What we talk about when we talk about bi healthcare.

I think about this a lot.

A few years ago, if you’d asked me to talk about bi healthcare needs, I probably would have stared at you blankly. With some prodding, I might have acknowledged that bi men are at an elevated risk for HIV and should be offered access to the same education and mitigation strategies that all men who have sex with men need access to, and after that I likely would have stalled out. As a bi cis woman, the idea that I would have had any special health needs would have absolutely baffled me. I mean, sure, it would be great for doctors to tell me about lesbian safer sex stuff, but since there’s little that lesbians engage in that’s not also potentially incorporated into straight sex, that just felt like a call for broader sex education from doctors, period. Queer healthcare, generally, was something I couldn’t mentally separate from reproductive healthcare, specifically, and as a bi woman it was hard for me to see how my reproductive healthcare needs were in any way special or deserving of consideration.

But then… then a few years ago I started learning about the stats about bi people and our general well-being and it was honestly pretty life changing. To recap here: research repeatedly shows that bi people, and bi women especially, are doing incredibly badly healthwise. We’re at elevated risk of both mood and anxiety disorders, of substance abuse, of suicidality; but we’re also at elevated risk of things like high cholesterol and asthma. And while you can kind of see how living in a biphobic society might contribute to adverse mental health outcomes, it’s harder to see how being bi would lead to… asthma. It certainly doesn’t seem at all related to the narrow, reproductive healthcare-focused definition of bi healthcare that I used to have in mind.

I’ll cut to the chase here and say that, more likely than not, the reason why bi people’s health is, on a population-wide scale, in the toilet is likely due to stress. It is stressful to be a bi person in a biphobic society, and many of us live with a constant low level anxiety all the time as a result — a low level anxiety that means we have elevated rates of various stress hormones that wear down our body and can lead to things like, yes, high cholesterol and asthma and high blood pressure and cancer and a variety of other ailments that bi people are at elevated risk for.

The problem with saying that bi people have shittier health outcomes because we have higher levels of stress is that in our highly individualized society it can often sound like the solution is, uh, bi people meditating more? Free Headspace subscriptions for every bisexual? And I hope you know that that is not the actual answer, that putting it on individual bisexuals to mitigate our stress levels on our own is a band-aid solution at best. Obviously the actual end goal is to end systemic biphobia*, but until we’re finished with that cakewalk… there’s gotta be something that the healthcare system, that doctors, can do, right?

This is the question I’ve been thinking about a lot these days, both for you and, honestly, me. How can the medical establishment serve us better, what exactly do we need? Bi-friendly therapists feel like a straightforward ask: it’s easy to see how a clinician whose job is to talk about your life with you should be comfortable with and able to converse about your sexual identity (especially since, as I learned firsthand, anti-bi bias can compromise their ability to properly diagnose and treat you). But medical doctors? Does your neurologist, your dermatologist, your ophthalmologist need to be bi-friendly? And what does it mean if they are?

A younger me would have probably said no — that it didn’t really matter, that it wasn’t going to come up, that it was easy to avoid. But since I’ve become more embodied in my bisexuality, more aware of it as central to who I am and not simply a fun fact about my sex life, I’ve started to reassess that belief. Because, sure, I’m probably not going to talk about being bi when a sports doctor is examining the tendonitis in my shoulder. It’s not going to come up. But the fact that I feel like it can’t come up, like it’s potentially going to be an issue if it does — that feeling just contributes to the very stress that’s creating a problem in the first place. By not being bi-friendly, and specifically by not being openly bi-friendly, doctors are exacerbating the very source of the problem they have pledged to treat.

And yes, on some level, “make all doctors openly bi-friendly” is just a smaller scale version of “end structural biphobia.” But on the other hand, if the people who have pledged to do everything they can to fix what ails us, to first and foremost do no harm, cannot be coaxed to eradicate their own biases, to actively work to make us feel welcome and at ease, then what hope do we actually have?

It seems small, I know, to ask that doctors give us the opportunity to identify as bi on our paperwork, that they actually read it and are chill about it and create a welcoming, supportive environment that just feels chill. I know that when I try to imagine it, I feel some of the tension releasing from my shoulders. And that, at least, feels like a start.

* Can’t believe no one’s tried that yet?

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