Jul 102017

This week’s post is different from our usual. No exploration of health disparities, no risk-reducing tips. And no complicated studies. Instead, this week I wanted to take a moment and explore the bisexual vs pansexual definition debate.

I will admit that like most posts, this one was inspired by an article. But this was an exploratory article looking at the definitions of pansexual that were online, not a formal study that recruited participants. I’m not going to explore their published results here. Instead, let’s talk definitions.

Why does language matter? Why talk about this?

The purpose of language is to communicate. To communicate, we need a common set of ideas we all agree on. If I say that “That tree is red”, you and I would need to share concepts for me to be understood. If your concept of a tree is a bush and my concept is a giant redwood tree, I would have failed to communicate. The same is true if my red is orange and your red is purple. My sentence would not be understood in the way I intended it.

Language also matters in terms of identity and labels. We use words to self-identify. We intentionally put ourselves into boxes. By doing so, we can use labels to quickly communicate. We also claim an “us” group we belong to. We claim a tribe, one that gives us a psychological sense of wellbeing.

In addition, language can hurt. That hurt may or may not have been intentional. The connotations, or unstated associations, of words have as much impact as the words themselves.

So there are several reasons to talk about language and word choice.

What is bisexuality?
The bisexual flag

The bisexual flag

Bisexual is an older term than pansexual. Bisexuality was originally used to refer to plants with both male and female reproductive parts. The definition changed in 1892. Bisexual referred to humans who had sex with both male and female partners that year. By the 1970’s, groups of bisexuals joined with homophile (gay and lesbian) groups. They advocated for equal treatment and raise awareness.

Modern definitions of bisexual include:

  • a person who is romantically or sexually attracted to both men and women, or to people of various gender identities; ambisexual. [Dictionary.com]
  • of, relating to, or characterized by sexual or romantic attraction to members of both sexes; also :  engaging in sexual activity with partners of more than one gender [Merriam-Webster]

Dictionary.com goes on to note that:

Traditionally bisexual has referred to romantic or sexual attraction to two, and no more than two, genders, specifically male and female. However, the term is increasingly being used to refer to a level of sexual fluidity in which an individual moves bi-directionally along a spectrum of sexuality. This newer sense accounts for attraction to people who do not fall within the gender binary.

What is pansexuality?
The pansexual flag

The pansexual flag

Pansexual is a much newer term. Sigmund Freud coined the term in 1926. Yes, that’s the “father” of psychology. He used the term to refer to sexual energy drives all human activity. Modern usage of the term seems to have emerged in the 1990’s. In particular, it became popular when Miley Cyrus came out as pansexual.

Today, the definition of pansexual includes:

  • of, relating to, or characterized by sexual desire or attraction that is not limited to people of a particular gender identity or sexual orientation [Merriam-Webster]
  • expressing or involving sexuality in all its forms, or sexual activity with people of any sexual orientation or gender identity. [Dictionary.com]

Some pansexuals also include gender-blindness in their definitions. Others explicitly include attraction to intersex and trans people in their definitions.

What’s the difference? They seem awfully alike…

And, in truth, there’s a lot of overlap. Both bisexuals and pansexuals are attracted to more than one sex or gender.

Bisexual is an older, more well established term. That also means it carries certain stigma. You likely know the stereotypes already — that bisexual people are promiscuous or can’t make up their minds. There’s discrimination from both the straight and gay communities.

Pansexual is new enough that it isn’t nearly as widely known. Ask an average person on the street and chances are they won’t know what it means. Pansexuals also face the stereotypes of promiscuity and inability to make up their minds.

What I’ve heard pansexuals say is that pansexuality emphasizes acceptance of genders and sexes outside the binary. That is, genders other than man/woman and sexes other than male/female. Some pansexuals explicit include attraction

The politics

And here is where the politics come in. Because of course there are politics.

Some bisexual people feel that term pansexual is an attempt to express the same sexual orientation as bisexual, only without the baggage of the term bisexual. Others argue that the pan in pansexual implies hypersexuality. Pan means “all”. Does that also mean attraction to all humans of consenting age? What are the borders of pan?

