Coming Out as Bisexual in a World That Doubts You: What Bi Erasure Is, Why It Hurts, and How to Reclaim Your Identity

Coming Out as Bisexual in a World That Doubts You: What Bi Erasure Is, Why It Hurts, and How to Reclaim Your Identity

Written by Abby Gerding, MFT

What Does It Mean to Be Bisexual?

Bisexuality is typically used to describe a sexual, romantic, and/or emotional attraction to folks of multiple genders, often including one’s own gender. Bisexuality often comes with a number of misconceptions, which are important to discuss.

One of the most common misconceptions is that bisexuality is a specific attraction to folks who fall under a traditional gender binary. The reality is that bisexual folks can experience attraction to multiple gender expressions, including non-binary, agender, trans, and gender fluid folks. Along these lines, it is common to hear the assumption that bisexuals experience a 50/50 split in their attraction to men and women. For many people, attraction is not neatly split and may be to more than two genders. 

Bisexuality is not just a “phase,” nor does it change depending on the gender of one’s partner. People don’t stop being straight or gay as soon as they enter into a relationship. So, why would that be different for bisexual people? While some people may experience more fluidity in their sexual identity or explore multiple labels in their journey to understanding their sexuality, bisexuality is a valid identity and is not a stepping-stone for many. Bisexuals do exist and do, in fact, make up the largest portion of the LGBTQ+ population, according to recent census data. 

Why Coming Out as Bisexual Hits Differently

Coming out as bisexual presents unique challenges. The myths mentioned above are only a small number bisexuals face when coming out. Both straight and queer communities may have doubts or carry misconceptions. Bisexual folks may feel a sense of pressure to explain their relationship history in order to provide a sense of validity to their identity that other folks may not feel the need to explain. Both straight and LGBTQ+ communities may subscribe to the idea that this is a “phase” or pose questions that feel invalidating. 

It can be especially difficult if the person coming out is already in a relationship or entering into one. If a bisexual person is in what may appear to be a straight-presenting relationship, their identity may not be seen as valid. They may be assigned a label that doesn’t fit for them based on the way their relationship looks. They may also face some skepticism that makes them feel out of place in the queer community, but they may not feel like they have a place in straight communities. This leads to a lot of bisexual folks feeling stuck in the middle or isolated from their community. 

What Is Bi Erasure and Where Does It Come From?

Bi erasure is a widespread phenomenon in which the legitimacy and prevalence of bisexuality is denied or dismissed. This process may occur through external factors, such as the exclusion of bisexuals from queer spaces, the belief that bisexuality is a transient identity rather than a valid destination, and the lack of representation, among other things. It can also be reinforced by internalized biphobia. The self-doubt that may be a product of many of these assumptions can be a form of self-erasure. A 2026 study looked at a number of themes that contribute to bi erasure, and found that a number of the misconceptions discussed here are major contributors to the process. The stereotypes and myths that surround bisexuality often serve to create doubt or further the idea that the bisexual identity is illegitimate, which increases the amount of stress bi folks face and contributes to a sense of invisibility. 

The lack of bisexual representation and validity often leads to the responsibility falling on bisexuals to defend and explain their identity. When a person’s sexuality is determined based on the perception of who they are in a relationship with, it often leads to assumptions that leave little room for bisexuality. This can be exhausting and have negative impacts on mental health.

The Real Mental Health Cost of Being Doubted

Many studies from across the world suggest that bisexual people report higher levels of depression and anxiety than both heterosexual and gay/lesbian populations. A 2022 Australian study suggests over 80% of bisexual people have experienced a mental health disorder compared to just over 63% of lesbian and gay people, and over 41% of heterosexual people. 

As mentioned previously, bisexual mental health is often impacted by a great deal of chronic stress. Many queer folks experience increased rates of discrimination due to their sexuality. However, bisexual people may be subjected to judgment and discrimination from both heterosexual and gay/lesbian communities, which can add more pressure and stress, leading to higher levels of anxiety and depression. People may also be less likely to come out due to the stigma, which may cause people to feel more alone and, in turn, not want to come out. 

