Bisexual Erasure: What It Is, Why It's a Threat to Health, and How to Put an End to It

The number of people in the US who identify as bisexual is increasing. But bisexuality continues to be overlooked and ignored, and that has consequences.

They're just confused. They're gay or lesbian, and this is 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 that surround bisexuality, it's a real, valid sexual orientation. According to a new Gallup poll, 3.1% of US adults identify as bisexual. Younger adults are even more likely to identify this way, with 5.1% of millennials and 11.5% of Gen Z adults reporting that they are bisexual.

But even as the number of people in the US who identify as bisexual increases, bisexuality continues to be played down, ignored, and essentially erased by mainstream culture. And erasing bisexuality can have potentially harmful consequences—including health complications.

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Bisexuality: a quick refresher

"Bisexual" is a term for a person who can be attracted to more than one gender, states the nonprofit Bisexual Resource Center (BRC). According to the Human Rights Campaign, "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."

What is bi erasure?

Bisexual erasure happens when "the existence or legitimacy of bisexuality (either in general or in regard to an individual) is questioned or denied outright," according to GLAAD, a national organization that fights defamation of people in the LGBTQ+ community. Bisexual erasure can be done at a societal or interpersonal level.

Some examples include downplaying bisexuality as just 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, and leaving out the bisexual community in LGBTQ advocacy. Anytime someone leans into any of these beliefs, bisexual erasure is reinforced.

Why does bi erasure happen?

Brian A. Feinstein, PhD, an associate professor of psychology at Rosalind Franklin University of Medicine and Science in Chicago, believes bisexuality is erased because many people think in stark, black and white terms. That rigid way of thinking leads many to assume that either someone is straight or gay/lesbian—disregarding the gray space in between.

"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, that it's not only being attracted to people of the same gender or of people of another gender, but that you could be attracted to more than one different type of person," Feinstein tells Health.

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

"There is this idea that you must either be gay or straight," Beach tells Health. "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. But a lot of people, including myself, say I'm not part this and not part that identity. I'm neither of those, I have a distinct identity as bisexual."

Bisexual people have been present in the LGBTQ+ movement since its beginning. For decades, the bisexual community has talked about erasure, and now the concept is spreading to the mainstream. Beach says she's happy that more attention is now being drawn to it. "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," she says. "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 bi erasure

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

That goes for both mental and physical health. A 2017 study published in The Journal of Sex Research showed that bisexual people have higher rates of anxiety and depression than straight, lesbian, or gay people. The researchers determined that bisexual invisibility and erasure was one of the key potential contributors to those mental health disparities.

If bisexual erasure is itself erased, the isolation that many bisexual people experience can be reduced, lowering rates of mental health issues like depression. "[Bisexual people] are not coming out; they're not getting support for the stigma that they face every day," Beach explains. "And there's been associations of some of [these 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."

The Human Rights Campaign reports that bisexual people also face poorer health outcomes. Compared to straight people, bisexual individuals are more likely to have high cholesterol and asthma and are also more likely to smoke or drink alcohol. Bisexual women also have higher rates of heart disease and obesity as opposed to straight women. The disparities are even more layered for transgender people and people of color who identify as bisexual, because they potentially have to navigate transphobia and/or racism as well.

Some of these disparities bisexual individuals face may stem from a lack of preventative care. According to the American Cancer Society, bisexual women receive routine health care, including breast, colorectal, and cervical cancer screening tests, less frequently than other women. As GLAAD puts it: "bisexual erasure plays a critical role in reducing the community's visibility and, in turn, reducing access to the resources and support opportunities bisexual people so desperately need."

One reason for this lack of access to the proper level or type of care might be because sexual orientation isn't a topic that a health care provider brings up. And it might be a topic that patients don't feel comfortable bringing up themselves. According to the Human Rights Campaign, research has shown that 39% of bisexual men and 33% of bisexual women don't disclose their sexual orientation to any health care provider. That's significantly more than the 13% of gay men and 10% of lesbians who don't disclose their sexual orientation to health care providers.

This can lead to erasure—and a lack of care. "One of the biggest challenges is the assumptions that doctors make," Feinstein says. He gives this example: A primary-care provider is discussing sexual behavior and screening for HIV and other STIs with a woman who is in a relationship with a man. In this situation, the doctor will often assume the woman is straight, and the screening or recommendation that follows is based on that assumption. But what if that woman is actually bisexual and has had or is having 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," he says.

Even if a bisexual person isn't explicitly asked about their sexual orientation and they feel it's relevant to bring it up, many are apprehensive to do so. "I think part of it is just expecting that providers will have some of the same negative attitudes and make the same sort of comments that they're used to," Feinstein says.

The Human Rights Campaign offers tips on how to be open with a provider during an appointment, including bringing up your bisexuality when you are most comfortable, maybe while you're still fully clothed or even before entering the exam room. "You can start to kind of shape the conversation, even if you don't want to tell your doctor that you're bisexual, to make sure you're getting the care that you need," Beach says.

Putting an end to bi erasure

Feinstein offers one solution for ending bisexual erasure: increased visibility, especially in the realms of pop culture and media: "I think that puts it out there that bisexuality is a sexual orientation, gets it into the discourse, and sort of get people seeing it more," he says. As more celebrities and popular figures like Halsey and Demi Lovato come out as bisexual, that's a win for bisexual visibility.

Supporting bisexual community organizations can also help promote bisexual visibility and, in turn, ending bisexual erasure. If you're already involved in LGBTQ allyship or advocacy, Beach suggests making sure that you include the bisexual community and bisexual people in your work.

The Human Rights Campaign lists a few other things people can do to be an ally for the bisexual community, including avoiding stereotyping bisexual people, calling out others when they make biphobic statements, and using inclusive language when talking about the LGBTQ+ community—for example, saying "LGBTQ" instead of "gay and lesbian."

Another step toward ending bisexuality erasure is to simply believe that bisexuality exists. "If you say things like [bisexuality isn't real], chances are that people who identify that way are listening to you," Beach says. "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 your judgmental on that front, what else are you judging on?"

Is pansexuality bisexual erasure?

According to the Human Rights Campaign "pansexual describes someone who has the potential for emotional, romantic, or sexual attraction to people of any gender though not necessarily simultaneously, in the same way, or to the same degree." The term has gained visibility in recent years, especially as more celebrities, like singers Janelle Monáe and Brendon Urie, have come out as pansexual.

"I think for a lot of people, it can be really 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," Feinstein says. "Because for some people who don't feel that any of the existing label 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 say 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," Feinstein says.

Acknowledging both sexual orientation labels gives people a way to better understand who they are and identify themselves. The 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," Beach says. And ultimately, she thinks "it's important that people use labels that make them happy to be who they are."

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