Sexual identity is a lot less rigid than you'd think.

Amanda MacMillan
October 13, 2017

In recent years, celebrities like Cynthia Nixon and Maria Bello have made headlines for dating or marrying women after spending years in heterosexual relationships. These Hollywood stars may have helped make it more socially acceptable—or perhaps even fashionable—to “switch sides” well into adulthood. Turns out the phenomenon has been going on for quite some time.

Research presented this week at the North American Menopause Society’s annual meeting in Philadelphia reveals that sexual fluidity throughout age is a real thing, and that it occurs in women much more than it does in men. Women should know they’re not alone if they begin to feel same-sex attractions later in life, say the presenters at the conference—and doctors shouldn’t assume that a woman will have partners of the same gender her entire life.

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“We’re not talking about bisexuality, when someone says they are attracted to both genders at any given time,” says Sheryl Kingsberg, PhD, division chief of ob-gyn behavioral medicine at University Hospitals Cleveland Medical Center and incoming president of NAMS, which moderated the discussion on lesbian health.

“Aside from orientation, there’s also the concept of sexual fluidity—that women can, at one point, be completely in love with a man and then at another point be completely in love with a women,” Kingsberg tells Health. “And that can change once or that can change several times throughout her life.”

The conference focused specifically on women who make these transitions at midlife or later. “We know of a number of women who have been in perfectly happy marriages with men, they raised a family, and at some point—in their 40s or so—they find themselves unexpectedly falling in love with a woman, without ever having thought that was possible,” says Kingsberg.

It’s not that these women have been closeted lesbians their whole life, Kingsberg insists, or have been in denial about their true feelings. “These are women who were perfectly happy with men and are suddenly seeing and feeling things differently,” she says.

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Kingsberg says there’s some evidence that choosing a female partner later in life may be a form of evolutionary adaptation. Once a woman reaches menopause and can no longer have children, having a male sexual partner is no longer as biologically important. “There’s also a theory that if you lose your mate, it’s safer for your children to be raised by two women than it is by a woman and a second male,” she adds.

Lisa Diamond, PhD, professor of developmental and healthy psychology at the University of Utah, says that sexual fluidity may also be due to “a complicated dynamic between hormonal changes, physical experiences, and certainly sexual desires,” according to the Daily Mail.

Diamond has been studying sexual fluidity for nearly two decades and presented her research during the session. In a 2008 study, for example, she followed 79 lesbian, bisexual, or "unlabeled" women for 10 years, and found that two-thirds of them changed which label they identified with at least once during that time. 

While research about late-in-life lesbians isn’t new, Kingsberg says it’s increasingly important to let the public—and the medical community—know about it. As same-sex marriages have become legal and relationships less taboo, she says, more women may feel comfortable taking this step who may not have been years ago.

In a press release, Diamond said that health-care providers “need to recognize this new reality” and incorporate it into their practices. “We see a lot on the topic of sexual fluidity in the media, but it seems as if little of this information has trickled down into clinical practice,” she adds.

Kingsberg agrees. “I am hoping that this message goes out to patients who happen to be in menopause, that they should pay attention to what’s going on with their sexuality—and not feel like they’re alone or that they’re an outlier,” she says. “If they discover, heading toward midlife, that they have shifted their love interest and are falling in love with a woman, they should know that it’s not unusual.”

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She wants to speak directly to primary-care doctors and ob-gyns, as well. “Don’t be so presumptive that the woman you’ve been caring for for 20 years is automatically always going to have the same partner or the same gender of partner,” she says. Doctors should ask open-ended questions about their patients’ sexual activity, she says, so women feel comfortable voicing concerns and questions.

“I like to ask patients, ‘What sexual concerns are you having?’ and ‘Are you currently sexually active with men, women, or both?’” says Kingsberg. “That opens the door for someone who’s maybe been married for 20 years but is now divorced to come out and say that her partner is now female, which she may be embarrassed to do otherwise.”

Coming out to anyone—especially a doctor who’s known you intimately for years—can be difficult, says Kingsberg. But it’s important to making sure you’re getting the best care for your specific situation and at every stage of your life.