What Affirmation Actually Looks Like

Affirmation can happen in three ways. Internal affirmation specifically looks at the internal validation of one’s identity. Empowerment can come from internal strength and knowing who you are can help protect against the misconceptions or doubt that may be present when coming out. Another source of affirmation comes from relationships with those closest to you. Having the support of a partner(s) and family (chosen or otherwise) can be wonderful. Not having to prove oneself to the folks around them or defend themselves can be very affirming. With romantic partners, not reinforcing biphobic stereotypes by questioning a partner’s loyalty or attraction can be key to providing an affirming space. Affirmation can also come from the community. When a community openly accepts folks who come out as bi without the assumption that this is a phase or that their partner determines the validity of their sexuality, it can feel incredibly validating. Finding a space where you can feel a sense of belonging and less on the outside of two different spaces creates a sense of visibility and affirmation that can help combat bi-erasure. 

How LGBTQ+ Affirming Therapy Supports Bisexual Clients Specifically

LGBTQ+ affirming therapy is a wonderful place to start! Affirming therapy goes beyond simply understanding that bisexuality exists, and enters a space in which bisexuality is honored and there is no pressure to prove that your identity is valid. Bisexual-informed care takes into consideration the challenges and pressures that come with being bi, and celebrates the unique joys that accompany this beautiful identity. The therapy room should be one in which your sexuality is met with warmth rather than skepticism.

You Do Not Owe Anyone an Explanation of Your Sexuality

Bisexuality is valid. Regardless of who you have or have not been in relationship with, how your relationship presents, or whether you are out or not, your bisexual identity is valid. Everyone’s journey is unique and, therefore, does not require proof or justification. 

You Deserve a Therapist Who Actually Gets It

Therapy can be a wonderful space to explore your bisexual identity. Having a therapist like our team at Embrace Sexual Wellness who understands the unique joys and challenges that bisexuality comes with is important. We provide LGBTQ+ celebratory therapy in Chicago that honors and affirms the bisexual experience. If you are ready to speak to someone who truly gets it, schedule a free 10-minute phone consultation with one of our sex therapists today!

Do Antidepressants Kill Your Sex Drive? What to Do About Sexual Side Effects of SSRIs

Do Antidepressants Kill Your Sex Drive? What to Do About Sexual Side Effects of SSRIs

Clinical note: This blog is for informational purposes only and does not constitute medical advice. Do not stop, reduce, or change your antidepressant medication without first speaking with the prescribing physician or psychiatrist. The options described below are well-documented in the clinical literature and worth discussing with your provider. They are not recommendations to act on independently.

You started antidepressants and they worked. The weight of depression lifted. Anxiety became manageable. You could function again in ways that had felt out of reach. And then you noticed something else: your interest in sex had quietly disappeared. Or arousal had become difficult. Or orgasm, once reliable, now felt distant or absent entirely.

If this is your experience, you are in a large company. Sexual side effects are among the most common reasons people stop taking antidepressants before they are clinically ready to do so, and one of the most underreported concerns in psychiatry. Many people assume the trade-off is inevitable. Many others feel too embarrassed to bring it up with the prescriber who manages their medication. And so they live with it, in silence, while something important to their wellbeing and their relationships quietly erodes.

There is a lot more that can be done than most people realize. Understanding what is happening physiologically, what options exist medically, and how sex therapy fits into the picture gives you a much more complete set of tools than most providers offer in a standard appointment.

How Common Is This, Really?

Sexual dysfunction caused by SSRIs and related antidepressants is strikingly prevalent, and the figures are higher than most people expect. A 2024 study found over 88% of female patients and over 84% of male patients reported sexual dysfunction while taking antidepressants, with the highest rates among those on SSRIs and SNRIs. A 2025 narrative review confirmed sexual side effects affect a significant majority of people on serotonergic medications and are a leading driver of medication non-adherence. In other words, many people are quietly stopping medication that is helping their mental health because nobody has adequately addressed what it is doing to their sexual wellbeing.

