Molly, a 16-year-old athlete, was brought to counseling by her mother due to contemplating suicide over a conflict with her best friend's parents who did not approve of their close relationship. In counseling sessions, Molly explored her sexual identity and realized she was homosexual. She came out to her supportive parents. Molly continued struggling with restrictions on her friend and when to come out more broadly. Her mother, a school counselor, also struggled with supporting Molly as her daughter and client. The document discusses sexual orientation, gender identity, assessment methods, counseling approaches, and sexual health rights.

1. Sexual orientation and counselling,
sexual health rights
Presenter: Dipsikha Aryal
MPH 2021
SPH and CM

2. Table of contents
1) Sex and gender
2) Sexual orientation
3) Gender identity/expression/presentation
4) Assessment method
5) Sexual counselling
6) Sexual rights
7) References
4/6/2022 2

3. Sexual health
• Sexual health is about well-being, not merely the absence of disease.
• Sexual health involves respect, safety and freedom from discrimination and violence.
• Sexual health depends on the fulfilment of certain human rights.
• Sexual health is relevant throughout the individual’s lifespan, not only to those in the
reproductive years, but also to both the young and the elderly.
• Sexual health is expressed through diverse sexualities and forms of sexual expression.
• Sexual health is critically influenced by gender norms, roles, expectations and power
dynamics.
4/6/2022 3

4. Sex and Gender
• Sex” refers to the physical differences between people who are male, female,
or intersex. A person typically has their sex assigned at birth based on
physiological characteristics, including their genitalia and chromosome
composition. This assigned sex is called a person’s “natal sex.”
• Gender, on the other hand, involves how a person identifies. Unlike natal sex,
gender is not made up of binary forms. Instead, gender is a broad spectrum. A
person may identify at any point within this spectrum or outside of it entirely.
4/6/2022 4

5. Sexual orientation (1)
• Sexual orientation is a term used to refer to a person's pattern of emotional,
romantic, and sexual attraction to people of a particular gender (male or female).
• Sexuality is an important part of who we are as humans. Beyond the ability to
reproduce, sexuality also defines how we see ourselves and how we physically
relate to others.
4/6/2022 5

6. Sexual orientation (2)
• Sexual orientation involves a person's feelings and sense of identity; it’s not
necessarily something that’s noticeable to others. People may or may not act on
the attractions they feel.
4/6/2022 6

7. Sexual orientation is usually divided into these
categories:
 Heterosexual: Attracted to people of the opposite sex
Bisexual: Attracted to people of either sex
Homosexual: Attracted to people of one's own sex
Pansexual: Attracted to people of any gender identity
Asexual: Not sexually attracted to other people
4/6/2022 7

8. Gender identity/expression/ presentation
• Heterosexual
Heterosexuality is the sexual orientation in which a person is attracted (affectionally,
sexually, romantically) to partners of the opposite sex. This is sometimes referred to
as being “straight.”
• Homosexual
Homosexuality is the sexual orientation in which a person is attracted (affectionally,
sexually, romantically) to partners of the same sex.
4/6/2022 8

9. • Bisexual
Bisexuality is a sexual orientation in which people are attracted to partners of the opposite
sex as well as partners of the same sex. There are those who believe that bisexuals are in
denial and are actually gay or lesbian. Research has repeatedly shown that many people are
in fact bisexual.
• Questioning
When a person is in the process of exploring their sexual orientation, they may choose to
identify as Questioning. Whether done consciously or not, this process is a healthy part of
understanding one’s own sexual orientation. Typically, this happens during early puberty,
but can happen at any time during a person’s life.
4/6/2022 9
Gender identity/expression/ presentation

10. Transgender
• A transgender person is someone whose gender identity does not correspond with
their biological/physical gender. Gender identity refers to a person’s internal sense
of being or feeling male, female, or something else.
• For example, a transgender man is a person who was born physically female, but
identifies as male, while a transgender woman is a person who was born
physically male, but identifies as female.
4/6/2022 10
Gender identity/expression/ presentation

11. Intersexed
• Born with aspects of both female and male genitalia, often referred to as
“ambiguous biological sex characteristics.”
• These people have often been put through genital surgery as infants, their sex
having been decided by the doctor. Historically, this was frequently done without
the parents’ consent, though this practice is changing.
4/6/2022 11
Gender identity/expression/ presentation

12. 4/6/2022 12

13. What Determines Sexual Orientation?
• Most scientists agree that sexual orientation (including homosexuality and
bisexuality) is the result of a combination of environmental, emotional, hormonal,
and biological factors. In other words, many things contribute to a person's sexual
orientation, and the factors may be different for different people.
• Homosexuality and bisexuality aren’t caused by the way children were reared by
their parents, or by something that happened to them when they were young. Also,
being homosexual or bisexual does not mean the person is mentally ill or
abnormal in any way.
4/6/2022 13

