Bisexual and Pansexual Health inclusivity

This article was originally published June, 2024

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No one likes to feel ignored, invalidated, or invisible, especially when they’re going to see a healthcare provider. If a woman fills out an intake form that she is married to a man, will the practitioner assume the woman is heterosexual and monogamous? Is it the practitioner’s business to know this information?

I identify as bisexual. In this article, I have included the lived experiences of friends and patients who identify as pansexual/bisexual. I did not do a formal survey, but there are common themes about microaggressions they have experienced. There are also common themes of when their healthcare practitioners made an effort to really ask them about their lives. Some of the suggestions for how to improve bisexual and pansexual health inclusivity may be applicable to people of all sexual orientations.

Let’s start with some definitions

Bisexuality is attraction to more than one gender.

Pansexuality is ”attraction to people of any gender or to people regardless of their gender, with the prefix “pan” coming from the Greek prefix for “all.” Pansexuality isn’t a more evolved or “politically correct” form of bisexuality; it isn’t more or less trans/nonbinary inclusive; it’s just a word to describe one kind of sexual orientation.” - from Pansexuality: What It is, What It Isn’t, TheTrevorProject.org

Bisexual+ includes bi, pan, fluid, queer, multiple-attraction spectrum (m-spec), and non-monosexual.

A microaggression is “a comment or action that subtly and often unconsciously or unintentionally expresses a prejudiced attitude toward a member of a marginalized group (such as a racial minority)”. - from MerriamWebster.org. Allie Brosh shows how microaggressions can build up over the course of a day in someone’s life in her comic called Sneaky Hate Spiral.

Intersectionality “describes the ways in which systems of inequality based on gender, race, ethnicity, sexual orientation, gender identity, disability, class and other forms of discrimination “intersect” to create unique dynamics and effects” - from “What is Intersectionality?” Because no one lives in a vacuum we also have to talk about where pansexuality and bisexuality crossover with other parts of patients’ lives.

Polyamory is having many loves. It is “a relationship style centered on the belief that it is possible to love more than one person” - from Polyamorous Relationship Structures.

Misconceptions can lead to microaggressions

Examples of microaggressions towards bisexual and pansexual people may include phrases like: “You just have to choose” or “It must be nice to have multiple options” but microaggressions are not always spoken out loud. Sometimes they are written on a patient’s chart with phrases like “high risk bisexual activity”. One person only found this out after asking for a printout of chart notes after an appointment.

Some misconceptions about bisexual and pansexual people include that they are hypersexual, promiscuous, or monogamous. If a healthcare provider doesn’t know their patient is pansexual or bisexual, they may only address monosexual health concerns. They may make assumptions based on the patient’s appearance - their clothes, their weight, gender, body modifications (including tattoos and piercings), and the color of their skin.

If a female-identified person appears butch, practitioners might assume they don’t have male partners. One pan/bi person’s doctor said: “So your boyfriend is transgender. So, you didn’t really have sex then. You don’t need to be screened for any STI’s?” Some practitioners argue with patients when they request STI testing because they don’t think the patient needs it. Other practitioners think bi/pan people need more STI testing and vaccines.

Access to gender-affirming gynecological care is a concern for pan/bi people who also identify as genderqueer. Talking about their bodies with women’s health terminology can cause gender dysphoria for some patients.

A bisexual patient’s story

One of my acupuncture patients told me how he/they had been misunderstood and mistreated by a former doctor who they went to see for pelvic pain. When my patient disclosed to their doctor that they were bisexual and polyamorous, the doctor assumed the pain had to do with a sexually-transmitted disease. The doctor tested them five times for chlamydia even though each time the test came back negative. The patient left with unresolved pelvic pain, frustration and irritability.

He/they sought out a new medical doctor. This patient also started pelvic floor physical therapy and acupuncture. Their new doctor looked diligently into other causes of the pain without judgment. He/they found short-term relief from prescription medication, but it didn’t solve the problem. They found long-term positive effects from a combination of physical therapy, pelvic floor physical therapy, acupuncture, and psychotherapy.

