Bisexual Health Disparities and Affirming Care

Root Causes

Why Bisexual People Face Unique Health Challenges

Bisexual people are the single largest group within the LGBTQ+ community by most estimates. Yet bisexual people receive less research funding, less tailored community programming, and less acknowledgment in healthcare systems than gay and lesbian populations. The result is a set of health disparities that are both serious and largely preventable.

The health challenges bisexual people face are not caused by being bisexual. They are caused by biphobia (prejudice specifically against bisexual people) and bisexual erasure (the tendency of both straight and gay or lesbian culture to deny or dismiss bisexual identity). These forces come from all directions and create a unique form of minority stress that is distinct from the minority stress experienced by gay men or lesbian women.

Double Discrimination: Biphobia from Multiple Directions

Bisexual people face prejudice not only from straight society but also from within LGBTQ+ spaces. Common biphobic attitudes include the belief that bisexuality is "just a phase," that bisexual people are confused or unable to commit, that a bisexual person in a different-sex relationship has "turned straight," or that bisexual people in same-sex relationships are "really gay." This double discrimination means bisexual people cannot always find safety in either heterosexual or LGBTQ+ communities, which increases social isolation and worsens health outcomes. This is not a perception problem. It is discrimination, and it has measurable health consequences.

Minority Stress, Compounded

The minority stress model explains that stigma and discrimination cause elevated stress that directly leads to worse health outcomes. For bisexual people, this stress comes from multiple directions at once: from anti-LGBTQ+ society, from within LGBTQ+ spaces, and from internalized biphobia absorbed over a lifetime. This compounded stress is directly correlated with higher rates of depression, anxiety, and suicidal ideation than either gay or straight populations.

Meyer IH, APA Research

Identity Erasure in Healthcare

Most healthcare settings do not ask about sexual orientation in a way that captures bisexuality. Forms often offer only "straight," "gay," or "lesbian" as options. When bisexual patients are in different-sex relationships, providers typically assume they are straight. When in same-sex relationships, providers assume they are gay. This invisibility means bisexual people are often receiving inappropriate preventive care guidance and their unique health needs go unaddressed.

Fenway Institute, Health Disparities Research

Community Isolation

Social connection with others who share your identity is a powerful protective factor for mental health. Many bisexual people feel marginalized in LGBTQ+ spaces if their current or recent partners are different-sex. They may be questioned about whether they "belong" in LGBTQ+ spaces. At the same time, they may be unable to discuss their identity in heterosexual social contexts. This double exclusion increases social isolation and its downstream health effects.

Bi Social Network, Bisexual Invisibility Report

Economic Disparities

Bisexual women have lower incomes and higher poverty rates than both straight women and lesbian women. Bisexual men have lower household incomes than gay men. These economic disparities compound health disparities through limited access to healthcare, insurance, and stable housing. The Movement Advancement Project found that 45% of bisexual women live in or near poverty, compared to 29% of lesbian women and 21% of straight women.

Movement Advancement Project, 2016

Health Impacts

Specific Health Areas Affected by Bisexual Disparities

Mental Health: Depression and Anxiety

Research consistently shows that bisexual adults and youth have higher rates of depression and anxiety than both heterosexual and gay or lesbian people. A 2011 meta-analysis in the Journal of Bisexuality found bisexual women had 5.9 times the odds of depression and 3.4 times the odds of anxiety compared to heterosexual women. Bisexual men also showed elevated rates compared to gay men. These differences are not explained by sexual behavior. They are explained by biphobia and erasure. Affirming therapy from a provider who explicitly understands bisexuality is significantly more effective than general LGBTQ+-affirming care that still centers gay and lesbian experiences.

Suicidal Ideation and Self-Harm

Bisexual youth and adults consistently report higher rates of suicidal ideation and self-harm than gay, lesbian, or straight peers. The Trevor Project's 2023 survey found 40% of bisexual youth seriously considered suicide in the past year. Studies of bisexual adults show elevated rates compared to the general population and in some measures compared to gay and lesbian adults. The reasons are the same minority stressors: biphobia, erasure, social isolation, and lack of community connection. Protective factors include: affirmation of bisexual identity as valid and real, connection with other bisexual people, and access to bi-affirming mental health care.

