The last time Lauren Krouse saw her GP, the physician assistant went through Krouse’s patient history form. She laughed and brushed off the sexual orientation question.
“I don’t even know why I’m asking this,” said the assistant. She assumed Krouse was straight.
Bisexual people are much less likely to disclose their sexual orientation than heterosexual or homosexual people. Bisexuals are much less likely to be released important people in their lives, and about 39% of bisexual men and 33% of bisexual women reported do not disclose their sexuality to a medical provider. For gays and lesbians, this number is 10% and 13%, respectively.
Bisexual people face single bias, often even in their own community. This includes the belief of other LGBTQ people that bi women are actually straight and bi men are actually gay, and both are “confused” and “sexually risky”. There is also research indicating increased risk of suicide attemptshigher rates of mood and anxiety disorders and drug addiction. Advocates are working to change the landscape of medical care, pushing for a more assertive space where physicians take a holistic view of patients who may face these disparities.
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Bi+ individuals, an umbrella term that describes any attraction to more than one gender and includes pansexual and fluid sexual orientations, constitute the largest population within the LGBTQ community. So why is staying in the doctor’s office closet so common?
A possible explanation: only about half of the clinics in a 2018 study said they regularly asked questions about sexual orientation.
Those who are asked and choose not to disclose may fear biphobia, says Brian Feinstein, researcher and associate professor at Rosalind Franklin University of Medicine and Science.
“Disclosure can have advantages and disadvantages … which can then put them at risk of discrimination, victimization,” Feinstein says. “Bisexual people have these same kinds of stigmatizing experiences with health care providers, where they will see providers saying things that essentially invalidate their identity, or even to the point of implying that once we have settled your depression, and it’s better, you’ll win ‘not to be bisexual anymore.
For Krouse, the assistant’s “glib” comment was off-putting enough that she didn’t reveal her bisexuality to her doctor that day.
“When you disclose, it’s a different decision each time, depending on your emotional state and what you’re able to handle,” Krouse says.
When disclosure makes a difference
Although disclosure is a personal decision that some may not feel comfortable with, the Centers for Disease Control and Prevention urges doctors to at least ask health care needs so specific and discrepancies can be addressed.
About 61% of bisexual women report rape, physical violence or harassment by an intimate partner, compared to 44% of lesbians and 35% of heterosexuals, according to the most recent national survey on intimate partners and sexual violence, almost half of bisexual women have been raped in their lifetime, compared to 13% lesbians. women and 17% heterosexual women.
Nic Johnson, a licensed psychologist and professor at Lehigh University, attributes this data to the perception of bi+ women in society.
“Hypersexual” is a word often associated with bi+ women, whose identity is often seen by men as a “signal not of female agency, but of female sexual commodification,Johnson’s research explains.
“Because of our culture’s view that bisexual women are hypersexual, and even deviant in terms of sexual behavior, maybe even well-meaning people react in really harmful ways, like, ‘Well, what did you expect? -you ? Did you tell them you were bisexual? said Johnson.
Feeling excluded by heterosexual and LGBTQ communities is an additional stressor on top of the trauma. And racism, in addition to biphobia and sexism, further exacerbates the trauma of bi+ women of color, according to Johnson’s research.
If you don’t share your sexuality for sexual health reasons, is it important to tell your doctor that you are bi+?
For Lux Alptraum, writer and podcast host, it absolutely is.
“Often being locked up, not feeling seen, existing in a biphobic society is stressful for bi people,” says Alptraum. “So if your doctor doesn’t understand that you’re bi and doesn’t understand this anxiety of being bi… how are they going to help you properly?”
Feinstein says the responsibility should lie with medical providers to create an environment where people feel comfortable disclosing.
“When people reveal they’re bisexual, if it’s to a provider who says so, that might be met with support,” Feinstein says. “And that’s something bisexual people miss or don’t get.”
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Bi+-affirm healthcare in practice
When Dr. Kimberly Herrmann started working at Whitman-Walker Health, a community health service in Washington, D.C., she knew she wanted a space to practice medicine that was specifically LGBTQ.
She creates a safe space by allowing patients to share what is comfortable, focusing primarily on anatomy in sexual health.
“Medicine is really far behind in how we define people as humans,” Herrmann says. “And for me as a doctor, I really need to know what body parts you have. Do you have a uterus? Are we worried about pregnancy? Do you have a penis? Are we worried about certain diseases? or resulting infections?
Until medicine “catch up,” she says, she will start every conversation by asking questions about pronouns, gender identity and sexuality.
Elizabeth Johnson, a DC-based counselor, says conversations with bi+ people in therapy often start with not making assumptions based on sexual and relationship history.
Johnson says she regularly sees bi+ patients invalidating their own sexuality. Bi+ women in relationships with cisgender, heterosexual men report higher stress levels and depressive symptoms than those in lesbian relationships. Especially on his first outing, Johnson addresses the stereotypes these patients might have internalized.
Johnson, who is lesbian, says having gay-identifying healthcare professionals working with gay patients could be another successful route to bi-affirming care. She recommends that all therapists address their own biases and assumptions about bi+ people.
For some, bi-affirmative care might seem as simple as a question on an intake form. For others, it is a longer, ongoing conversation about sexuality and its nuanced impact on a patient’s life.
Hermann prefers the latter.
“When you come for a sore throat, it should feel like an affirmation visit. Even when you come for a stumped toe, it should feel like an affirmation visit,” Herrmann says. medical care to think about: how does bisexuality impact my care beyond sexual health?”
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