CASE

STUDY

Ryan Banning , B . A . ( Primary Investigator ) – UAMS College of Medicine , Hendrix College Kelsey Atwood , B . A . ( Co-Author ) – George Washington University , Hendrix College

Abstract :

INTRODUCTION

Many guidelines and studies group bisexual women with women who identify as lesbian under the umbrella term “ women who have sex with women ” ( WSW ) rather than operationalizing their sexual identity as distinct . We hypothesize , however , that ( 1 ) bisexuality is a distinct identity with its own unique health implications , ( 2 ) that bisexual women ’ s sexual and medical histories more closely approximate those of heterosexual women than those of lesbians , and ( 3 ) that there is an ordered “ health care hierarchy ” in which bisexuals fall between lesbians and heterosexual women . This paper presents original research , as well as drawing on current sociology and anthropology literature , public health studies , and medical research to provide additional support .

Risk Factors and Behaviors among Different Sexual Identities

Little is known about the similarities or differences between the health of lesbians and bisexual women , so information is lacking on how to focus preventative efforts specific to these two distinct identities . Lesbians show especially low levels of access to gynecological care . 1 Lesbians ’ odds of having a Papanicolaou test – also known as a Pap smear – are about half those of the female population at large ; bisexual women , however , had the highest odds of having a Pap test , even when compared with heterosexual women . 2

This difference in utilization of Pap tests supports the case for a distinction between lesbians and bisexual women when addressing their health care needs . The main risk of not receiving Pap tests is that cervical cancer – the main sequela of HPV , which is being tested with a Pap test – may go undetected in its earlier stages – i . e .,

when it has the highest chance of being successfully treated . Therefore , lesbians are at higher risk for cervical cancer than both heterosexual women and bisexual women .

Separation of Sexual Identity for Health Care

Current literature shows that bisexual women have “ similar sociodemographic profiles to [ heterosexual ] women ,” though they have more diverse sexual networks . 1 In fact , bisexual women report larger numbers of male partners over their lives than heterosexual women . This finding has significant health implications because WSM have higher rates of STIs than WSW . 3

Bisexual women should not , however , simply be placed in the same category as heterosexual women for the purposes of health care , as there are several key differences in these two populations . Bisexual women are more likely to test positive for Chlamydia trachomatis than heterosexual women , and are significantly less likely to be aware that HPV can be transmitted by sex with men . 4 Furthermore , while bisexual women are more likely to have had a Pap test , they are also more likely to have reported abnormal results .

Bisexual women tend to have more sexual encounters with partners who are considered unimportant , and who are involved in other relationships . 1 In addition , bisexual women are more likely than heterosexual women to find sexual partners using the internet . Because bisexual women may engage in anonymous and at-risk sexual networks by using the internet to find partners , the diversity of their sexual life may be underreported ; therefore , they may be less often advised to undergo screening for STIs / HIV .

Health Testing and Recommendations

In addition to the problematic assumption that lesbians and bisexual women fit into one sexual behavior category , many data sources do not include sexual identity as a demographic vari-

206 • THE JOURNAL OF THE ARKANSAS MEDICAL SOCIETY VOLUME 114