Table 2 Schema Determining adequate representation of sex and gender

Accurately used the terms ‘sex’ and/or ‘gender’

When authors use the word gender to refer to sex-based factors and/or sex to refer to gender-based factors, it contributes to an inadequate representation of sex and/or gender. ‘Sex’ typically refers to biological and bodily processes and characteristics like phenotype, genetic makeup, and hormone profile that can change throughout the life course due to medical procedures, environmental conditions, and events like menopause [7, 8]. It is important to acknowledge that while sex is related to biological and bodily processes and factors, sex is also a construct that is used to categorize other people in our highly gendered society [9]. ‘Gender’ is multifaceted and includes concepts such as gender identity, gender expression, and social roles, norms, and expectations. Gender is enacted in everyday social practices that are embedded within social institutions and larger societies [4]. To refer to gendered social characteristics as ‘sex’ may suggest that said characteristics are somehow inherent or natural. This has the potential to be problematic as it further entrenches social norms and suggests they are ‘natural’ or ‘right.’ For example, to refer to women’s social role as caregivers as a sex-based characteristic implies that women should and must continue to occupy those often un- or under-paid roles. Using sex/gender interchangeably similarly contributes to a false understanding of sex/gender as binary, which will be further unpacked immediately below.

55 (85)

Used the terms ‘sex’ and/or ‘gender’ in a nonbinary way

When authors present sex and/or gender as binary, usually in the form of categorical variables versus social constructs or processes, it obscures the existence and experiences of people who fall outside of the limited female/male and woman/man sex and gender categories and contributes to an inadequate representation of sex and/or gender. Sex as a construct is not limited to males and females, but also includes intersex people. Similarly, gender as an identity is not limited to women and men, but also includes people who are transgender, gender fluid, gender nonbinary, two spirit people, or one of many other genders that have existed across space and over time. While authors may be working with pre-existing data sets that do not include gender minorities or may not have been successful in recruiting gender minority participation in their studies, authors should still take care to acknowledge that sex and gender are not binary and to acknowledge the shortcomings of how sex and gender are framed in their data sets.

2 (3)

Defined ‘sex’ and/or ‘gender’

Sex and gender are frequently misunderstood terms. When they remain undefined in research, readers may be prone to confuse or conflate the terms. To avoid inadequate representation of sex/gender, authors should define what they mean when they use the terms sex/gender. Because sex and gender mutually affect and shape health and wellbeing, it is not always possible to disentangle the two and may be more appropriate at times to refer to sex/gender [9, 23]. In such instances, authors should clearly describe and justify their use of terms and be clear about the dimensions of sex and gender that are difficult to disentangle.

8 (12)

Accurately used gender- and/or sex-related terms

When authors use gender-related terms like woman/man to refer to sex-based factors and/or sex-related terms like female/male to refer to gender-related social factors, it contributes to an inadequate representation of sex and/or gender. Sex-related constructs like male/female/intersex generally refer to bodily and biological processes and factors, whereas gender-related constructs like man/woman/gender nonbinary person/transgender person/gender fluid person are generally used in reference to sociocultural identities.

14 (22)

0 (0)