Bisexual Erasure: Why It's a Health Threat and How to Stop It

More people identify as bisexual, but face challenges with acceptance.

They're just confused. They're gay or lesbian. It's a transitional phase until they fully come out. They're actually straight, but they want the attention. It's not even real.

Despite the many stereotypes surrounding bisexuality, it's a legitimate sexual orientation. A Gallup poll released in 2021 showed that 3.1% of adults in the United States identify as bisexual. Younger adults are even more likely to identify as such, with 5.1% of millennials and 11.5% of Gen Z adults reporting that they are bisexual.

But even as the number of people who identify as bisexual increases, others continue to play down, ignore, and essentially erase bisexuality. And erasing bisexuality can have potentially harmful consequences—including health complications.

Here's how denying bisexuality, sometimes called bisexual erasure, has negative consequences, as well as how to put an end to it.

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What is Bisexuality?

Bisexuality refers to a person attracted to more than one gender. According to the Human Rights Campaign (HRC), an LGBTQ+ advocacy organization, "a bisexual person is someone who is emotionally, romantically, or sexually attracted to more than one sex, gender, or gender identity, though not necessarily simultaneously, in the same way, or to the same degree."

Research has found that people who identify as bisexual face more negative health outcomes—including adverse mental health outcomes, like depression and anxiety, as well as substance abuse—than those who identify as straight.

Defining Bi Erasure

Bisexual erasure happens when people question or deny the legitimacy of bisexuality as an identity. A person or a society can perpetuate bisexual erasure. Examples of bisexual erasure may include:

  • Downplaying bisexuality as a phase
  • Assuming two women who are in a relationship together must be lesbians
  • Assuming a man and a woman who are in a relationship together are both straight
  • Asking a partner who is bisexual to label their sexual identity in a way that "reflects" your relationship
  • Leaving out the bisexual community in LGBTQ+ advocacy

Anytime someone leans into those beliefs, bisexual erasure is reinforced, according to LGBTQ+ advocates.

Reasons Why Bisexual Erasure Happens

Brian A. Feinstein, PhD, an associate professor of psychology at Rosalind Franklin University of Medicine and Science in Chicago, said he believed people erase bisexuality because many think in stark, black-and-white terms.

Feinstein explained that rigid ways of thinking lead many to assume that someone is straight, gay, or lesbian—disregarding gray space between those identities.

"I think, for some people, it's hard to get their heads around this idea that sexual orientation doesn't have to be either-or," explained Feinstein. "That it's not only being attracted to people of the same gender or people of another gender but that you could be attracted to more than one different type of person."

Lauren B. Beach, PhD, a faculty member at Northwestern University's Institute for Sexual and Gender Minority Health and Wellbeing, agreed that bisexual erasure stems from what Beach referred to as "a Westernized social obsession with binary." 

Sexuality is Not Always Black and White

"There is this idea that you must either be gay or straight," said Beach. "And that, therefore, eliminates the possibility of being bisexual. And then also, if you do allow for an ability to be identified as bisexual, the way that the dominant cultures talk about it is that bisexuality is a little bit of this or a little bit of that. So, that 50-50 stereotype because you're part gay and part straight."

Beach disagreed with that definition.

"But a lot of people, including myself, say I'm not part this and not part that identity," continued Beach. "I'm neither of those. I have a distinct identity as bisexual."

Bisexual people have been present in the LGBTQ+ movement since its beginning. The bisexual community has talked about erasure for decades, and the concept is spreading to mainstream culture, according to Beach.

Beach liked that people were paying more attention to bisexuality.

"If you go through the history of depictions of bisexuality in the press and the media, the themes that come over and over and over is that bisexuality is a new sexual orientation when it is not," explained Beach. "And I'm glad that the media are shifting away from newness and shifting toward the erasure because that is a much more accurate portrayal of the reality of bisexual people and community."

The Health Consequences of Bisexual Erasure

"Bisexual erasure is a form of stigma. And stigma is bad for health, just to put it in a nutshell," noted Beach.

That goes for both mental and physical health. Some evidence suggests that bisexual people have higher rates of anxiety and depression than straight, lesbian, or gay people. And bisexual erasure is a critical potential contributor to those mental health disparities.

Beach said that getting rid of bisexual erasure may help many bisexual people experience less isolation, lowering the incidence of mental health issues.

"[Bisexual people] are not coming out; they're not getting support for the stigma they face every day," Beach explained. "And there's been associations of some of [those mental health diagnoses] with poverty and other structural level social determinants of health. And so, it's important to help to fight back against bisexual erasure."