In turn, some pansexuals argue that the term bisexual refer to attraction only to two cisgender sexes. They say that bisexuals are not attracted to androgynous, transgender, and intersex people. Except that many people who identify as bisexual are attracted to those people. Those bisexuals resent being put into a box that implies transphobia.

Other pansexuals say they are attracted to “the person, not their parts.” Does that imply that bisexuals are attracted to the parts more than the person?

Yet others have argued that bisexual is an umbrella term that includes pansexual. In this scenario, bisexual might refer to anything other than straight/gay. And pansexual might specifically refer to attraction to all genders/sexes. Another term, as yet undefined, lumped within bisexual might then refer to someone who’s only attracted to a subset of genders/sexes.

But as you can see, there are a lot of minefields in this debate.


Yes. Yes it is. If you’ve made it this far, congratulations. Debate over definitions can be confusing. I’m glad you’re still with me here.

I’d like to leave you with my personal thoughts.

Here is how I personally define and use bisexual and pansexual:

  • A bisexual person is attracted to more than one sex or gender. I used it as an umbrella term, including anyone who isn’t heterosexual/straight or homosexual/gay.
  • A pansexual person is someone in a subgroup of individuals within the bisexual group. In general the term refers to people who wish to explicitly welcome gender nonconformity and non-binary gender identities.
  • I tend to use the terms roughly synonymously.

Because of its age and flexibility, I prefer the term bisexual. It’s the one that I choose to use for myself. It’s also the term I default to when referring to people who are not straight or gay.

However, I don’t personally identify with the term pansexual. So I try to get my definition from those who do. I also try to avoid labeling other people with labels they themselves do not use. If someone prefers bisexual, I’ll use that. If someone prefers pansexual, I’ll use that.

Remember: Language needs to communicate. I try to communicate to as many people as I can. So I tend to default to terms that are commonly understood. It has the best chance of communicating. I use the same philosophy when it comes to bisexual and pansexual.

Although languages need to communicate, they also evolve to meet the needs of the speakers. The definitions of bisexual and pansexual are likely to change. I look forward to seeing it.


Want to read the original article yourself? The abstract is publicly available.

May 082017

Can you spare 30 minutes a year to increase our knowledge of LGBTQ health?

Do you identify as LGBTQ?

If yes, then please check out The PRIDE Study!

The PRIDE Study is a new longitudinal study by the t of California San Francisco. It is the first long-term study ever launched on LGBTQ health.

Long time readers may remember when I wrote about the Institute of Medicine report on LGBT health. I jokingly summarize it as “400 pages to say that we need more data.” With studies like The PRIDE Study, we can change that. We can get real, hard, high quality data on the health needs of our communities.

Knowing the health needs of our neighbors, lovers, and friends means we can have a real impact on their health.

As always, data collected as part of the study is kept confidential. You can opt out any time you want. You can also opt into additional studies that will be connected to The PRIDE Study.

So please — if you identify as LGBTQ and can spare 30 minutes a year, join The PRIDE Study.

And spread the word!

We’ll be back to our regular programming here at Open Minded Health next week.

Sep 212015

This week’s post is a reader request! Ricki B asked for more information on gender dysphoria before and after transition. While I can’t speak from personal experience, I can dive into the literature and answer the question that way. Luckily there’s a summary article that talks about this very topic!

Gender dysphoria is a term that refers to the distress associated with having a mismatch between gender identity and physical sex. It’s a hallmark of being transgender or transsexual. People with gender dysphoria are often in intense distress. Some (but not all) individuals try to commit suicide, self-castrate, or self harm because of their distress.

This summary was published in 2010. The authors looked at studies that examined dysphoria and other psychological factors before and after medical transition (hormones or surgery or both).

Across all the studied the authors looked at, this is what they found:

  • 80% of the individuals found relief from their gender dysphoria by transitioning — some even to the point that they had no dysphoria at all.
  • 78% had relief from other psychiatric disorders, such as anxiety and depression. They also had relief from psychiatric symptoms that had not been diagnosed as a disorder. Suicide attempts also dropped, though they were still above that of the general population.
  • 80% had a significant increase in their quality of life. At least 2/3rds found that they had an improvement in concrete factors in their life. Their relationships improved. Their job prospects improved. They were generally happier.
  • More than half were satisfied with their sexual life after transition.