The specific side effects vary between individuals and between medications, but the most commonly reported include reduced sexual desire, difficulty with arousal, delayed or absent orgasm, and in men, erectile difficulties. These effects are not a sign that something is uniquely wrong with your body. They are a pharmacological consequence that is predictable, documented, and in most cases addressable.

Why SSRIs Affect Sexual Desire and Function

To understand why SSRIs create sexual side effects, it helps to understand what they do. SSRIs work by increasing the availability of serotonin in the brain, which is what makes them effective for depression and anxiety. The problem is that serotonin has an inhibitory effect on sexual function through several mechanisms.

A 2024 review summarized the primary mechanisms: SSRIs activate serotonin receptors that suppress dopamine release, and dopamine is central to sexual motivation and desire. SSRIs also suppress nitric oxide, which is involved in genital arousal and erection, and can elevate prolactin levels, which further dampens libido. The result is a medication that treats the mind and simultaneously applies a brake to the biological systems that generate sexual interest and response.

This is not a character flaw or a sign that you are not attracted to your partner. It is a pharmacological effect operating at a neurochemical level that has nothing to do with how you feel about the people in your life or your inherent capacity for desire.

It is also worth distinguishing SSRI-induced sexual side effects from the sexual effects of depression itself. Depression independently suppresses libido, often significantly. Some people starting antidepressants find their sexual function improves as their mood lifts. For others, the medication addresses depression while simultaneously creating a new layer of sexual difficulty. Understanding the impact of your medication in addition to hormones and low libido can help you identify which factor is doing what matters for choosing the right response.

What You Can Discuss With Your Prescriber

Several well-documented medical approaches exist for managing antidepressant-induced sexual dysfunction. These are conversations to have with your prescribing physician or psychiatrist, not decisions to make unilaterally. The options below are included so you can walk into that conversation informed.

•  Dose reduction. Sexual side effects from SSRIs are dose-dependent in many cases. A 2024 review of the literature found dose reduction by 50% led to meaningful improvement in sexual function in the majority of patients studied, and that complete discontinuation after full remission resolved the side effects entirely in those cases. Whether dose reduction is appropriate depends on the stability of your mental health and is a clinical decision your prescriber needs to make with you.

•  Switching to a lower-risk antidepressant. Not all antidepressants carry the same sexual side effect burden. Bupropion (Wellbutrin) works via dopamine and norepinephrine rather than serotonin and is consistently associated with fewer sexual side effects, sometimes with improvement in desire. Mirtazapine is another option with a more favorable sexual side effect profile. Switching is not always straightforward, and the clinical benefit of the current medication needs to be weighed carefully, but it is a legitimate and frequently successful strategy.

•  Drug holidays. Some clinicians recommend planned short breaks from SSRIs with shorter half-lives on weekends, when sexual activity is more likely. The evidence for this approach is mixed and it carries some risks. It is worth discussing but not appropriate for all medications or all patients.

•  Adjunctive medications. PDE5 inhibitors such as sildenafil have been studied as adjunctive treatments for SSRI-induced erectile dysfunction with some evidence of benefit in men. Bupropion added to an SSRI regimen has also shown promise for improving desire in both men and women. These decisions belong with your prescriber.

What Sex Therapy and Psychological Support Offer

Medical management addresses the pharmacological dimension. What it cannot address is the psychological and relational impact of months or years of sexual difficulty: the shame that builds when your body stops responding, the distance that can develop between partners, the anxiety that now surrounds sexual encounters, or the disconnection from your own sense of yourself as a sexual person.

Psychological intervention has its own evidence base here. A 2025 study tested online CBT and mindfulness-based therapy programs against a waitlist control for women with sexual interest and arousal disorder and found both interventions produced significant improvements in sexual desire, arousal, and distress at post-treatment and at six-month follow-up. While this trial focused on sexual interest and arousal disorder broadly rather than SSRI-induced dysfunction specifically, the mechanisms at work, addressing self-consciousness, rumination, body disconnection, and avoidance, are directly relevant to the psychological sequelae of medication-induced sexual side effects.

