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!

Somatic Therapy for Sexual Trauma: What It Is and How It Works

Somatic Therapy for Sexual Trauma: What It Is and How It Works

You can know, intellectually, that the trauma is in the past. You can understand it, name it, have worked through it in talk therapy. And yet something in your body still responds. Sex feels unsafe even when your mind knows it is not. You go numb at a moment of closeness. You startle at a touch that should feel good. Your nervous system has not received the message that the threat is over.

This is not a failure of insight or willpower. It is how trauma works. And it is one of the central reasons that talk therapy alone, while valuable, is sometimes not sufficient for healing the ways sexual trauma has settled into the body and disrupted the body’s capacity for safety, pleasure, and connection.

Somatic therapy offers a different entry point: one that works with the body directly, rather than around it. Understanding what somatic therapy is, how it addresses trauma physiologically, and what the evidence says about its effectiveness can help survivors make informed decisions about their healing.

Why Trauma Lives in the Body

Trauma is not simply a memory. It is a physiological event that reshapes how the nervous system responds to perceived threat. When a person experiences something overwhelming, the body initiates survival responses: fight, flight, or freeze. In many cases of sexual trauma, the freeze response is dominant. The person becomes immobilized, unable to fight or flee, and the defensive response that was initiated in the body never completes.

According to the model underlying Somatic Experiencing, one of the most established body-based trauma therapies, this incomplete defensive response leaves the nervous system in a state of chronic activation or shutdown. A 2021 scoping literature review summarizing research on Somatic Experiencing found that post-traumatic stress symptoms are understood, within this framework, as a persistent overreaction of the innate stress system: the body remains primed for a threat that has passed, unable to return to a baseline state of regulation.

The impact on sexuality is both direct and significant. A 2023 study on trauma-focused treatment and sexual functioning found that sexual dysfunction is highly prevalent in individuals with PTSD, and that symptoms including reduced sexual desire, difficulty with arousal, dissociation during sex, and avoidance of intimacy frequently accompany trauma regardless of whether the original trauma was sexual in nature. The body’s threat response does not distinguish between contexts: if the nervous system is chronically activated, the conditions for sexual safety and pleasure are undermined across the board.

What Somatic Therapy Is (and What It Is Not)

“Somatic therapy” is an umbrella term for a range of therapeutic approaches that incorporate body awareness, physical sensation, and nervous system regulation as primary tools for healing, rather than treating the body as secondary to cognitive or verbal processing. The most researched modality within this category is Somatic Experiencing (SE), developed by Dr. Peter Levine and grounded in neurobiological and ethological research on how animals complete and discharge survival responses after threat.

Other body-based approaches that fall under the broader somatic umbrella include sensorimotor psychotherapy, EMDR (Eye Movement Desensitization and Reprocessing), and trauma-sensitive yoga, each with their own theoretical frameworks and evidence bases. When a clinician describes working somatically with trauma, it is worth asking specifically which modality or approach they are using, as these differ in meaningful ways.

What somatic approaches share is the premise that healing trauma requires engaging the body’s own regulatory processes, not just the thinking mind. This is sometimes described as a “bottom-up” approach, in contrast to the “top-down” approach of purely cognitive or verbal therapies. Both directions of processing are valuable; somatic work is most often used alongside, rather than instead of, other therapeutic approaches.

Somatic therapy does not involve sexual touch of any kind. Sessions take place in a fully clothed, professional setting, with the therapist using verbal guidance, attention to sensation and posture, gentle movement, breath work, and tracking of physiological states to facilitate nervous system regulation and trauma discharge.

How Somatic Therapy Addresses Sexual Trauma Specifically

Sexual trauma creates a particular challenge for healing because the body part associated with the trauma is also the body part associated with intimacy, pleasure, and connection. Survivors frequently experience a splitting: a learned disconnection from their own physical experience as a protective strategy, which can generalize from the original threat to all sexual contexts.

