A female graduate student went to her gynecologist for a routine exam and was asked how many sexual partners she’s had. The doctor suggested the number must have been only two or three since she seemed like a “nice girl.” When the student asked her what she meant by sexual partners, the doctor said, “You know … sexual partners.”
The student responded, “The reason I’m asking you this question is because I happen to identify as bisexual so I wanted to know what your definition of sex was, and since you asked me the question I thought you would know your own definition of sex.”
After disclosing she was bisexual, the gynecologist then amended her assumption about the number of sex partners the student must have had.
“She said, ‘Oh, bisexual, then you probably mean like 30 or 40,'” the patient recounted.
The graduate student in the story was Dr. Lauren Beach, Ph.D., JD, who is advocating for better research on the health issues bisexual people face.
“I decided to go somewhere else but a lot of people don’t have that choice. If my choice were, ‘Do I go back to this provider or do I not go back?’ I probably wouldn’t go back, because I don’t want to go through something like that again. It was horrifying,” she said, referring to how offended she was by the assumption that bisexual people are more promiscuous than straight people. “And this is primary preventative care, which so important. But it’s also someone who is a gynecologist and touches you in ways that is not the every day experience … So that was jarring.”
Beach’s story was one of many recounted at a panel discussion about providing better health care for bisexual people that was held at the Human Rights Campaign headquarters on Tuesday night. Other women recounted gynecologists who only defined sex as “deep vaginal penetration,” asked women whether they could insert medical devices based on how well-endowed their assumed male partners were, and asked patients to define what bisexuality is.
With experiences like these, it’s no wonder that many bisexual people, who are attracted to various sexes and gender identities — though not necessarily to the same degree or at the same time, avoid getting the preventative care they need or avoid disclosing their sexual orientation at all. A 2012 study by the Williams Institute found that 33 percent of bisexual women and 39 percent of bisexual men did not disclose their sexual orientation to their health care provider, while only 13 percent of gay men and 10 percent of gay women did not disclose their sexual orientation.
“Experiences of biphobia make you not want to go back. It makes you want to delay necessary screenings and it’s not a matter of bi people being somehow inherently sicker, or inherently prone to sexual risk behaviors, or all of us being really prone to mental health issues,” said Beth Sherouse, senior content manager for the Human Rights Campaign. “It’s because we’re not getting the care that we need and we’re facing biphobia in and outside of heath care settings. And we’re experiencing minority stress. We’re facing stress within the LGBT community as well as outside of it.”
The lack of disclosure to health care professionals mirrors a lack of disclosure in other areas of bisexual people’s lives. According to a 2014 report released by the Movement Advancement Project, an independent think tank focusing on LGBT issues, 60 percent of bisexual people heard biphobic comments or jokes in their workplace and nearly half of bisexual people reported being out to coworkers. In a 2015 Pew Research Poll, 28 percent of the bisexual people surveyed, most of whom were women, said they were out to all or most of the important people in their lives.
What medical schools need to do to improve health in the bi community
Bianca Palmisano is the owner of Intimate Health Consulting, which is trying to get more medical schools and residency programs to recognize LGBT health needs. Palmisano said that there is not enough sexual health education for medical students, much less LGBT sexual health education. Medical school is not always a welcoming place for medical students in the LGBT community either. A 2015 Stanford University School of Medicine survey found that 40 percent of students who identified as “not heterosexual” reported they were afraid of discrimination at medical school and a third of those students chose not to disclose their sexual identity.
“That’s terrifying,” Palmisano said on the lack of knowledge of sexual health issues in the medical community. “So my company is this tiny, tiny bridging of that gap. We’re trying to go to residency programs, and say ‘This needs to be in your curriculum.’ We can talk about being advocates but I want to move to a place where our systems are serving us where they should be. We need to also speak about what it means to talk honestly and ethically about sex in general, because that’s not something out society has taught us to do very well.”