In practice, sex therapy for SSRI-related sexual difficulties may involve:

•  Psychoeducation. Understanding the mechanism clearly, including that this is pharmacological rather than personal, reduces shame and interrupts the self-critical narrative that many people develop around it. Sometimes naming the mechanism accurately is itself therapeutic.

•  Addressing performance anxiety. Once sexual difficulties become established, anticipatory anxiety about whether things will work often develops as a secondary layer. This anxiety is itself a meaningful inhibitor of arousal and response, and it does not resolve simply because the medication side effect is managed. It needs direct attention.

•  Mindfulness-based approaches. SSRI side effects can create a disconnection from physical sensation that extends beyond arousal to a general sense of physical numbness or detachment. Mindfulness practices that rebuild present-moment body awareness can help restore access to sensation and pleasure, even when arousal response is still pharmacologically blunted.

•  Couples work. Partners are often affected by medication-induced sexual changes without fully understanding what is causing them. This creates misreads, hurt feelings, and relational distance that do not resolve on their own. Including a partner in some of the therapeutic work, with appropriate framing, can significantly shift the relational climate around sex.

•  Exploring responsive desire. People who tend to experience responsive sexual desire may find that SSRI side effects push their experience further in that direction, making the absence of spontaneous desire feel more alarming than it needs to. Understanding that desire can be contextually generated, not just spontaneously felt, opens up different approaches to maintaining a sexual relationship while on medication.

When Side Effects Persist After Stopping Medication

A smaller but clinically significant number of people experience sexual side effects that continue after discontinuing SSRIs. This condition, known as Post-SSRI Sexual Dysfunction (PSSD), is characterized by persistent genital numbness, reduced or absent orgasm, loss of libido, and in some cases emotional blunting. A 2024 paper highlighted PSSD as a genuine and under-recognized clinical phenomenon, noting significant barriers to accurate prevalence estimates due to underreporting and methodological inconsistency. If you have discontinued an SSRI and are still experiencing sexual dysfunction several months later, this is worth raising directly with a physician and a sex therapist who is familiar with the condition.

PSSD is not fully understood, and treatment options are limited and still being researched. Psychological support remains relevant for managing the distress, relational impact, and identity effects of the condition while the medical picture continues to develop.

You Do Not Have to Choose Between Your Mental Health and Your Sexual Wellbeing

The belief that you must simply accept sexual side effects as the cost of treating your mental health is neither accurate nor inevitable. There are documented options on the medical side. There is meaningful support available on the psychological and relational side and the two work best in combination.

The most important first step is talking about it, with your prescriber about the medical dimensions, and with an experienced sex therapist about everything the medication has created in your relationship with your body, your partner, and your own sexuality.

At Embrace Sexual Wellness, our Chicago-based sex therapists work regularly with individuals and couples navigating medication-related sexual changes. We bring clinical knowledge, genuine warmth, and a collaborative approach that works alongside your medical team rather than in isolation from it.

If antidepressants have affected your sex life and you are ready to address it, we invite you to schedule a free 10-minute phone consultation today!

Can Trauma Cause Low Libido? Understanding Your Body’s Response

Can Trauma Cause Low Libido? Understanding the Body’s Response to Sexual Stress

You cannot find a reason. Your relationship is solid. Your hormones have been checked. Your stress levels are no higher than they have been before. And yet your desire for sex has gone quiet in a way that feels different from simply being tired or busy. Something has shifted, and you cannot quite name what.

For a significant number of people, the missing piece is trauma. Not always obvious, dramatic, or recent trauma. Sometimes the kind that happened quietly, years ago, that you processed intellectually and largely moved on from. The body often has a different timeline than the mind, and when it comes to sexual desire, the body’s memory of threat can linger in ways that are easy to miss if you do not know what you are looking for.

