Women who identify as lesbian or bisexual face specific health disparities, study finds

Young women who identify as lesbian, bisexual or “somewhere in between” face specific health disparities in comparison to heterosexual women, researchers say.

Health outcomes differed by identity, as mostly lesbian (those who identify as “somewhere in between bisexual and lesbian) and bisexual women reported higher levels of depression, anxiety and poorer physical health, concluded a 2019 study published in LGBT Health.

When compared to their heterosexual counterparts, those in the LGBTQ community are at an increased risk for certain health conditions — including heart disease, cancers, and obesity — and face healthcare discrimination.

The findings add to the body of research that highlights health disparities consistent with other studies on LGBTQ populations. 

LGBTQ individuals face higher rates of psychiatric disorders, substance abuse and suicide, according to the Office of Disease Prevention and Health Promotion. The health disparities the LGBTQ community face are linked to societal stigma, discrimination, harassment, social rejection and violence, according to the Centers for Disease Control and Prevention.

The goal of the recent study was to examine  subgroups of sexual minority women (SMW) — those who identify as lesbian, bisexual or somewhere in between — separately to better understand their specific health concerns. The recent study included responses from young women who identified as lesbian, bisexual or “somewhere in between,” referred to as mostly lesbian. 

The study was conducted by researchers at Old Dominion University and the Virginia Consortium Program in Clinical Psychology, both in Norfolk, Virginia. It was supported by the National Institute on Alcohol Abuse and Alcoholism of the National Institutes of Health and was funded by the National Institutes of Health.

The researchers also aimed to examine a larger group of people, as previous research had much smaller sample sizes, the study suggested.

A total of 990 participants were recruited primarily from Facebook advertisements and ranged in age from 18-30 years old, and all of them were considered sexual minority women. Following a preliminary online screening, the participants completed a 30-minute online survey. Those participants who described drinking alcohol in the past 30 days also completed an alcohol use questionnaire.

The study showed significant differences among lesbian, bisexual and mostly lesbian women in terms of anxiety symptoms, depression symptoms and physical health symptoms, which were measured as physical health problems — such as headaches and back pain — experienced in the past two weeks. Mostly lesbian and bisexual women demonstrated increased depression, anxiety and physical health symptoms than exclusively lesbian women.

“No matter how hard we try to smile and look OK, when we’re out in the world, the truth is when you have to work harder than the person next to you in order to get ahead, it has a toll on you emotionally.”

– Dr. Jill Bley, clinical psychologist and sex therapist

On the subject of alcohol, mostly lesbian women reported more frequent alcohol consumption and more alcohol-related consequences, than bisexual and exclusively lesbian women.

Sarah Ehlke, a doctoral student at Old Dominion University, was an author of the paper. She believes the health outcomes vary by identity because of their experiences. 

Ehlke said they noticed bisexual women experienced more stressors linked to their identity as a sexual minority. For example, she noted that many bisexual women face stessors from both the heterosexual community and from the LGBTQ community because they’re attracted to both men and women. Other studies have noted this anti-bisexual prejudice from both communities, including the misconceptions that bisexual individual are confused about their sexuality or that bisexuality doesn’t exist. 

Stressors could include things like microaggression experiences that aren’t intended to be harmful but unintentionally are. Common migroagressions toward LGBTQ individuals include verbal slights — such as saying “That’s so gay” when referring to something considered strange, dumb, or unpleasant — or other microinsults, such as asking a gay or lesbian couple who “wears the pants” in the relationship. 

Dr. Jill Bley is a clinical psychologist and sex therapist certified by the American Association of Sexuality Educators, Counselors and Therapists. She’s also the author of “The Gender Revolution and New Sexual Health: Celebrating Unlimited Diversity of the Human Sexuality Hypercube.” 

Bley has extensive knowledge and experience with sexuality issues due to her work with women at a rape crisis center in Cinncinati during the ’70s. Many of the volunteers were gay or lesbian, and Bley said she got to know the LGBTQ community pretty well.

Women already face gender discrimination and sexuality can potentially make things more difficult, Bley said. In her clinical experiences working with couples, Bley said she frequently finds sexual abuse in their history. 

“No matter how hard we try to smile and look OK, when we’re out in the world, the truth is when you have to work harder than the person next to you in order to get ahead, it has a toll on you emotionally,” she said. 

In addition to these stressors, Ehlke said identity uncertainty — how uncertain someone is about their own sexuality — might affect health. 

“If we’re not acknowledging these more non-modern sexual identities in our culture and our society, that then impacts your overall health, so physical health and mental health and alcohol variables,” she said. 

Ehlke said this study shows that labels can be important. 

“The younger generation, we try to avoid labels as much as possible, but it’s almost inevitable that we — at some point — group ourselves somehow,” she said. “Acknowledging that people identify differently and that’s OK … we should still treat you the same and not create any sort of extra stress that you may be experiencing.”

While the research highlights important findings regarding LGBTQ health, there are several limitations of the study. For example, participants self-identified as lesbian, mostly lesbian or bisexual and did not include other nonmonsexual identities (e.g., pansexual, queer).  The majority of participants were white and well educated, and therefore this group may not represent the entire population of sexual minority women.

The researchers note that future research should explore why these differences in health among sexual minority women exist. One explanation is minority stressors, with examples such as identity uncertainty. In addition, distal and proximal stressors, such as discrimination, harassment and internalized heterosexism, should also be assessed, the researchers suggest.

Those in the LGBTQ community face specific health disparities related to the stigma and discrimination toward LGBTQ individuals.

Those in the LGBTQ community face specific health disparities related to the stigma and discrimination toward LGBTQ individuals.

Ehlke hopes further research will explore the process of events happening and unveil the story the variables are telling.

“The research is needed,” she said. “I think a lot of people would acknowledge it’s needed.  It’s harder to do sometimes with the different climate and just this society, but it makes it even that more important.”

On a broader note, Bley said LGBTQ-specific health is important to study, more now than ever. 

“It hasn’t been studied very well in the past, and it’s only the recent past where people are willing to talk much more openly about who they are, who they love and what they do in their lives,” Bley said. “So we’ve never really studied LGBTQ issues … now, we have a chance to study.” 

She said one of her biggest pet peeves are people — often those older than 55 — who look around and see LGBTQ people living their lives in 2020 and claim being gay is a fad. 

“This is what I hear from so many people since my book came out: ‘This is such a fad. It seems like everybody is talking about it now and everybody thinks they’re gay,’” Bley said. “I look at them and go, ‘What? No, people are finally able to talk about who they are.’”