14. How Do People Know Their Sexual Orientation?
• Many people discover their sexual orientation as teens or young adults, and in
many cases without any sexual experience.
• For example, someone may notice that their sexual thoughts and activities focus
on people of the same sex, or both sexes. But it’s possible to have fantasies or to
be curious about people of the same sex without being homosexual or bisexual.
4/6/2022 14

15. Assessment method of sexual orientation
• The basic assumption of most of the previous methods of assessment is that sexual
orientation is determined by one’s gender or genitalia and the gender or genitalia of the
individual one is attracted to.
A model for assessment of sexual orientation is proposed which includes nine dimensions:
 Current relationship status,
 Self identification identity,
 Ideal self-identification identity,
 Global acceptance of their current sexual orientation identity,
4/6/2022 15
Ref: Eli Coleman PhD (1987) Assessment of Sexual Orientation, Journal of Homosexuality

16. Assessment method of sexual orientation
 Physical identity,
 Gender identity,
 Sex role identity
 Sexual orientation identity as measured by behavior, fantasies and emotional
attachments and
 Finally the individual’s past and present perception of their sexual identity
compared to their idealized future.
4/6/2022 16

17. Kinsey Scale
• First published in Sexual Behavior in the Human Male (1948) by Alfred
Kinsey, Wardell Pomeroy.
• The Kinsey scale, also called the Heterosexual–Homosexual Rating Scale, is
used in research to describe a person's sexual orientation based on one’s
experience or response at a given time. The scale typically ranges from 0, meaning
exclusively heterosexual, to a 6, meaning exclusively homosexual. In both the
male and female volumes of the Kinsey Reports, an additional grade, listed as
"X", indicated "no socio-sexual contacts or reactions".
4/6/2022 17
Ref: https://en.wikipedia.org/wiki/Kinsey_scale

18. Questions
1) To whom you are attracted?
2) Who have you had sex with?
3) Who have you had sexual fantasies about?
4) With whom do you form strong emotional bonds?
5) Who do you feel the most comfortable socializing with?
6) The idea of having sex with someone of the opposite sex from mine is: Desirable,
Tolerable, Irritable
7) The idea of having sex with someone of the same sex as mine is: Desirable, Interesting,
Disgusting
4/6/2022 18
Ref: https://www.idrlabs.com/kinsey-scale/test.php

19. 4/6/2022 19

20. Counseling to their sexual orientation
Individual
 Education may begin the process of awareness, but only through introspection,
reflection, and experience, can one begin to understand his/her, overt and covert,
tendencies to respond from a personal worldview.
Through consultation and supervision of their activities
4/6/2022 20

21. Family and community
(a) Offer support but assume if any help needed;
(b) Be a role model of acceptance;
(c) Listen, listen, listen;
(d) Assure and respect confidentiality;
(e) Ask questions that demonstrate understanding, acceptance, and compassion;
(f) Challenge traditional norms
4/6/2022 21
Counseling to their sexual orientation

22. National Level
• Policy and law
• Strive to understand the experiences and challenges faced by lesbian, gay, and
bisexual parents.
4/6/2022 22
Counseling to their sexual orientation

23. Case story
The case example is from previous clinical work conducted in a private practice setting. It has been presented in
a way to protect the client and her mother’s identity. Molly, an athletic 16-year-old female, was brought to
counseling by her mother, Sue, who explained that Molly was contemplating suicide and was going through a
“tough time.” Sue knew the counselor (who is the major researcher in this study) from a school counseling
program in a rural Southern university where she attended several years before, and this counselor was a
faculty member there. In the first session, Molly appeared emotional and told of her recent conflict with her best
friend’s parents, who had recently decided that they no longer could see each other. As the session continued,
Molly hesitantly discussed the conflict, which began when her friend’s parents became concerned and suspicious
about the closeness of the relationship. She went on to describe their fears, which mainly focused on their
daughter and Molly possibly having a homosexual relationship. Molly stated that she did not want to live
without being able to see her friend and that she was obsessed with her and could think of nothing else.
4/6/2022 23