Understanding the relationship between trauma and low libido does not require you to have a clinical diagnosis or a clearly defined traumatic event. It requires only the willingness to consider that your body may be protecting you in ways that have simply outlasted the original threat.

The Research Is Clear: Trauma and Desire Are Directly Linked

The connection between trauma and sexual desire is not speculative. It is one of the most consistently documented findings in sexual health research. A 2020 study compared 132 women with hypoactive sexual desire disorder (HSDD) to 137 women with no sexual concerns. Women with low desire were 5.5 times more likely to meet criteria for current PTSD and 2.78 times more likely to meet criteria for lifetime PTSD. Critically, the two groups did not differ in the number or type of potentially traumatic events they had experienced. What differed was how their nervous systems had responded to those events.

This is an important distinction. It is not the trauma itself that most reliably predicts low desire. It is the lasting physiological impact of how the nervous system processed and stored that experience. Two people can go through similar events and have very different sexual health outcomes depending on factors including prior history, available support, attachment patterns, and individual nervous system sensitivity.

The link holds across populations and trauma types. A 2022 study found PTSD symptoms including avoidance and hyperarousal were consistently associated with reduced sexual desire and impaired sexual function, even when the original trauma was not sexual in nature. Feeling emotionally or physically vulnerable during sex can activate the same threat response that was conditioned during an earlier traumatic experience, regardless of whether that experience involved sexuality at all.

Why the Body Suppresses Desire After Trauma

To understand why trauma affects desire, it helps to understand what the body is actually doing when it experiences a threat.

The relationship between the stress response and low libido is well established. The short version is this: when the nervous system perceives danger, it prioritizes survival. The sympathetic nervous system activates, cortisol and adrenaline are released, and the body’s resources are redirected toward threat response. Sexual desire, which depends on the parasympathetic nervous system, a state of safety and openness, is suppressed. This is not a malfunction. It is the body doing exactly what it was designed to do.

In acute stress, this suppression is temporary. The threat passes, the nervous system returns to baseline, and desire can re-emerge. The problem with trauma is that the nervous system does not always return to baseline. In some people, particularly those who did not have adequate support during or after a traumatic experience, the threat response becomes a kind of default setting. The body remains partially activated or, in other cases, chronically shut down, not because the threat is ongoing but because the nervous system learned to anticipate it.

In this state, the conditions that sexual desire requires, felt safety, physical openness, the capacity to be present without vigilance, are chronically unavailable. Low libido is not a choice in this context. It is the body’s best available strategy for self-protection.

The Role of Dissociation and Avoidance

Two specific trauma responses deserve attention in the context of sexual desire: dissociation and avoidance. Both are common, both are often invisible to the person experiencing them, and both directly interfere with the capacity for desire and sexual connection.

Dissociation, the experience of feeling disconnected from one’s body, emotions, or immediate environment, is a common response to overwhelming experience. In sexual contexts, it can manifest as checking out during intimacy, feeling numb or absent when physical closeness occurs, or going through the motions of sex without any genuine engagement or pleasure. A 2025 study found greater dissociation predicted poorer improvement in sexual distress even during active trauma treatment, and that dissociation during sexual activity was linked to increased shame and greater difficulty relaxing and experiencing intimacy.

Avoidance operates differently but produces a similar result. After trauma, many people learn to stay away from situations that activate threat responses. In sexual contexts, this can look like declining intimacy, losing interest in initiating, or finding reasons not to be physically close with a partner. Over time, avoidance reduces anxiety in the short term but maintains and deepens the problem. The less often someone engages with intimacy, the more threatening it becomes, and the further desire recedes.

Neither dissociation nor avoidance is a character flaw. Both are adaptive responses to overwhelming experience. Understanding them as such, rather than as personal failures or evidence of something wrong with you, is one of the first and most important shifts that therapy can support.

