The season prominently features a transgender character, Sophia, who endures a hate crime in episode 12, alongside ongoing lesbian relationships between Piper Chapman and Alex Vause that drive multiple subplots. Casting places women of color such as Uzo Aduba (Crazy Eyes), Danielle Brooks (Taystee), Dascha Polanco (Daya), and Samira Wiley (Poussey) in major recurring roles with arcs tied to race, motherhood, and incarceration experiences, while spiritual movements around Norma and religious conversions add layers of identity exploration.

Creator Jenji Kohan has emphasized expanding beyond the source memoir to highlight diverse female stories, making these elements foundational rather than incidental. Audience reception included praise for representation alongside criticisms of prioritizing social messaging over plot coherence, with episode titles and synopses like "Empathy Is a Boner Killer" and "Finger in the Dyke" signaling overt framing around gender and sexuality. The core premise of power struggles among inmates and guards repeatedly invokes systemic oppression tied to race, gender, and sexuality, elevating the score due to their centrality across the 13 episodes.