While life did not improve for everyone on hormone therapy or after surgery, it was a strongly positive influence in the vast majority.

This particular summary article did not go deep into potential differences in the benefits of surgery and hormones, though individuals studies do. The current consensus is that both are beneficial for the alleviation of suffering.

If you’re looking for a more personal account of how dysphoria improved with treatment, I highly recommend visiting the transgender communities on reddit, or picking up one of the many books written by trans people.

Aug 172015

715px-715px-Sunbedoff_largeA new study finds that gay and bisexual men use tanning beds more frequently than straight men. The use of tanning beds is strongly associated with skin cancers, especially melanoma (the most dead form of skin cancers).

Campaigns to dissuade people from using tanning beds usually target straight women, as they’ve been the most frequent users of tanning beds. These new data show that gay and bisexual men use tanning beds just as frequently as straight women. Lesbian and bisexual women were less likely than straight women to use tanning beds.

Tanning beds should not be used for cosmetic reasons. While many perceive a tan as “healthy” or enjoy the experience of tanning, tanning damages the skin and raises the risk of skin cancer.

Want to read the study for yourself? It’s publicly available!

Jun 262015

800px-Phaedriel's-orchidVaginoplasties for transgender women have been performed for a little over 80 years. The first known surgery was in 1931. Those early surgeries (link includes surgical images) were a little crude by modern standards. The patients in question already had penectomy (removal of the penis) and orchiectomy (removal of the testes) performed so most erogenous sensation was lost. No labia were formed as far as I can tell, and the vagina was made of skin from the inner thigh.

In the 80-some-odd years that have followed those first surgeries, the techniques have improved tremendously. However there’s little evidence to suggest which techniques are the best. Studies have been small and inconsistent in the factors they examine. Study results may be inaccurate. Without more data, and more consistent measures, nothing can be said for certain. Still, a recent meta analysis pulled what data we do have together into one document. And today I’ll translate and summarize their summary.

There are three basic techniques for vaginoplasty for trans women:

  • Penile inversion. The tissue of the penis itself is used to line the vagina and labia. Parts of the scrotum and/or urethra may also be used.
  • Intestinal graft, either from the ileum (part of the small intestine) or rectosigmoid region (end of the large intestine). This is less common among US surgeons than among non-US surgeons.
  • Non-penile skin graft. This is an older technique, primarily used before 2000. Grafts were often taken from the inner thigh or abdomen.

Penile inversion is the most common technique in the United States today. It’s also the most well researched. In contrast, intestinal grafts are rarely performed by surgeons who specialized in transgender vaginoplasty in the United States today. Intestinal grafts are more commonly performed by non-US surgeons or for individuals who do not have a penis to invert. Lastly, the non-penile skin graft is an older technique that does not appear to be used much anymore.

All three techniques appears to produce overall satisfactory results. The average depth was around 10cm to 13.5 cm, and the vast majority of trans women were satisfied with their depth. The majority of women were also able to have vaginal intercourse (75%) and obtain orgasm (70%+). A majority were also aesthetically pleased by their results (90%) and had an improvement in their quality of life.

All techniques had their own levels of complications. Overall the most common complication was narrowing of the vagina (anywhere from 12%-43% of patients depending on technique). Urine stream changes and increases in risk of urethral infection were also fairly common, affecting 1 in 3 women. Rare serious complications included tissue death, rectal injuries, fistulas, deep vein thrombosis, and pulmonary embolism.

Comparisons between techniques was difficult because the details of each technique differed and the outcome measurements differed too. It does seem that, as far as the researchers could tell, there were fewer complications for intestinal graft vaginoplasties than for penile inversion vaginoplasties.However abdominal discomfort and “foul” vaginal secretions during intercourse have been reported for intestinal graft vaginoplasties, largely with rectosigmoid vaginoplasty. For penile inversion vaginoplasties, using urethral or scrotal skin in addition to penile skin was associated with more complications as well.

More research in general, and more standardized research, is crucial to understanding the best surgical techniques. Patients deserve the best results and the safest surgeries possible. Surgeons have already made great strides. Time to make more!

Want to read the study for yourself? The abstract is publicly available!