It Does Not Have to Be Sexual Trauma

One of the most important things to understand about trauma and low libido is that the original trauma does not need to have been sexual to affect your desire. The nervous system does not categorize threats by type. It categorizes it by intensity, repetition, and the presence or absence of safety and support in response.

Childhood emotional neglect, a period of severe illness, a relationship marked by control or unpredictability, a significant loss, a car accident, exposure to violence, a medical procedure that felt violating: all of these can condition the nervous system in ways that later surface in sexual contexts. The body learned somewhere that closeness, vulnerability, or the loss of control was dangerous. Sex involves all three. The connection is not always obvious, but it is often there.

This is part of what makes somatic therapy approaches so relevant to trauma-related low libido. Because the original conditioning happened at a physiological level, in the nervous system rather than the thinking mind, approaches that work with the body directly often reach places that cognitive or talk-based therapy alone cannot.

When Trauma and Other Factors Overlap

Trauma does not operate in isolation. In many people with low libido, trauma is one thread in a more complex picture that also includes hormonal factors, relationship dynamics, mental health conditions, or the cumulative effect of chronic stress.

Understanding whether trauma is a primary driver, a contributing factor, or one piece among several requires careful clinical assessment. This is one of the reasons that a thorough intake with a sex therapist is so valuable: it maps the full picture rather than targeting a single variable including hormonal contributors to low libido and the role of a stress response in suppressing desire. When trauma is also present, it often interacts with both, amplifying the impact of hormonal shifts and keeping the nervous system in a state that chronic stress alone might not sustain.

It is also worth naming that trauma-related low libido can affect anyone, regardless of gender, relationship status, or sexual orientation. It does not require a formal PTSD diagnosis. And as we have discussed in our post on responsive versus spontaneous desire, what looks like absent desire sometimes reflects desire that is present but cannot find conditions safe enough to emerge. Distinguishing between these presentations matters clinically and therapeutically.

What Treatment Looks Like When Trauma Is the Driver

Treating low libido rooted in trauma requires a different approach than treating low libido driven primarily by hormonal or relational factors. Attempting behavioral interventions, such as increasing frequency or working on initiation, before addressing the underlying nervous system dysregulation often fails or makes things worse. The body cannot be pushed into desire because it needs to feel safe first.

An effective approach typically involves:

•  Trauma-informed assessment. Understanding the history, the patterns, and the specific ways that past experience has shaped current responses, without requiring you to relive or re-narrate trauma in ways that reactivate rather than resolve it.

•  Nervous system stabilization. Building the capacity to tolerate a wider range of internal states without activating threat responses. This is foundational work that precedes any direct focus on sexual desire or function.

•  Body-based and somatic approaches. Working with the physiological imprints of trauma directly, rather than only through cognitive processing. This may include approaches drawn from somatic therapy, mindfulness, or sensate focus, depending on the clinical picture.

•  Shame reduction. Trauma and low libido both carry significant shame loads. Explicitly addressing the self-blame, the sense of being broken, and the belief that desire should not require this much work is a meaningful clinical target in its own right.

•  Gradual reintroduction of intimacy. When the nervous system has enough regulation and the relational container is safe, carefully paced work to restore the association between closeness and safety, rather than closeness and threat.

Whether this is best approached in individual therapy, couples therapy, or a combination depends on the specific presenting picture. What matters most is that the approach is trauma-informed from the outset, and that it is led by someone with specific training in both trauma and sexual health.

Your Body Is Not Working Against You

If your libido has gone quiet and you cannot find a straightforward explanation, trauma may be part of what your body is holding. That is not a statement on your past, your relationships, or your capacity for desire. It is a clinical picture with a pathway through it.

At Embrace Sexual Wellness, our Chicago-based sex therapists are trained in trauma-informed care and bring that lens to every aspect of sexual health work. We understand that low libido rooted in trauma requires patience, precision, and a genuine understanding of how the nervous system holds experience. Learn more about what a certified sex therapist is and why it matters.

If you suspect that trauma may be shaping your relationship with desire, we invite you to schedule a free 10-minute phone consultation today!