Bisexual Physical Healthcare

Following are the health issues GLMA’s healthcare providers have identified as most commonly of concern for bisexual people. While not all of these items apply to everyone, it’s wise to be aware of these issues.

1. Come Out to your Healthcare Provider
In order to provide you with the best care possible, your clinician should know you are bisexual. It should prompt him/her to ask specific questions about you and offer appropriate testing. Many providers are less familiar with bisexuality and may make assumptions about your behavior. Be honest, and you will get better care. Remind your provider each time you see them about your current partner(s) —it may change the screening tests they offer you. If your provider does not seem comfortable with your sexual orientation, find another provider.1

2. HIV/AIDS, Safe Sex
Many bisexuals who have sex with men are at an increased risk of HIV infection, but the effectiveness of safe sex in reducing the rate of HIV infection is one of the LGBT community’s great success stories. If you are HIV positive, you need to be in care with a good HIV treatment provider. Safe sex is proven to reduce the risk of receiving or transmitting HIV. You should also discuss and be aware of what to do in the event that you are exposed to HIV (Post-Exposure-Prophylaxis)—contacting your provider IMMEDIATELY following an exposure to explore your options. If you are in a relationship where one of you is positive, you should discuss options for prevention with your provider as well. Although women who have sex with women have lower rates of HIV, if you have sex with a gay or bi man (who have increased rates) it is important to understand their HIV status and how to protect yourself.

3. Hepatitis Immunization and Screening
If you have sex with multiple partners (of any gender) you are at an increased risk of hepatitis, which are infections of the liver caused by sexually transmitted viruses.  These infections can be potentially fatal, and can lead to very serious long-term issues such as liver failure and liver cancer. Immunizations are available to prevent two of the three most serious viruses. Universal immunization for Hepatitis A Virus and Hepatitis B Virus is recommended for all sexually active people. Safe sex is effective at reducing the risk of viral hepatitis, and is currently the only means of prevention for the very serious Hepatitis C Virus. If you have Hepatitis C, there are new, more effective treatments for that infection.

4. Fitness (Diet and Exercise)
Problems with body image are more common among bisexuals, and bisexuals are much more likely to experience an eating disorder such as bulimia or anorexia nervosa. While regular exercise is very good for your health too much of a good thing can be harmful. The use of substances such as anabolic steroids and certain supplements can be dangerous. Obesity and being overweight are problems that also affect many bisexuals. These can lead a number of health problems, including diabetes, high blood pressure, and heart disease and breast cancer.

5. Substance Use/Alcohol
Bisexuals may use substances at a higher rate than the general population and not just in larger communities such as New York, San Francisco, and Los Angeles. These include a number of substances ranging from amyl nitrate (“poppers”), to marijuana, Ecstasy, and amphetamines. The long-term effects of many of these substances are unknown; however, current wisdom suggests potentially serious consequences as we age. If your drug use is interfering with work, school or relationships, your healthcare provider can connect you to help.

6. Depression/Anxiety
Depression and anxiety appear to affect bisexuals at a higher rate than in the general population. The likelihood of depression or anxiety may be greater, and the problem may be more severe for those who remain in the closet or lack adequate social support. Many bisexuals keep their orientation and sexual behavior a secret from their providers. Adolescents and young adults may be at particularly high risk of suicide because of these concerns. Culturally sensitive mental health services targeted specifically at bisexuals may be more effective in the prevention, early detection, and treatment of these conditions.

7. STDs
Sexually transmitted diseases (STDs) occur in sexually active bisexuals at a high rate. These include STD infections for which effective treatment is available (syphilis, gonorrhea, chlamydia, pubic lice, and others) and for which no cure is available (HIV, Hepatitis, Human Papilloma Virus, herpes, etc). There is absolutely no doubt that safe sex reduces the risk of sexually transmitted diseases, and prevention of these infections through safe sex is key. The more partners you have in a year, the more often you should be screened. You can have an STD without symptoms, but you may still be able to give that to others.

8. Prostate, Testicular, Breast, Cervical and Colon Cancer
Bisexuals may be at risk for death by these cancers. Screening for these cancers occurs at different times across the life cycle, and access to screening services may be harder for bisexuals because of because of culturally insensitive care. All bisexuals should undergo these screenings routinely as recommended for the general population.

9. Tobacco
Recent studies seem to support the notion that bisexuals use tobacco at much higher rates than heterosexuals, reaching nearly 50 percent in several studies. Tobacco-related health problems include lung disease and lung cancer, heart disease, high blood pressure, and a whole host of other serious problems. Bisexuals should be screened for tobacco use and those who use tobacco should be offered culturally sensitive prevention and cessation programs for tobacco use.

10. HPV (virus that causes warts and can lead to anal & cervical cancer)
Of all the sexually transmitted infections bisexuals are at risk for, human papilloma virus (HPV) — which cause anal and genital warts — is often thought to be little more than an unsightly inconvenience. However, these infections may play a role in the increased rates of anal cancers in bisexual men. Some health professionals now recommend routine screening with anal Pap Smears, similar to the test done for women to detect early cancers. Safe sex should be emphasized. Treatments for HPV do exist, but recurrences of the warts are very common, and the rate at which the infection can be spread between partners is very high. Individuals with a a cervix should get routine pap smears as instructed by their clinician.1

INJURY/VIOLENCE
Data show that bisexual adults (47.4 percent) are significantly more likely to report experiencing intimate partner violence than heterosexual adults (17.2 percent).12  Providers should routinely assess all clients for any history of domestic violence and/or victimization.

TESTING BEHAVIORS
Studies have also yielded mixed results relative to testing and screening behaviors among bisexual women. One study found that among women ages 40 to 64 years old, bisexual women (89.5 percent) are more likely to report having had a mammogram in the past 2 years than heterosexual women (70.1 percent).13

However, another study found that among heterosexual, lesbian, and bisexual women, bisexual women have the highest rate of never having received a Pap test—a key step in the prevention and early detection of HPV.14 Providers should therefore encourage all clients to seek routine health assessments.2

1Robert J Winn, MD AAHIVMS. Medical Director, Mazzoni Center. Philadelphia, PA. Revised May 2012.
2Substance Abuse and Mental Health Services Administration, Top Health Issues for LGBT Populations Information & Resource Kit. HHS Publication No. (SMA) 12-4684. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2012.