Top 10 Things Bisexual People Should Discuss with their Healthcare Provider

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 primary healthcare provider

In order to provide you with the best care possible, your primary care provider should know you are bisexual. Knowing your sexual orientation and sexual behaviors will help your healthcare provider offer the correct preventative screenings, and order the appropriate tests. Many providers are less familiar with bisexuality and may make assumptions about your behavior. 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. You can consult the LGBTQ+ Healthcare Directory for help finding a provider.

2. Reducing the risk of getting or transmitting HIV/AIDS

Bisexual people are at an increased risk of getting HIV, but the ability to prevent aquisition and transmission of HIV has improved drastically in recent years. If you are living with HIV, anti-HIV medications can help you live a normal lifespan and prevent you from transmitting HIV to your sex partners (Treatment as Prevention), taking this worry out of sex. Studies show that if you take anti-HIV medications and have an undetectable viral load, HIV cannot be transmitted through sex (Undectable = Untransmitable).

If you don’t currently have HIV, taking pre-exposure prophylaxis (PrEP) is an effective way to nearly eliminate the chance of you getting HIV. PrEP is effective for men, women, and gender nonbinary people. It is important to remember that PrEP does not protect against other sexually transmitted infections (STIs) like gonorrhea and chlamydia. If you aren’t taking PrEP and you have an unexpected exposure to HIV, taking post-exposure prophylaxis (PEP) within 72 hours can drastically reduce the chance of you getting HIV from that exposure. PEP can be prescribed by emergency rooms, by your primary healthcare provider, or by some sexual health clinics. Know where you can get PEP ahead of time. If you are HIV-negative and are in a relationship with someone who is living with HIV, you can talk with your primary healthcare provider about options for prevention.

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 hepatitis, a serious condition of the liver. 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. Condoms are effective at reducing the risk of viral hepatitis, and are currently the only means of prevention for sexually transmitted Hepatitis C. If you have Hepatitis C there are newer, highly effective treatments.

4. Fitness (diet and exercise)

Problems with body image are more common among bisexual people and bisexual people 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. A healthy diet and a frequent exercise routine are just as important for bisexual people as for anyone else. Try to eat a healthy diet and try to exercise for at least 30 minutes three times a week. Talk to your primary care provider if you have questions about nutrition or exercise.

5. Substance use/Alcohol

Bisexual people may use substances at a higher rate than the general population, and not just in larger cities. These include a number of substances ranging from amyl nitrate (“poppers”), to cannabis, ecstasy, and amphetamines. The long-term effects of many of these substances are unknown, however, current knowledge 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. You can also talk to your healthcare provider about strategies and local resources to help optimize your safety when using substances.

6. Depression/Anxiety

Depression and anxiety appear to affect bisexual people 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 people who remain in the closet or who do not have adequate social support. Many bisexual people 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 bisexual people may be more effective in the prevention, early detection, and treatment of these conditions. A good way to begin to address depression/anxiety is to tell your healthcare provider you would like to discuss your emotional health at your next visit.

7. Sexually-transmitted infections (STIs)

Sexually transmitted infections (STIs) occur commonly in sexually active people. These include infections for which curative treatment is available (e.g., syphilis, gonorrhea, chlamydia) and for which no cure is available (e.g. Human Papillomavirus, herpes). Condoms can reduce the risk of many sexually transmitted infections when used properly. You can have an STI without having any symptoms, and still pass it to your sex partners. Getting screened for STIs regularly is important for your health and the health of your sex partners. Most sexually active people should get tested at least every 6-12 months, but every 3 months may be more appropriate if you have a higher number of sex partners.

8. Prostate, testicular, breast, cervical and colon cancer

Bisexual people are 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 bisexual people because of barriers to accessing culturally sensitive care. All bisexual people should undergo these cancer screenings routinely as recommended for the general population.

9. Tobacco

Recent studies seem to show that bisexual people use tobacco at much higher rates than heterosexual people, 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 bisexual people should be screened for and offered culturally sensitive prevention and cessation programs for tobacco use. Additionally, people over the age of 55 who have smoked for many years should ask their healthcare provider if yearly lung cancer screening is right for them.

10. HPV (virus that causes warts and can lead to anal & cervical cancer)

Human papillomavirus (HPV) — which causes anal and genital warts — is often thought to be little more than an unsightly inconvenience. However, besides causing warts, HPV also causes anal cancer and cancer of the throat. A vaccine to prevent HPV infection is recommended for all men and women age 9-26 years and also for people age 27-45 who are not planning to remain monogamous. It is estimated that 90% of HPV associated cancers can be prevented if you get the vaccine. The HPV vaccine does not cure, nor protect against strains of HPV you have already been exposed to. Several treatments are available for HPV-associated pre-cancerous lesions. Screening for anal cancer is sometimes recommended for people living with HIV, in whom the risk of anal cancer is higher. Discuss with your provider if screening for anal cancer is appropriate for you.

Revised 2023. (2012 Author: Robert J Winn, MD AAHIVMS)