Introduction

This concept provides definitions for the words "sex" and "gender" and other gender-related terms, describes the current state of sex and gender related variables available in the Manitoba Population Research Data Repository (Repository), identifies additional data in the Repository that contains a broader scope of gender-related data, and provides links to information containing guidelines, resources and tools that describe approaches to using sex and/or gender in health research.

Definitions of Sex. Gender, Gender Identity and Gender Expression

The words sex and gender are often used interchangeably, but the meaning of these terms have evolved in recent years.

As currently defined on the Canadian Institutes of Health Research (CIHR) website:

"Sex refers to a set of biological attributes in humans and animals ... primarily associated with physical and physiological features including chromosomes, gene expression, hormone levels and function, and reproductive/sexual anatomy. Sex is usually categorized as female or male but there is variation in the biological attributes that comprise sex and how those attributes are expressed.

Gender refers to the socially constructed roles, behaviours, expressions and identities of girls, women, boys, men, and gender diverse people. It influences how people perceive themselves and each other, how they act and interact, and the distribution of power and resources in society. Gender identity is not confined to a binary (girl/woman, boy/man) nor is it static; it exists along a continuum and can change over time."

(Source: Canadian Institutes of Health Research (CIHR) website: What is gender? What is sex? Accessed December 8, 2023)

As currently defined on the Statistics Canada website:

"Gender refers to an individual's personal and social identity as a man, woman or non-binary person (a person who is not exclusively a man or a woman). Gender includes the following concepts:



• gender identity, which refers to the gender that a person feels internally and individually;
  
• gender expression, which refers to the way a person presents their gender, regardless of their gender identity, through body language, aesthetic choices or accessories (e.g., clothes, hairstyle and makeup), which may have traditionally been associated with a specific gender.


A person's gender may differ from their sex at birth, and from what is indicated on their current identification or legal documents such as their birth certificate, passport or driver's licence. A person's gender may change over time. Some people may not identify with a specific gender."

(Source: Statistics Canada website: - Gender of person (Accessed January 30, 2025)

Sex and Gender Related Variables in the Repository

In the Manitoba Population Research Data Repository, the variables labelled either as SEX or GENDER (usually only one is present) are available in many of the datasets. These variables are often used interchangeably in our research and most values are recorded as either female or male, although some additional values are available in some datasets.

The values recorded for female and male can be represented in different ways depending on the dataset being used. For example, females can be identified by the values: Female, F, or 2 and males can be identified by the values: Male, M or 1, depending on the dataset being used.

In some datasets, a small number of additional values may be recorded, such as:


• "X", "U", "O", "3", "4", or "A" - these values carry the meaning of undefined, undifferentiated, unspecified, unknown, other, or ambiguous, depending on which dataset they are recorded and defined in.
  
• In some cases, the value can be missing (blank); indicating that no value is recorded in the data.

The current collection and reporting of sex and gender data is largely limited to values of female or male, or "other" sex/gender-related terminology. When GENDER is available as a variable, it is unclear whether these values are intended to describe biological aspects or a broader social / cultural perspective.

When using these variables, it is important to note sex is not a placeholder for gender (or vice-versa) and data users should attempt to avoid conflating these terms and / or acknowledge limitations in the data.

Repository Data with a Broader Scope of Gender-Related Data

The Repository currently contains limited data available to investigate gender identity or gender expression in your research. The datasets in the Manitoba Population Research Data Repository that do contain more specific gender-related information are:


• Canada Census data - 2021 - see the Statistics Canada web page titled Filling the gaps: Information on gender in the 2021 Census for more information on what gender-related information is available in the 2021 Census.
  
  
• Youth Health Survey (YHS) data (2012-2013) - includes a question on IDENTITY with response values of: different sex, same sex, transgender, and missing. However, the limited range of values available seem to conflate identity and orientation.
  
  
• Canadian Community Health Survey (CCHS) data that contains the following variables:
  
  • Gender of person (in effect since October 1, 2021), including the following classification:
    
    1. Man - includes persons whose reported gender is male. It includes cisgender (cis) and transgender (trans) men.
       
    2. Woman - includes persons whose reported gender is female. It includes cisgender (cis) and transgender (trans) women.
       
    3. Non-binary person - includes persons whose reported gender is not exclusively male or female (e.g., agender, pangender, genderqueer, genderfluid, or gender-nonconforming); persons whose reported gender is Two-Spirit, a term specific to some Indigenous peoples of North America; persons whose reported gender is both male and female, neither male nor female, or either male or female in addition to another gender; persons who reported or were reported by proxy as questioning or in the process of deciding.
    
    ( Source: Statistics Canada website - Gender of person - Accessed January 30, 2025)
    
    
  • Gender diversity status of couple family (in effect since November 29, 2021), including the following classification:
    
    1. Different-gender couple (cisgender) - includes couple families in which members are cisgender and of different genders (one man and one woman).
       
    2. Same-gender couple (cisgender) - includes couple families in which members are cisgender and of the same gender (two men or two women).
       
    3. Transgender or non-binary couple – includes couple families in which at least one member is transgender or non-binary.
    
    ( Source: Statistics Canada website - Gender diversity status of couple family - Accessed January 30, 2025)
  
  
• Hospital Abstracts data and / or the Medical Services / Medical Claims data that contains specific ICD / CCI diagnoses and intervention codes that identify gender-related medical conditions and procedures/interventions.

Approaches to Using Sex and/or Gender in Health Research

The following links provide some suggestions and ideas on how to approach using sex and / or gender in health research.

The Canadian Institutes of Health Research (CIHR) website provides some guidelines, resources, and tools to assist researchers in using sex and/or gender in their research. Two of these resources are:


• Sex and Gender in Health Research
  
• How to integrate sex and gender into research

In the article Integrating and evaluating sex and gender in health research by Day, S, Mason, R, Lagosky, S, and Rochon, PA (Health Research Policy and Systems 2016;14(1):75) they examine some of the challenges of using and investigating sex and gender in research, and offer some strategies in dealing with these challenges.