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10 Things Bisexuals Should Discuss With Their Health Care Provider

May 2012

Following are the health issues GLMA's healthcare providers have identified as most commonly of concern for bisexual people. While not all of these items apply to everyone, it's wise to be aware of these issues.

1. Come Out to Your Health Care Provider

In order to provide you with the best care possible, your clinician should know you are bisexual. It should prompt him/her to ask specific questions about you and offer appropriate testing. Many providers are less familiar with bisexuality and may make assumptions about your behavior. Be honest and you will get better care. Remind your provider each time you see them about who your current partners are -- it may change the screening tests they offer you. If your provider does not seem comfortable with your sexual orientation, find another provider.

2. HIV/AIDS, Safe Sex

Many men who have sex with men are at an increased risk of HIV infection, but the effectiveness of safe sex in reducing the rate of HIV infection is one of the LGBT community's great success stories. If you are HIV positive, you need to be in care with a good HIV provider. Safe sex is proven to reduce the risk of receiving or transmitting HIV. You should also discuss and be aware of what to do in the event that you are exposed to HIV (Post-Exposure-Prophylaxis) -- contacting your provider IMMEDIATELY following an exposure to explore your options. If you are in a relationship where one of you is positive, you should discuss options for prevention with your provider as well. Although women who have sex with women have lower rates of HIV, if you have sex with a gay or bi man (who have increased rates) it is important to understand their HIV status and how to protect yourself.


3. Hepatitis Immunization and Screening

If you have sex with multiple partners (of any gender) you are at an increased risk of sexually transmitted infection with the viruses that cause the serious condition of the liver known as hepatitis. These infections can be potentially fatal, and can lead to very serious long-term issues such as liver failure and liver cancer. Immunizations are available to prevent two of the three most serious viruses. Universal immunization for Hepatitis A Virus and Hepatitis B Virus is recommended for all sexually active people. Safe sex is effective at reducing the risk of viral hepatitis, and is currently the only means of prevention for the very serious Hepatitis C Virus. If you have Hepatitis C there are new, more effective treatments for that infection.

4. Fitness (Diet and Exercise)

Problems with body image are more common among bisexuals and bisexuals are much more likely to experience an eating disorder such as bulimia or anorexia nervosa. While regular exercise is very good for your health too much of a good thing can be harmful. The use of substances such as anabolic steroids and certain supplements can be dangerous. Being overweight or obesity are problems that also affect many bisexuals. These can lead a number of health problems, including diabetes, high blood pressure, and heart disease and breast cancer.

5. Substance Use/Alcohol

Bisexuals may use substances at a higher rate than the general population, and not just in larger communities such as New York, San Francisco, and Los Angeles. These include a number of substances ranging from amyl nitrate ("poppers"), to marijuana, Ecstasy, and amphetamines. The long-term effects of many of these substances are unknown; however current wisdom suggests potentially serious consequences as we age. If your drug use is interfering with work, school or relationships, your healthcare provider can connect you to help.

6. Depression/Anxiety

Depression and anxiety appear to affect bisexuals at a higher rate than in the general population. The likelihood of depression or anxiety may be greater, and the problem may be more severe for those men who remain in the closet or who do not have adequate social supports. Many bisexuals keep their orientation and sexual behavior a secret from their providers. Adolescents and young adults may be at particularly high risk of suicide because of these concerns. Culturally sensitive mental health services targeted specifically at gay men may be more effective in the prevention, early detection, and treatment of these conditions.

7. STDs

Sexually transmitted diseases (STDs) occur in sexually active bisexuals at a high rate. These include STD infections for which effective treatment is available (syphilis, gonorrhea, chlamydia, pubic lice, and others), and for which no cure is available (HIV, Hepatitis, Human Papilloma Virus, herpes, etc). There is absolutely no doubt that safe sex reduces the risk of sexually transmitted diseases, and prevention of these infections through safe sex is key. The more partners you have in a year, the more often you should be screened. You can have an STD without symptoms, but are still able to give that to others.

8. Prostate, Testicular, Breast, Cervical and Colon Cancer

Bisexuals may be at risk for death by these cancers. Screening for these cancers occurs at different times across the life cycle, and access to screening services may be harder for bisexuals because of not getting culturally sensitive care. All bisexuals should undergo these screenings routinely as recommended for the general population.

9. Tobacco

Recent studies seem to support the notion that bisexuals use tobacco at much higher rates than heterosexuals, reaching nearly 50 percent in several studies. Tobacco-related health problems include lung disease and lung cancer, heart disease, high blood pressure, and a whole host of other serious problems. All gay men should be screened for and offered culturally sensitive prevention and cessation programs for tobacco use.

10. HPV (Virus That Causes Warts and Can Lead to Anal & Cervical Cancer)

Of all the sexually transmitted infections bisexuals are at risk for, human papilloma virus (HPV) -- which cause anal and genital warts -- is often thought to be little more than an unsightly inconvenience. However, these infections may play a role in the increased rates of anal cancers in bisexual men. Some health professionals now recommend routine screening with anal Pap Smears, similar to the test done for women to detect early cancers. Safe sex should be emphasized. Treatments for HPV do exist, but recurrences of the warts are very common, and the rate at which the infection can be spread between partners is very high. Individuals with a a cervix should get routine pap smears as instructed by their clinician.

Robert J. Winn, M.D., A.A.HIV.M.S., is the medical director of the Mazzoni Center.

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This article was provided by Gay and Lesbian Medical Association.

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