24. • Molly tentatively explained that she was not sure about the relationship herself. She knew that she loved her friend in a
different way than she had ever loved anyone else and that she had never felt this way about the few boys she had dated. The
suicidal thoughts were discussed with her mother and safety precautions were put into place. Molly continued in therapy for
three sessions. During these sessions she worked through her sexual identity questions and became certain that she was
homosexual. She was truthful to her parents, and they accepted and supported her in this revelation. It was at this time that
she reminisced about her favorite aunt, who was deceased and who she now realized was a lesbian, and told of the fondness
that she felt for her and wished that she could talk to her. She continued to struggle with the restrictions placed on the
relationship with her girlfriend and also struggled with when she should “come out.” She questioned whether she should wait
until she went away to college or if she should go ahead and “come out” to her high school friends and classmates. Molly’s
mother, Sue, was working as a school counselor in a small, rural school during this event, and she was dealing with her own
issues both as her daughter’s school counselor and as her mother. Although Molly discontinued therapy after a short time,
Sue continued to keep Molly’s counselor updated on her progress, as well as her own struggles as her mother. Because both
Sue and Molly were extremely open and honest about Molly’s journey through her sexual identity crisis.
4/6/2022 24
Story of a 16 years Athletic Molly, her mother explained that Molly was
contemplating suicide and was going through a “tough time” In the first
counseling session, Molly appeared emotional and told of her recent conflict
with her best friend’s parents, who had recently decided that they no longer
could see each other. Molly stated that she did not want to live without being
able to see her friend and that she was obsessed with her and could think of
nothing else. Molly tentatively explained that she was not sure about the
relationship herself. She knew that she loved her friend in a different way than
she had ever loved anyone else and that she had never felt this way about the few
boys she had dated. . Molly continued in therapy for three sessions. During these
sessions she worked through her sexual identity questions and became certain
that she was homosexual. She was truthful to her parents, and they accepted and
supported her in this revelation.

25. Sexual rights (1)
• There is a growing consensus that sexual health cannot be achieved and
maintained without respect for, and protection of, certain human rights.
• “The fulfilment of sexual health is tied to the extent to which human rights are
respected, protected and fulfilled. Sexual rights embrace certain human rights that
are already recognized in international and regional human rights documents and
other consensus documents and in national laws.
4/6/2022 25

26. Rights critical to the realization of sexual health include:
• the rights to equality and non-discrimination
• the right to be free from torture or to cruel, inhumane or degrading treatment or
punishment
• the right to privacy
• the rights to the highest attainable standard of health (including sexual health) and
social security
4/6/2022 26
Sexual rights (2)

27. • the right to marry and to found a family and enter into marriage with the free and full
consent of the intending spouses, and to equality in and at the dissolution of marriage
• the right to decide the number and spacing of one's children
• the rights to information, as well as education
• the rights to freedom of opinion and expression, and
• the right to an effective remedy for violations of fundamental rights.
4/6/2022 27
Sexual rights (3)

28. Policy and Legal Provision to advance SRH in Nepal
• National Health Sector Strategy; 2016-2021
• Safe Motherhood and RH Act-2075, Regulation-2077
• National Adolescent Health and Development Strategy-2075
• Nepal Safe Motherhood and Newborn Health Program Roadmap 2030
4/6/2022 28

29. Sexual health right
 In April 2007, the Blue Diamond Society, MITINI Nepal, Cruse AIDS Nepal, and
Parichaya Nepal, all organizations representing lesbians, gays, and "people of the third
gender", filed a writ petition under Article 107(2) of the Interim Constitution of
Nepal demanding representation and laws that provide protection to the LGBT
community, thus prohibiting any discrimination on the basis of sexual orientation and
gender identity.
Nepal's citizenship card system provided benefits to all the citizens such as ration cards,
passports, residency cards, etc. however, those who identified themselves within the third
gender were denied these rights by the officials.
4/6/2022 29

30. • The Court therefore decided that it is appropriate that same-sex marriage is
decriminalized and de-stigmatized. Also, laws were introduced to ensure that all
the genders are provided equal rights therefore, this resulted in new citizenship
cards which have column for the third gender.
4/6/2022 30
Sexual health right

31. New constitution of NEPAL and LGBT rights
• Article 12 states that citizens will be allowed to choose their preferred gender identity
on their citizenship document. The choices available are male, female or other.
• Article 18 states that gender and sexual minorities will not be discriminated against by
the state and by the judiciary in the application of laws. It further adds that the
government may make special provisions through laws to protect, empower and advance
the rights of gender and sexual minorities and other marginalized and minority groups.
• Article 42 lists gender and sexual minorities among the groups that have a right to
participate in state mechanisms and public services to promote inclusion.
4/6/2022 31

32. References
1) Assessment of Sexual Orientation, Journal of Homosexuality, 14:1-2, 9-24, DOI:
10.1300/J082v14n01_02
2) https://www.bouldercounty.org/families/lgbtiq/lgbtiq-definitions/
3) Proc Natl Acad Sci USA.2020 Nov 3;117(44): 27080: 2020 Nov 3. doi: 10.1073/pnas.2015820117
4) https://en.wikipedia.org/wiki/Kinsey_scale
5) The Counselor’s Role in Helping Students With Sexual Identity Issues: A Case Study of a Mother
and Daughter
6) https://www.who.int/teams/sexual-and-reproductive-health-and-research/key-areas-of-
work/sexual-health/defining-sexual-health
7) The Right to Safe Motherhood and Reproductive Health Act, 2075 (2018)
4/6/2022 32

33. Thank you
4/6/2022 33