Unfortunately, this person’s story is not unique. Other bi/pan people have received misdiagnoses because of practitioner’s assumptions.

Why does this matter? Because misconceptions and microaggressions in healthcare can lead to physical, emotional and spiritual health issues such as:

• Rejection
• Social isolation
• Depression
• Substance abuse
• Increased suicide risk
• Eating disorders
• Cardiovascular disease
• Some cancers
• Intimate partner violence, domestic violence
• Rape, and sexual assault
• Missed opportunities for HIV and sexually transmitted infections (STI) testing

From “Invisible Majority: The Disparities Facing Bisexual People And How To Remedy Them” by Movement Advancement Project

Microaggressions and misconceptions means patients may avoid getting the healthcare that they need. Bi/Pan people may avoid going to preventative healthcare appointments if they don’t feel safe or comfortable being who they really are with their practitioner. If someone is scared their practitioner is going to call them things like ‘sex demon’,‘slut’ or ‘freak show’ why would they want to show up to an appointment?

Five elements and health

How are each of the five elements reflected in our interactions with our patients?

The Wood element helps us speak up and stand up for who we are and what we believe in. If someone can’t share this with their practitioner, on a mental emotional level, this may lead to anger, irritability, frustration. They might also avoid going to preventative healthcare appointments.

The Fire element lets us connect with others and be our true selves. One of the first connections we have with patients in person is noticing the shen in their eyes. Are we welcoming enough in our practices to encourage patients to be their true selves with us?

The Earth element helps us with commitment, integrity and knowing our true purpose in life. As holistic practitioners, are we considering this in our intake forms and appointments? In addition to helping with physical and emotional issues, are we helping our patients find their purpose?

The Metal element helps us to acknowledge our own self-worth and appreciate worthiness in others. It also has to do with being proud of who we are. How can we best support our patients to know they are worthy of relationships in which people value them? And how can we support not only their self-worth but also their pride in who they are?

The Water element tells us about who we are and how we want our life to unfold. Some of our patients may be in the midst of self-discovery. How can we support patients through this process?

How can practitioners do better?

Not every healthcare practitioner takes the Hippocratic oath, but ‘first, do no harm’ is a good rule of thumb for all of us. We can improve our communication with our patients while trying to help rather than harm them. No matter what chief complaint your patient has, seeing, valuing, and treating them as a whole person is truly important. Here are suggestions on how to make healthcare experiences more positive for bi/pan people.

• Have inclusive new patient intake forms. What might this look like? Include blank lines in addition to or instead of check boxes for their name, gender, and sexual orientation. (For insurance purposes, you may also need their legal name as it appears on their insurance card.)
• One pan/bi person suggested this beautiful phrase: “What should we know to best honor your body, identity and health?”
• Include gender neutral terminology in the sections of your forms that are about sexual and reproductive health.
• Ask what language people would like to refer to parts of their body such as breast/chest, uterus/AFAB (Assigned Female at Birth), AMAB (Assigned Male at Birth) body. Have community referrals available for patients of all genders.
• Ask if there is any language they’d prefer you use such as terms of endearment, titles, or honorifics including ma’am, mister, mx., etc. If you haven’t met someone before, greeting them with ‘hello’ followed by their preferred name is one easy way of doing this.
• And, be sure to read the new patient intake forms before a patient shows up for their first appointment.

Don’t make assumptions about your patients based on:

• their answers on the intake forms
• their appearance (including clothing, weight, tattoos, piercings, skin color, etc.)
• their relationship status or who they are in a relationship with

If you have questions, ask politely. It’s ok to be curious, but not ok to be judgemental. Know that even if you mean well, your question may not be received as you intended. Apologize sincerely to the patient and move on. Mistakes happen and it’s important to learn from them and try to do better next time.

Show support all year round without rainbow-washing. Rainbow-washing is an attempt to commodify queerness, especially during Pride month.

