Staying healthy while staying open: The polyamory dilemma

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January 5, 2023 – Angie Ebba, 42, of Portland, OR, has two local girlfriends, a long-distance relationship, and a platonic partner.

low tide polyamorousto have several intimate love relationships at the same time. Her partners know about each other and would have agreed to the arrangement, she says.

Polyamory is becoming increasingly common in the United States. In 2021, one in nine Americans said they had been in polyamorous relationships, and one in six said they wanted to try. according to a study by researchers at the Kinsey Institute.

While a high level of transparency is required for polyamory to work, those who practice it are not always comfortable sharing their relationship status with healthcare professionals. The fear of disclosure is not unfounded. Of those in the Kinsey study who said they weren’t interested in polyamory or had never been interested, less than 15% said they respect people who engage in the practice.

“I hear constantly from patients who have sexual questions and issues but feel uncomfortable talking to their doctors or even other therapists,” says Dr. Ian Kerner, psychotherapist and sex therapist in New York City. “Because polyamorous systems are still on the fringes of the mainstream, some physicians may have implicit bias or explicit judgments, especially if they lack experience.”

barriers to caregiving

People who practice polyamory struggle with unique health issues. This includes a potentially higher risk of sexually transmitted infections (STIs) through multiple sex partners and anxiety or depression arising from managing multiple relationships.

“This is of particular concern in OB/GYN given the risk of STI transmission and its consequences such as infertility, vaginal discharge and systemic disease,” said Cheruba Prabakar, MD, CEO of Lamorinda Gynecology and Surgery in Lafayette, CA. “Disclosure of information will allow the provider to think more holistically about the patient.”

Ebba doesn’t tell her doctors anything about her personal life. She knows other people in these relationships who have felt judged in clinical encounters, and she avoids disclosure unless absolutely necessary.

“First and foremost, I don’t let my service providers know because I’ve faced discrimination and embarrassment in the past because you are queer; I don’t want to either because I’m poly,” she says. “If I can avoid it, I will.”

A 2019 study with 20 people in consensual non-monogamous relationships—which may involve polyamory—found that most of them reported challenges in managing their health care needs related to a lack of provider knowledge, insufficient screening, and stigma affecting their health and confidence impacted the medical system.

“Polyamorous people often have difficulty accessing medical care because they fear being judged by their doctor or other physicians who don’t understand or respect their lifestyle habits,” says Akos Antwi, psychiatrist and co-owner of Revive Therapeutic Services in Rhode Iceland and Massachusetts. “They may also be reluctant to share information about their relationships with providers unfamiliar with the complexities of polyamory.”

Sharon Flicker, PhD, a clinical psychologist and assistant professor of psychology at California State University-Sacramento, says she understands why people are concerned about bringing up the issue of multiple relationships with their healthcare provider.

Healthcare providers’ interactions with patients are often shaped by theirs mononormative assumptionsthe Monogamy is ideal and deviations from that ideal are pathological,” she says. “Secrecy is an obstacle to sensitive care that meets the individual needs of the patient.”

Flicker says health care professionals can continue to educate themselves to break down their biases and better understand and respond to the unique needs of people involved in consensual non-monogamous relationships. Additionally, Offering to answer any questions a doctor might have after disclosure can open the door to dialogue, Prabakar says.

“Maybe they’re just embarrassed to ask, since many might not be familiar with polyamory,” says Prabakar.

People in polyamorous relationships may also look for affirmative language on healthcare provider websites, which may mention that they welcome patients of all sexual orientations or gender identities. A first appointment can serve as a conversation to find out what terms a provider uses when referring to non-monogamy.

Navigate safely through the sexy time with several partners

Prabakar says sexual health and safety are paramount for her patients in polyamorous relationships because they deal with multiple partners.

She recommends anyone who has multiple partners use condoms and rubber dams to prevent STDs like herpes and gonorrhea, in addition to regular screening tests for the diseases.

Tikva Wolf of Asheville, NC says she has been in polyamorous relationships for 20 years. She says she has strict boundaries about entering new romantic relationships to protect her sexual health: She only has sex with people who know her current STI status, communicate clearly, and use protection.

“If the conversation feels awkward or they don’t seem to know what they’re being tested for, I don’t have sex with them,” she says. “I don’t get into romantic partnerships with people unless they agree on relationships, and I don’t have casual sex.”

Wolf says their transparency measures reflect the larger community of people who engage in polyamorous relationships.

monogamy is the default, so there’s a tendency to be more transparent about certain preferences up front in any relationship that doesn’t quite fit into that default box,” she says.

Some research supports Wolf’s hypothesis. A 2015 study in The Journal of Sexual Medicine found that polyamorous people reported more lifelong sexual partners than people in monogamous relationships, but were more likely to report using condoms and getting tested for STIs. About a quarter of monogamous partners reported having sex outside of their main relationship without informing their main partner.

Kerner explains that each partner in a polyamorous relationship may have different ideas about sexual activity; Some partners may be interested in casual sex, while others may be interested in maintaining solid primary and secondary relationships.

“These systems are always different, and without clear boundaries, honesty, and communication—for example, around the use of protective measures—the potential of contracting an STI within the system increases,” and the potential for the polyamorous relationship not to work increases , he says.

Taking care of mental health

A polyamorous lifestyle requires not only talking about sexual health and romantic boundaries, but also being open about feelings as they arise.

“Couples in a polyamorous relationship don’t fully anticipate the emotional response they might have if their partner is with another person,” says David Helfand, PsyD, a therapist in St. Johnsbury, VT, who works with many polyamorous couples has worked.

People may have feelings of insecurity or jealousy, which can lead to anxiety when navigating the complexities of multiple relationships.

“The first time your spouse is on a date with someone else, or you hear them in the bedroom with someone else, it can trigger an intense emotion that you may not be able to process or were prepared for,” says Helfand.

Seeing a therapist can help process emotions brought on by dating multiple people. Ebba says she sees a therapist regularly, in part to help her set boundaries for how much time to spend with different partners.

“Poly relationships can be great because you have more supportive people in your life,” she says. “But you also give away more time and energy.”


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Staying healthy while staying open: The polyamory dilemma
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