Bisexuality, often stigmatized, typically has been lumped with homosexuality in previous public health research. But when Indiana University scientists recently focused on the health issues and behaviors specific to behaviorally bisexual men and women, they found tremendous variety, and that commonly used labels, such as heterosexual and homosexual, can sometimes do more harm than good.
Bisexual, gay, lesbian, queer, men who have sex with men (MSM), women who have sex with women (WSW) -- these are just some of the terms commonly used to characterize sexual partnering and attraction in recent research. Behavioral science researchers have long known that socially constructed sexual identity "labels" (like "gay") are often not always reflective of the diversity and complexity of an individual's sexual behaviors. A study led by Vanessa Schick, assistant research scientist at the Center for Sexual Health Promotion at IU Bloomington, found that how women relate to their label could influence their health.
Schick's study involved 2,578 women who reported a history of attraction or sexual encounters with women. The Web-based survey asked about mental, physical and sexual wellness. In the paper "Bidentity: Sexual Behavior/Identity Congruence and Women's Sexual, Physical and Mental Well-Being," Schick reports finding that the women who identified themselves as bisexual or lesbian reported the best health when their sexual identity matched their recent sexual history.
Schick, however, warned against interpreting this as evidence that women should declare a sexual identity that corresponds to their sexual behavior. Instead, she points to the experiences of women who labeled themselves as "queer," a sexual identity that is sometimes endorsed by individuals who want to reject traditional labels that suggest the gender of their sexual partners.
"Unlike the other women in the study, the mental, physical and sexual well-being of queer-identified women was not related to the gender of their recent sexual partners," she said.
"This suggests that, instead of encouraging women to adopt labels that are more descriptive of their behavior, we should be more flexible in the behavioral expectations that we attach to these labels."
For a variety of reasons, men and women often identify openly or just to themselves with a label that is different from their sexual history. One such reason is biphobia, the stigma and discrimination that bisexual individuals experience from both heterosexual and homosexual individuals.
Brian Dodge, associate professor in the School of Health, Physical Education and Recreation and associate director of the Center for Sexual Health Promotion, found in his study on sexual health among bisexual men that factors associated with biphobia contributed to feelings of isolation and social stress reported by many of his study participants. Dodge's qualitative study, which is funded by the National Institutes of Health, is based on in-depth interviews with 75 bisexual men from the Indianapolis area, ages 19 to 70, equally divided among Latino participants, non-Latino black participants and non-Latino white participants.
"There have been large quantitative studies that examined the mental health status of men who have sex with both men and women," Dodge said, "but no one has sat down and talked with these men about it. When we did, men were saying explicitly that being bisexual, not having a community to be involved with, not having people they could disclose to, homosexual or heterosexual, was tied to their experiences of adverse mental health."
These are just some of the findings in the special issue of Journal of Bisexuality, published last week. Guest edited by Dodge and Schick, the special issue includes articles that stray from the more typical focus on sexual risk and sexually transmitted infections and covering topics including physical health and wellness, sexual health, and mental health among people whose identities or behaviors indicate bisexuality. Researchers contributing to the issue come from such institutions as Emory University, George Mason University, Columbia University, George Washington University and the IU School of Medicine.
"The issue gives a nice snapshot of how diverse bisexuality is among both men and women," Dodge said.
Here are more findings from Dodge's and Schick's studies:
- Schick's paper "Variations in the Sexual Repertoires of Bisexually Identified Women in the United States and the United Kingdom" examined the diversity of sexual behavior reported by bisexual women. When looking at their recent sexual experiences, the women were divided almost evenly as having no recent sexual partners, having only a male sexual partner, only a female sexual partner, or both male and female sexual partners. This study involved 710 bisexually identified women, making it one of the largest studies of its kind. "Like all people, bisexual women are living their sexual lives in diverse ways," Schick said. "Some women may choose to have both male and female partners while others may engage in sexual behavior with only men or women. Other bisexually identified women may decide not to have any sexual partners at all. They don't simply fit into one mold. This contradicts the hypersexualized representations of bisexual women that we often find within the media."
- For both papers in the special issue, Schick and her research team gathered more detailed information than other studies because of the variety of questions asked. Instead of asking whether they used a sex toy, for example, they asked about five different kinds of toys. When they asked about behaviors such as oral sex, they asked who was giving and receiving separately for men and women. Overall, they found that bisexual women tended to engage in parallel behaviors with men and women. In other words, they were similarly as likely to engage in oral sex with a male partner as they were to engage in oral sex with a female partner.
- In Dodge's study, men were asked to report a wide range of sexual behaviors with both male and female partners based on measures developed for the National Survey of Sexual Health and Behavior, a recent study conducted by the Center for Sexual Health Promotion examining the sexual behaviors and experiences of a nationally representative sample of more than 6,000 individuals in the United States. Such detailed data on the specific oral, vaginal, anal and other sexual behaviors in which these men engage with both male and female partners have been absent from scientific literature. The paper "Sexual Behaviors and Experiences Among Behaviorally Bisexual Men in the Midwestern United States: Implications for Interventions," written by postdoctoral research fellow Omar Martinez of the HIV Center for Clinical and Behavioral Studies at Columbia University, explores the unique sexual behaviors and experiences of bisexual Latino men in the study.
- In Dodge's paper "Individual and Social Factors Related to Mental Health Concerns Among Bisexual Men in the Midwestern United States," participants reported mental health concerns tied to both individual and social struggles associated with being bisexual, particularly the isolation and lack of support and perceived stigma associated with bisexuality among men. They reported feeling they would automatically receive negative reactions from both homosexual and heterosexual family, friends and other people in their social networks. As a result, participants were not likely to disclose their bisexuality, further increasing their invisibility and isolation.
- In large part, men in Dodge's study tended to use condoms with male partners for HIV/STI prevention purposes and with female partners for pregnancy prevention purposes. Women were seen as being "safer" in terms of STI transmission risk. In the paper "Subjective Sexual Experiences of Behaviorally Bisexual Men in the Midwestern United States: Sexual Attraction, Sexual Behaviors and Condom Use," authored by IU doctoral candidate Phillip Schnarrs, participants describe the patterns and meanings of their sexual repertoires with both male and female partners.
Dodge said a better understanding of men's sexual behaviors and experiences will lead to more effective health programming for bisexual men and their male and female sexual partners.
"Because the content of most current sexual health programs for gay and bisexual men focus only on their behaviors and experiences with male partners, interventions are urgently needed that are specifically tailored to the wide range of sexual behaviors and experiences which bisexual men share with both male and female partners," he said.
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