For Pride Month, Nature Reviews Gastroenterology & Hepatology recognizes and celebrates the LGBTQ+ community (we use LGBTQ+ as an umbrella term for lesbian, gay, bisexual, transgender, queer and other people who are sexual and gender minorities (SGMs)). Our June issue aims to raise awareness and shine a spotlight on key issues affecting people who are SGMs, who continue to experience challenges globally, including discrimination, exclusion, injustice and violence.

“Our June issue aims to raise awareness and shine a spotlight on key issues affecting people who are SGMs”

Structural stigma — that is, society-level conditions, cultural norms and institutional policies that constrain opportunities, resources and well-being — has been linked to poor health in LGBTQ+ communities1. A collaboration with Rainbows in Gastro2 in this issue sees members of this network contribute a series of Comments on key topics relevant to the care of patients from the LGBTQ+ community, highlighting approaches that can overcome disparities in the care of SGM patients. Communication is key to creating a safe and inclusive space for patients, and Sonali Paul and colleagues propose a cultural safety framework to guide communication with SGM patients, including the importance of using SGM terminology, minimizing presumptive narratives and acknowledging intersectionality. Nikki Duong and colleagues highlight the critical part that allies play in supporting and uplifting the LGBTQ+ community, and how effective allyship that includes active engagement and advocacy can help contribute to equity. Finally, Sarah Singh et al. survey the changing landscape of transgender care in the United States and the concerning introduction of legislation in some states that limits the abilities of clinicians to provide gender-affirming and supportive care, highlighting how these issues might affect patients with gastrointestinal or liver disease.

Receptive anal intercourse (RAI) is a common, pleasurable sexual activity but is often stigmatized and overlooked in the discourse around sexual health and sexual pleasure, despite being enjoyed by both heterosexual and non-heterosexual populations3,4. For patients with gastrointestinal disease or cancer, the disease itself and associated treatments (including surgery) can affect the ability to have pleasurable RAI. Yet, data and formal guidelines are lacking about how to adequately address this important consideration. In this issue, Daniel Dickstein and colleagues provide a comprehensive overview of pleasurable and problematic RAI. The Review highlights the anus as a sexual organ and aims to educate, inform and hopefully improve clinical practice, providing practical insights for gastroenterologists to be more inclusive in their care for patients and acknowledge that the gastrointestinal system can be directly involved in sexual pleasure.

A common thread in the discussion of LGBTQ+ issues and science is lack of data and major gaps in knowledge, including in the workforce itself5. Information is power, and without it we cannot fully support LGBTQ+ patients with gastrointestinal or liver disease, and indeed those working within gastroenterology and hepatology. Although progress is being made — for example, the National Science Foundation will now include data collection on sexual orientation and gender identity in its workforce surveys6 — more could be done, and that includes specifically acknowledging and discussing SGM patients in clinical guidelines and extending demographic data collected during clinical trials to include variables such as gender identity to improve trial diversity. Now is the time to take pride in the gastroenterology and hepatology community and create a safe and inclusive space for our LGBTQ+ colleagues and patients.