One of the major problems bisexual patients face is the misconception that because a doctor knows how to communicate well with lesbian and gay patients, they must know how to discuss health issues with bisexual people, said Theresa Sparks, executive director of the San Francisco Human Rights Commission. Sparks is involved in ongoing research on LGBT health challenges.
“The health care providers I talk to, they say, ‘We understand gays and lesbians and we’re now getting trans, but doesn’t bi include all of that other stuff so shouldn’t we understand it just intuitively? And so that needs to be changed,” Sparks said. “We need to differentiate to health care providers what the differences are with bisexual health, because I don’t think they understand it and they’re crossing over these boundaries.”
Sparks discussed the challenges of doing sexual health training for health care providers, when she worked as the former general manager of Good Vibrations, an online store selling sex toys and adult entertainment.
“At first they’re surprised that we think they need it. And then they’re reluctant to get it. And then they’re embarrassed when they hear it. And these are health care providers! And so these things that need to be discussed,” Sparks said.
The importance of mental health care
Although mental health care is often neglected in conversations about LGBT health care issues, it is especially important for the bisexual community. Studies show that bisexual women have double the rate of eating disorders compared to gay women and have higher rates of alcohol use, heavy drinking, and alcohol-related problems than gay or straight women. Those bisexual women who were not out reported higher rates of contemplating suicide compared to straight women. According to a 2012 Human Rights Campaign survey, bisexual youth were also less likely to have certain social supports in place when they were feeling sad compared to gay and lesbian youth.
Being out and having support is important, said Khafre K. Abif, author of Cornbread, Fish and Collard Greens: Prayers, Poems & Affirmations for People Living with HIV/AIDS and founder/executive director of Cycle for Freedom, who spoke about the secrets he kept growing up as an African-American bisexual man and rape survivor.
“I check in once a week and I’ve been doing the work with my provider and I lead a pretty transparent life … I’ve found that the ultra relevance for African Americans is that you don’t talk about stuff outside of your house. I don’t know about any other culture but I know in our culture, you literally do not talk about what is going on in your house with anyone else … In the context of that, it develops into holding onto secrets and that’s what we don’t talk about. Holding on to secrets, so by the time you get to be an adult, who can you tell?”
It can be tough to find the right therapist, however, said Faith Cheltenham, president of BiNet USA. Cheltenham, who is a survivor of reparative rape, or rape that is supposed to “fix” someone’s sexuality, said she visited six therapists before finding the right one.
“It was like a revolving door. I said, ‘No, I’m good!’ I’m going to the next one. And I kept going and it was so hard,” Chelteham said.
Bizone provides a list of therapists across the country, as well as medical providers, that are affirming of bisexual patients. Other strategies include using your insurer’s provider search website, such as Anthem Blue Cross, by selecting multiple boxes, such as someone who has experience with LGBT issues and whichever mental health issues you find relevant. However, one of the best methods bisexual people have for finding the right therapist or doctor is through the recommendations of bisexual friends and acquaintances, panelists said.
How to stand up for yourself as a bisexual patient
Abif, who has been living with HIV for more than 20 years, said he makes sure to let his doctor know that he has certain expectations for his care. Because he has moved many times in his life, Abif has had to switch health care providers many times and has learned how to be an assertive patient.
“For me, I’m pretty upfront, I would research people, but when I meet the provider I’m letting them know, ‘I’m interviewing you, because you may not be my provider,'” Abif said. “And I say that to them because we need to have this discussion. This is what I do. And this is what I’m coming here for. I need to have a relationship with you that meets my expectations.”
One of the difficult things for any patient is to make sure the doctor takes their time and answers all of your questions.
“You think you have questions and you’re spun out around so quickly, and then you’re out the door. So you need to write the questions down and bring the questions with you and you need to slow that provider down. Slow that process down,” Abif said.
Palmisano said one of the most important things for bisexual patients to remember is that it’s okay to call out health care providers when they say something hurtful. She advises bisexual people who are treated poorly by their doctors and therapists to make sure they let providers know that will never come back and that they will tell fellow bisexual patients to steer clear of them in the future.
“Hey, the squeaky wheel gets the grease,” Palmisano said.