Substance Use

Bisexual people, particularly bisexual women, have higher rates of alcohol use disorder, binge drinking, and other substance use than both straight and lesbian women. Bisexual men also show elevated rates compared to straight men. Substance use often functions as a coping mechanism for the unique stressors bisexual people face, including social isolation, identity invalidation, and lack of community. Treatment programs that specifically acknowledge bisexual identity and its associated stressors produce better outcomes. Many substance use programs remain oriented toward heterosexual clients, and even LGBTQ+-inclusive programs often center gay and lesbian experience.

Intimate Partner Violence

The CDC's National Intimate Partner and Sexual Violence Survey found that bisexual women experience intimate partner violence at the highest rate of any group, with 61% reporting rape, physical violence, or stalking by an intimate partner over their lifetime. Bisexual men also reported higher rates than gay or straight men. Multiple factors contribute: higher rates of poverty that create financial dependency, higher rates of depression that reduce capacity to leave, and a history of experiencing their identity dismissed in ways that may make it harder to recognize abuse. LGBTQ+-affirming DV services that understand bisexual experience are essential for this population.

Sexual Health and STI Prevention

Bisexual people have unique sexual health needs that are often unaddressed by healthcare providers who make assumptions based on current partner gender. A bisexual person in a same-sex relationship may not be asked about PrEP; a bisexual person in a different-sex relationship may not be offered STI testing appropriate to their full history. The Fenway Institute found that most bisexual people are not out to their healthcare providers, meaning they are not receiving accurate risk assessments. Bi-inclusive sexual health care requires understanding that a person's current partner does not define their full sexual history or future risk profile.

Cancer Disparities

Research has found that bisexual women are less likely to receive recommended cancer screenings, including Pap smears, mammograms, and colorectal cancer screenings, than both straight and lesbian women. This is partly explained by lower insurance rates and by providers making incorrect assumptions about sexual history. Bisexual women in relationships with women may not be offered Pap smears if a provider incorrectly assumes they have no need for them. Bisexual women in relationships with men may not be connected with LGBTQ+-aware oncology resources. These screening gaps have real consequences for early detection and survival.

In the Healthcare System

Bi Erasure in Healthcare Settings

The Fenway Institute has documented that bisexual people are significantly less likely to disclose their sexual orientation to healthcare providers than gay or lesbian patients. The reasons are practical. Bisexual people frequently encounter providers who dismiss their identity, make assumptions based on their current partner, or simply do not have the knowledge or vocabulary to provide appropriate care. The result is that bisexual patients either self-censor or stop seeking care entirely.

What Providers Get Wrong

Common provider failures around bisexual health include: assuming a patient's risk profile based on current partner gender rather than full history, using "gay" and "lesbian" as umbrella terms that erase bisexual identity, failing to ask about both same-sex and different-sex partners and history, reacting with skepticism or curiosity to a bisexual disclosure, assuming that a bisexual patient in a different-sex relationship does not need LGBTQ+-specific care or resources, and not knowing about bisexual-specific health research or resources. These failures are not malicious but they are harmful. They result in care that does not match the patient's actual health needs.

What You Have the Right to Expect from a Provider

You have the right to a provider who uses intake forms that include bisexual, pansexual, and queer as identity options. You have the right to a complete sexual health history that does not assume your future risk based on your current partner. You have the right to have your bisexual identity acknowledged as real without skepticism, qualification, or curiosity. You have the right to referrals to bisexual-specific resources when relevant. You have the right to care that is informed by the actual research on bisexual health rather than care that conflates your experience with that of gay or straight patients.