If you want to offer discounts or other promotions, don’t offer them to queer people only during Pride month. If you want to display rainbow flags in your office or wear them on your work uniforms, do so all year round.

In your literature, posters, articles, website, and social media, use photos of diverse people, including different kinds of families, not just one man and one woman with kids. Pexels has over 8,000 photos if you search for LGBTQIA+ and the photos are free for commercial use. The Gender Spectrum Collection is another great example but cannot be used for commercial purposes.

Do something more than buying rainbow flags and clothing: Donate to organizations that support LGBTQIA+ issues and share them with others so they may do the same. Support Queer small businesses.

Share your own sexual orientation with your patients. This is a personal decision and many factors go into making it. Depending on where you live, it may not be safe for everyone to do this. For me, it’s important to say that I identify as queer, bisexual, and demisexual so people know that I am part of the community.

Actively promoting Diversity, Equity, Inclusion, and Belonging (DEIB) in our clinics

DEIB merits a longer discussion, but here are a few basic definitions:

• Diversity is the presence of people from different social groups and identities.
• Equity means equal access for everyone regardless of their social group.
• Inclusion is about who you welcome and value. It means people from different social groups are integrated into another group.
• Belonging is the next step after Inclusion. It’s when people feel connected, safe and at home.

I taught a short online course in 2020 on Understanding Diversity, Equity and Inclusion Definitions and Concepts. You can watch the recording here. The target audience for that course is the Society for Creative Anachronism (SCA), but the material is applicable to any organization.

There are several continuing education courses on cultural competency for LGBTQIA+, Diversity, Equity, Inclusion & Belonging through the NCCAOM and the California Acupuncture Board if you are interested in learning more.

A brave path forward

In both my acupuncture practice and my Diversity, Equity, Inclusion, and Belonging work I strive to create a “brave space” as described in the poem by Mickey Scottbey Jones:

AN INVITATION TO A BRAVE SPACE

“Together we will create brave space
Because there is no such thing as a “safe space”
We exist in the real world
We all carry scars and we have all caused wounds.
In this space We seek to turn down the volume of the outside world.
We amplify voices that fight to be heard elsewhere,
We call each other to more truth and love
We have the right to start somewhere and continue to grow.
We have the responsibility to examine what we think we know.
We will not be perfect. It will not always be what we wish it to be
But It will be our brave space together,
And We will work on it side by side.”

If we want our patients to feel comfortable being their authentic selves around us, then we need to create a safer/brave environment for them to feel welcome to be who they are. And if we allow room for this in our healing spaces, maybe our patients will be able to find this in other parts of their lives. That is the best we can hope for.

Resources

• “Will The Doctor See Me Now? Bi-Visibility when our health depends on it” https://medium.com/@allegrahirschman/will-the-doctor-see-me-now-bi-visibility-when-our-health-depends-on-it-a7c3c247c889
• https://bihealthmonth.org
• https://www.bizone.org
• https://www.thetrevorproject.org/blog/pansexuality-what-it-is-what-it-isnt/
• https://bipanlibrary.com/mspec/
• https://affirmativecouch.com/polyamorous-relationship-structures/
• https://www.merriam-webster.com/dictionary/microaggression
• https://hyperboleandahalf.blogspot.com/2010/05/sneaky-hate-spiral.html
• https://www.intersectionaljustice.org/what-is-intersectionality
• “Invisible Majority: The Disparities Facing Bisexual People And How To Remedy Them” https://www.lgbtmap.org/file/invisible-majority.pdf
• https://www.theallusionist.org/transcripts/rainbow-washing
• https://www.pexels.com/search/lgbtqia%2B/
• https://genderspectrum.vice.com
• https://www.relias.com/blog/what-is-deib-for-healthcare-organizations-and-why-is-belonging-important
• https://www.genderqueermenopause.com/
• https://thediversitymovement.com/sir-maam-mr-mrs-ms-mx-what-to-do-when-you-dont-know-someones-gender/
• https://www.youtube.com/live/Fb6xmnCnlUI?si=4VPiH8ferSrQHyqN