Compared to straight people, bisexual and LGBTQ+ people as a whole are more likely to experience the following adverse health outcomes:

  • Increased cardiovascular risk factors due to stress
  • Smoking
  • Overweight or obesity

Bisexual individuals may face those disparities because of a lack of quality preventative care. For instance, bisexual women receive routine health care less frequently than other women—including breast, colorectal, and cervical cancer screening tests.

Further, the disparities become increasingly layered for transgender people and people of color who identify as bisexual. That's because they potentially have to navigate transphobia or racism.

Obstacles Bisexual People Face in Healthcare Settings

One reason for that lack of access to adequate health care might be because sexual orientation isn't a topic that a healthcare provider brings up. And it might be a topic patients don't feel comfortable bringing up themselves. 

"One of the biggest challenges is the assumptions that [healthcare providers] make," explained Feinstein.

Feinstein offered an example scenario: A healthcare provider is discussing sexual behavior and screening for human immunodeficiency virus (HIV) and other sexually transmitted infections (STIs) with a woman in a relationship with a man. In that situation, the healthcare provider may assume the woman is straight, and the following screening or recommendation is based on that assumption.

But what if that woman is bisexual and has relationships with people of other genders?

"People might not get treated [as they should] if they're not recognized as a member of a certain group," noted Feinstein.

Additionally, bisexual people may be afraid to bring up their sexual orientation if their healthcare provider doesn't inquire about it.

"I think part of it is just expecting that [healthcare providers] will have some of the same negative attitudes and make the same sort of comments that they're used to," said Feinstein.

Bring up your bisexuality when you are most comfortable, maybe before entering the exam room.

"You can start to kind of shape the conversation, even if you don't want to tell your [healthcare provider] that you're bisexual, to make sure you're getting the care you need," added Beach.

Putting An End to Bisexual Erasure

Feinstein offered one solution for ending bisexual erasure: Increased visibility, especially in pop culture and media.

"I think [the media] puts it out there that bisexuality is a sexual orientation, gets it into the discourse, and sort of get people seeing it more," said Feinstein. 

Supporting bisexual community organizations can also help promote bisexual visibility and, in turn, end bisexual erasure. If you're already involved in LGBTQ+ allyship or advocacy, Beach suggested including the bisexual community in your work.

Other steps you can take to become an ally for the bisexual community include:

  • Acknowledge the individual—including cisgender, transgender, and non-binary people who identify as bisexual.
  • Don't question a bisexual person's identity when they tell you they're bisexual.
  • Call out others when they make biphobic statements.
  • Use inclusive language when talking about the LGBTQ+ community—for example, saying "LGBTQ+" instead of "gay and lesbian."
  • Avoid stereotyping bisexual people—for example, don't hypersexualize bisexual people.

"If you say things like [bisexuality isn't real], chances are that people who identify that way are listening to you," said Beach. "That's a really important thing to keep in mind because you're only letting people know who you are, and people don't forget that. Because if you're judgmental on that front, what else are you judging on?"

Is Pansexuality Bisexual Erasure?

Pansexuality refers to people who have an emotional, romantic, or sexual attraction to people of any gender but at varying times or degrees of attraction.

The term has gained visibility, especially as more celebrities, like singers Janelle Monáe and Miley Cyrus, have come out as pansexual.

"I think for a lot of people, it can be affirming, comforting, and validating to know that there is a word for what you're feeling and experiencing. And I think that's part of why we see the emergence of new labels as time goes on, like pansexual," explained Feinstein. "Because for some people who don't feel that any of the existing labels really fit what they're experiencing, there is this pull to find language to better convey what they're experiencing."

But as pansexuality gains visibility, does it become a form of bisexuality erasure? Feinstein said no. While the identities might share similarities, they are two distinct labels. 

"I think there's space for both of [the labels] to exist without necessarily one invalidating or erasing the other," noted Feinstein.

Acknowledging both identities gives people a way to understand who they are and identify themselves. Those labels can also help in-person and digital communities form.

"These communities are really important for people to get the support they need to navigate what it's like in the world as a person who is multigender attracted," said Beach. And ultimately, "It's important that people use labels that make them happy to be who they are."

A Quick Review

Bisexual people face challenges ranging from social stigma to poorer health outcomes, all leading to a phenomenon known as bisexual erasure. That occurs when people acknowledge, represent, or treat bisexuality as if it's just a phase and not an actual identity.

It's important to acknowledge that bisexuality is a legitimate identity, and sexuality is not always black-and-white.

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