Finding Care

How to Find Bisexual-Affirming Care

Bisexual Resource Center

The Bisexual Resource Center (biresource.net) maintains one of the most comprehensive directories of bisexual-affirming mental health providers in the United States. Therapists listed have specifically identified as affirming to bisexual, pansexual, and queer identities. Also an excellent source for bi+ community groups and resources.

biresource.net

Psychology Today with Bisexual Filter

On Psychology Today (psychologytoday.com/us/therapists), you can filter by LGBTQ+ identity issues and specifically search for therapists who list bisexual or pansexual among their specializations. When reviewing profiles, look for explicit mention of bisexual identity, not just general LGBTQ+ experience. These are different clinical skill sets.

psychologytoday.com

LGBTQ+ Health Centers

LGBTQ+ community health centers typically have experience with bisexual patients and are more likely to use inclusive intake forms and care protocols than general practices. Use the QueerLine resource finder to locate LGBTQ+ health centers near you. Ask specifically about bi-affirming care and about whether their intake process includes bisexual and pansexual as identity options.

Find Local Resources

Telehealth Options

Telehealth platforms like Folx Health and the Inclusive Therapists directory include providers with specific bisexual and pansexual health expertise. Telehealth expands your geographic options significantly, which matters for bisexual people in areas with few affirming providers. The QueerLine Telehealth Directory can help you identify nationwide platforms with LGBTQ+ affirming care.

Telehealth Directory

GLAAD and Bi Community Organizations

GLAAD's bisexual resources and the Bisexual Organizing Project (bipride.org) can connect you with bi-specific community events, support groups, and regional organizations. Community connection with other bisexual people is one of the most evidence-based interventions for bisexual mental health, reducing the social isolation that drives many health disparities.

glaad.org | bipride.org

Peer Support and Community

Bi+ social groups, online communities, and meetups provide the kind of identity-specific peer support that dramatically improves mental health outcomes. The Bisexual Resource Center, BiNet USA, and local LGBTQ+ centers often host bi-specific programming. Online communities including Reddit's r/bisexual provide immediate peer connection for people in areas without local resources.

binetusa.org

Self-Advocacy

Advocating for Yourself with Healthcare Providers

You should not have to educate your provider about bisexuality. But until bi-inclusive care is universal, these strategies can help you get more appropriate care from providers who have gaps in their knowledge.

Be Specific on Intake Forms

If a form only offers "gay/lesbian" as options, write "bisexual" in the other field. If given an opportunity to note health concerns, you can note "I am bisexual and want affirming care that acknowledges my full identity and history." This signals your needs before you walk into the exam room.

Name Your Identity Explicitly

Rather than waiting for a provider to ask in a way that includes bisexual identity, state it directly: "I'm bisexual and I've had both male and female partners. I want to make sure my sexual health care reflects my full history." This is information your provider needs to give you appropriate care, not personal disclosure.

Ask About Bi-Inclusive Experience

When screening a new therapist or primary care provider, it is appropriate to ask: "Do you have experience working with bisexual and pansexual patients?" and "Do you understand the specific health research on bisexual populations?" A confident yes with specifics is a good sign. Hesitation or vague LGBTQ+ generalities may indicate a gap.

Switch Providers When Needed

If a provider dismisses your bisexual identity, assumes your identity is confused or temporary, or provides care clearly calibrated to straight or gay assumptions about your history, you have the right to switch providers. You are not obligated to educate biphobic providers. The Bisexual Resource Center and GLMA directories can help you find better options.

Prioritize Bi-Affirming Community

Social connection with other bisexual people is one of the highest-impact things you can do for your health. Research shows that bisexual people who are connected with bisexual-specific community and peer support have significantly better mental health outcomes than those who rely solely on general LGBTQ+ or heterosexual social networks.

Your Identity Is Valid

Bisexuality is not a phase, a choice, a transition identity, or confusion. It is a stable, valid sexual orientation documented in psychological research for decades. Internalized biphobia from outside messages can affect self-perception. Affirmative therapy specifically helps with reclaiming a positive bisexual identity that is entirely your own.

Bisexual Health Disparities:The Gap No One Talks About