Somatic therapy approaches this through several mechanisms that operate below the level of conscious narrative:

•  Nervous system regulation. Before any trauma processing can occur, the nervous system needs enough stability and capacity to tolerate activating material without becoming overwhelmed. Somatic work begins by building this regulatory foundation, helping the client develop the ability to move between states of activation and calm without becoming flooded or shut down.

•  Titration and pendulation. Rather than flooding the client with traumatic material, somatic therapy works in small doses, approaching the edges of distress and then returning to a resource or a regulated state. This back-and-forth movement, called pendulation in Somatic Experiencing, gradually expands the client’s tolerance and begins to discharge stored survival energy without retraumatizing.

•  Completing interrupted defensive responses. A core principle of SE is that the freeze response leaves incomplete motor sequences in the body: impulses to fight or flee that were suppressed. In a safe, titrated way, somatic therapy creates conditions for these responses to complete, which can produce a profound sense of release and resolution.

•  Restoring interoception. Sexual trauma often disrupts interoception, the ability to sense and interpret one’s own internal bodily states. Somatic work gently rebuilds this capacity, helping survivors reconnect with their bodies as a source of information and eventually of pleasure, rather than only as a site of threat.

•  Addressing dissociation. Dissociation during sexual activity is common among trauma survivors and can be profoundly distressing. Somatic approaches work directly with the physiological patterns underlying dissociation, helping clients develop greater presence and continuity of experience in their bodies.

What the Research Shows

The evidence base for somatic approaches to trauma is growing, though it is important to characterize it accurately. The 2021 literature review found preliminary evidence for positive effects of somatic experiencing on PTSD-related symptoms, with gains also noted in emotional regulation and overall wellbeing. The review’s authors were appropriately cautious, however, noting that the evidence base includes methodological limitations: most studies had small samples, few were randomized controlled trials, and long-term follow-up data were limited.

A more recent 2025 meta-analysis found somatic therapy was congruent with many patients’ lived experiences and their beliefs about mental health and further research is needed to develop somatic based interventions for PTSD.

The honest summary of the evidence is this: somatic approaches to trauma show meaningful promise and are widely used in clinical practice with good clinical rationale, but the research base is younger and less standardized than that of more established approaches such as CBT or EMDR. For most survivors, somatic work is used as part of a broader integrative treatment plan rather than as the sole intervention, and this integrative approach is consistent with how the research community understands best practice.

Somatic Therapy in the Context of Sexual Wellness

When somatic approaches are incorporated into sex therapy or sexual wellness treatment for trauma survivors, the goal is not simply symptom reduction but restoration: restoring the client’s relationship with their own body, their capacity for presence during intimacy, and their access to pleasure and connection on their own terms.

This work may involve:

•  Mapping body-based responses to sexual contexts. Understanding which physical sensations, postures, or situations activate threat responses, and working gradually to expand the window of tolerance around those cues.

•  Rebuilding a sense of safety in the body. For many survivors, the body itself has come to feel like an unsafe place. Somatic work helps to rehabilitate this relationship, creating the physiological conditions that make pleasure accessible again.

•  Integrating cognitive and body-based approaches. Combining somatic work with the psychoeducation, cognitive restructuring, and relational repair that sex therapy also offers creates a more comprehensive pathway to healing than either approach can provide alone.

Progress in this work is not linear, and it often requires patience. But for many survivors, it is the approach that finally reaches the places that talking alone could not.

Healing Is Possible, and It Starts with the Right Support

Sexual trauma affects the body, the nervous system, the capacity for intimacy, and the sense of safety in one’s own skin. Healing it requires approaches that meet the body where it is, not just where the mind can reach.

At Embrace Sexual Wellness, our Chicago-based clinicians work with survivors of sexual trauma using trauma-informed, body-aware approaches that respect both the complexity of what you have experienced and the pace at which your nervous system can safely engage with healing. We integrate somatic principles with sex therapy and evidence-based psychological approaches to provide care that is both clinically grounded and genuinely responsive to you as a whole person.

If you are a survivor of sexual trauma and are ready to explore what healing can look like for you, we invite you to take the first step. Schedule a free 10-minute phone consultation today. You do not have to navigate this alone.