Various sexual identities among a cohort of Italian adolescents: from their own perception of selves to social and healthcare acceptance

Background: Gender incongruence (GI) is the conflict between the sex assigned at birth and the perceived gender identity, sometimes leading to significant distress (gender dysphoria). The WPATH Standards of Care (SOC) estimate that transgender youth make up approximately 3% of the global pediatric population, increasing to 8% when considering all gender-diverse identities. GI and perceived non-conforming sexual orientation can lead to reduced access to care and marginalization in non-inclusive socio-healthcare contexts. This study aims to overview the prevalence of different sexual identities among Italian adolescents, highlighting non-conforming gender identities and sexual orientations. Methods: A cross-sectional study used an online, anonymous questionnaire administered to adolescents aged 12 to 17 years at the Pediatric Clinic of the University Hospital of Parma, Italy, from January 2023 to April 2024. Informed consent was obtained from the adolescents and their parents. Results: Fifty-one adolescents [31 assigned female at birth (AFAB)] completed the questionnaire, with a mean age of 14.9 ± 1.4 years. Among them, 3.9% (all AFAB) reported GI causing significant distress. Among AFAB adolescents, 19.3% experienced gender-based discrimination, and about 13% desired to belong to a different gender at least once. Regarding sexual orientation, 13% identified as bisexual, 3.2% as asexual, and 16.1% were unsure. Among males assigned at birth (AMAB), 100% identified as cisgender, and 5% were homosexual. Sexual activity was reported by 41.9% of AFAB adolescents (3.2% homosexual, 38.7% heterosexual) and 15% of AMAB peers (all heterosexual). Most adolescents (68.6%) felt comfortable discussing sexual identity topics with their pediatrician/general practitioner. Conclusions: The study indicates that 3.9% of the adolescents experience GI and a notable percentage exhibit non-conforming sexual orientations. A significant proportion of adolescents wish to discuss their sexual orientation and gender identity with their healthcare providers, underscoring the need for medical competence and inclusive dialogue.