removes gender from the equation.

3. STI instead of STD

STI stands for sexually transmitted infection, and STD for sexually transmitted disease. While “STD” is more common, there is currently a trend to use “STI” instead. This is because “infection” more accurately reflects what we’re talking about. Having a disease requires that there are symptoms, but in a lot of cases, STIs don’t have any noticeable symptoms, and you can’t know you have them unless you get tested.

“STI” is not only more medically accurate, but it also decreases the stigma against having an STI. And stigma is serious: it can have a dramatic effect on people’s mental health, and keep people from getting tested in the first place.

4. STI-free instead of clean

It’s common for people to say they’re “clean” when they mean that they don’t have any sexually transmitted infections. But that implies that people with STIs are “dirty,” and we’ve got a MAJOR problem with that. People with STIs, especially HIV, face a lot of stigma. That not only has a major effect on many people’s mental health, but it keeps them from getting tested and treated in the first place.

5. Partner instead of boyfriend/girlfriend

We never want to assume that anyone is in a different-sex relationship. Assuming people are straight until told otherwise implies that being straight is “normal” and having any other sexual orientation is weird, or abnormal. And that’s just not true! Unless we are positive of someone’s gender and sexual orientation, we’ll use a gender-neutral term. “Gender-neutral” just means that it can be used for someone who’s a boy, girl, or anything in between. Gender-neutral terms are good to use when you’re not positive about someone’s gender identity or sexual orientation. Other popular gender-neutral alternatives to “boyfriend” and “girlfriend” are “significant other,” “SO,” or even “bae.”

6. Has a mental illness instead of “is mentally ill”

Again, this question revolves around stigma and identity. People who have a mental illness are not only that illness. Calling someone with schizophrenia, for example, a schizophrenic, labels them and makes schizophrenia the only aspect of that person’s identity. Really, we are all complex human beings, and no one deserves to be reduced to one part of their identity.

7. Assigned male/female at birth instead of “born a man/woman”

People do not know their gender at birth (They don’t even know what gender is!), so they cannot be “born a man” or “born a woman.” Instead, people typically develop their gender identity as they grow. When someone is born, a doctor will usually look at their genitals to in order to judge the baby’s sex. This is what we mean by “assigned male/female at birth.” However, there are a lot of other factors at play that the doctor typically does not look at, including hormones and chromosomes. And going beyond these physical characteristics, there’s just no way to tell what gender a baby will identify as later in life.

8. Men who have sex with men/Women who have sex with women instead of gay, bi, or lesbian

We often use these phrases when discussing risky behavior. For example, people (including health care providers) often discuss how gay and bi men are more likely to get HIV than other populations. While this can help providers target high-risk groups for risk-reduction, it can also further stigmatize a group that already faces stereotypes and discrimination. We talk about “men who have sex with men” instead, because it focuses on the behavior rather than the identity. After all, gay men are not more likely to become HIV+ because of their identity but because of their behavior. A gay man who has never had sex is at very low risk for HIV. And a man who identifies as straight, but occasionally has unprotected sex with other men, is at much higher risk for HIV. This is because of his behavior: Having unprotected anal sex with multiple partners puts someone at a high risk of acquiring the virus.

Of course, when we’re talking about sexual orientation, we still use terms like gay, bi, lesbian, etc.

At Mount Sinai Adolescent Health Center, every young person is welcome, regardless of their background, identity, or any other reason. It would be impossible for us to provide non-judgmental care if we didn’t think seriously about the language we use, and how that language affects the young people who walk through our doors. Of course, this list isn’t comprehensive. What terms or phrases would you add?

The Mount Sinai Adolescent Health Center is located in New York City. It provides comprehensive, confidential, judgment free health care at no charge to over 10,000 young people every year. This column is not intended to provide medical advice, professional diagnosis, opinion, treatment or services to you or to any other individual, only general information for education purposes only.