In some ways, maintaining sexual health as a bisexual is just like maintaining sexual health as someone with any other sexual orientation.
For example, Denarii Monroe of the Bisexual Resource Center says, "Staying sexually healthy for me personally means making sure that I'm getting regular STI and HIV checkups, preferably before starting a new sexual relationship with someone."
"In terms of tips for the happy, healthy bisexual, my number 1 tip for sexual health is to maintain [it] by getting those exams," says Amy Andre, who works with the Bisexual Research Collaboration on Health at The Fenway Institute in Boston. She argues that routine screenings and preventative medicine are essential for long-term health.
"Unfortunately," Andre acknowledges, "studies show that compared to women of other orientations, women who identify as bisexual are less likely to get cancer screenings like Pap smears and mammograms."
It's one of the many health disparities between bisexual women and men versus their non-bi counterparts.
"Bi+ sexual health means recognizing the specific systemic obstacles that bi+ people have to [overcome] obtaining adequate health care, including sexual health care," says Monroe, who prefers the more inclusive "bi+" -- a moniker meant to include pansexual, polysexual, and other orientations beyond gay, lesbian, or straight.
One of the main impediments for bisexual health is the "biphobia, bi invisibility, and the discrimination that people face who are out as bisexual," says Andre. That stigma "impacts our physical and mental health, and even our ability to make choices around sexual health screenings."
Andre sees being out to healthcare providers as an essential part of maintaining sexual health, but acknowledges, "the unfortunate reality is that many people do experience discrimination in healthcare settings when they come out, so it's kind of a double-edged sword."
Monroe says she fights this using "my community as resources to find doctors and other health professionals that aren't just 'LGBT' friendly, but that are specifically bi+ friendly, so that bi+ antagonism doesn't creep into my doctor's visits so much when my sexual history and sexual desires are being discussed."
Andre says health care providers truly committed to serving bisexual clients should publicize that they are nondiscriminatory -- and then live up to that promise.
"For so many of us, even within the LGBT community, there are still enormous areas of discrimination. Just because this doctor has a rainbow sticker, or the [Human Rights Campaign] equality sign, does that necessarily mean that I'm welcome? Or that I can come out to them as someone who has male and female partners? Or as someone who identifies as bisexual regardless of the gender of a partner? I think that healthcare providers really need to go the extra mile to make it very clear that they [offer] a welcoming environment for their bisexual patients and clients."
Preventative sexual health screenings are just the tip of the iceberg, when looking at the health needs of bisexuals, Monroe argues, because "we have higher rates of poverty than both straight people and gays and lesbians, [and] lower rates of health insurance coverage."
Andre agrees. "There's very little research on this, but what research there is shows that we tend to have less money, have higher rates of unemployment and underemployment. As we all know, healthcare in the United States can be expensive, and for many people, prohibitively expensive."
Meanwhile, Andre says, bi folks have perhaps even more need for competent health care. "Bisexual women in particular, have higher rates of being victims of domestic violence. We have higher rates of depression, anxiety, suicidality, alcoholism, and other addiction behaviors. We already have a whole mess of things that we're dealing with, and then to think, Oh, I better schedule my mammogram. That might not be at the top of someone's list when they don't have money, and they're trying to escape from an abusive relationship, and they're feeling like shit, and they're thinking about suicide. I think that all of these things kind of snowball on each other and make it difficult for us to take care of ourselves. That's just the unfortunate reality."
"The majority of bi+ people are people of color and the majority of transgender people are bi+," adds Monroe, who notes that the unique socioeconomic issues that bisexuals face impact "how much we're able to access to adequately address our needs in a very oppressive set of systems, especially when we're multiply marginalized. For me, addressing bi+ sexual health means addressing these specific needs, which means specifically acknowledging and then tackling bi+ erasure, bi+ antagonism, and monosexism."
H. Sharif "Dr. Herukhuti" Williams, Ph.D., who cofounded both BiRCH and the Center for Culture, Sexuality, and Spirituality, says he tries to "practice acceptance and self-love for my sexual fluidity. Part of that also means being able to resist external societal pressures that aim to confine and limit my sexuality, and to pathologize it."
"If I choose to be with a particular person of a particular gender," Herukhuti maintains, "the outside world will want to place labels on me that can be internalized. I must stand in the power of my own truth, and give myself the space to be moved sexually across genders."
Sexual health, for many bisexuals, also involves establishing and maintaining healthy relationships.
"I make sure that I understand my own relationship needs so that I can communicate them clearly and confidently to my partner or partners," says Monroe. "I stay sexually healthy by only engaging in sexual encounters with sober people when I'm sober."
Herukhuti adds that "when seeking a relational partner," he tries to be prepared "for their lack of knowledge, their biphobia, their fears and prejudices that have not been explored. Being able to counter those things and stand in my own truth is a part of my sexual health. I grew up in the '80s, in the height of fear-based HIV messaging, so I must continue to stand in the power of my own truth, to be rigorously honest about my own fears and anxieties in seeking a partner, and be able to work through those."
"There are different sexual cultures that exist in our society between men and women," Herukhuti concludes. "I have learned how to swim in both of those cultures and recognize the problematics of both. The ways that men are not socialized to be emotionally intelligent, or how women are socialized to limit their sexual agency. That also has an impact on my social interactions and relationship possibilities. As a bi man, I am often challenged by the patriarchy and misogyny that men are socialized to uphold. I am personally attracted to women who are sexually empowered -- who don't limit their sexual agency -- and to men who have developed their emotional intelligence in ways that are deeply moving. All of these things are involved in maintaining my personal sexual health and wellness."
Herukhuti and Andre are both founding members of BiRCH (Bisexual Research Collaboration on Health), a groundbreaking group, formed at the Fenway Institute in Boston, which is focused on researching and raising public awareness about bisexual health issues.