Women who are neither heterosexual nor lesbian-identified have traditionally been ignored in research and healthcare practice. Yet, recent research evidence indicates that these women have significant health inequities in areas of mental health, substance use, physical health and sexual health. Reasons for these inequities are not clear, although hypotheses include greater marginalisation and social isolation, and an absence of a unifying activist voice. Emerging literature indicates that these women are a disparate group with few unifying features, and varied sexual attraction, behaviour and identity.
Mixed methods were used for this exploration of the middle ground of women’s sexual orientation. Secondary data analysis of surveys from the Australian Longitudinal Study of Women’s Health examined women who identify as lesbian, bisexual, mainly heterosexual and exclusively heterosexual. Measures of mental health, substance use, physical health, victimisation and health care usage were compared against sexual identity using logistic regression modelling. A qualitative study was also conducted using a critical hermeneutic approach, involving in-depth interviews with 33 same sex attracted women and 27 GPs, including 24 woman-GP pairs.
Women’s sexual identity experience plays a significant role in the risk and protective factors influencing their health. It also influences their interaction with the healthcare system and wider social networks. For example, the degree of importance women place on their sexual identity is central to whether they disclose this identity publicly, including within healthcare settings, and this, in turn, can influence the effectiveness of their healthcare experience.
Although substantial progress has been made in understanding health risks among bisexual and mainly heterosexual women, there are still many questions regarding who these women are and what underpins their health inequalities. Nevertheless, researchers, clinicians and policy makers need to consider the diversity within sexual minority populations and develop more targeted prevention and intervention strategies to reduce health disparities and engage these women more effectively.
