Staying Healthy While Staying Open: The Polyamory Dilemma
Jan. 5, 2023 – Angie Ebba, 42, of Portland, OR, has two local girlfriends, one long-distance partner, and a platonic life partner.
Ebba is polyamorous, having multiple intimate romantic relationships at the same time. Her partners know about each other and have consented to the arrangement, she says.
Polyamory is becoming more common in the United States. In 2021, one in nine Americans said they’d been in polyamorous relationships, and one in six said they wanted to try it, according to a study by researchers at the Kinsey Institute.
While a high level of transparency is required to make polyamory work, those who practice it don’t always feel comfortable sharing their relationship status with health care professionals. The fear of disclosure is not unfounded. Of the those in the Kinsey study who said they weren’t and had never been interested in polyamory, fewer than 15% said they respect people who engage in the practice.
“I hear all the time from patients who have sexual questions and issues but are uncomfortable talking to their doctors or even other therapists,” says Ian Kerner, PhD, a psychotherapist and sex therapist in New York City. “As polyamorous systems are still on the outskirts of the mainstream, some doctors may have implicit biases or explicit judgments, especially if they are lacking in experience.”
Roadblocks to Care
People who practice polyamory face unique health issues. These include a potentially higher risk of sexually transmitted infections (STIs) from having multiple sexual partners, and anxiety or depression stemming from managing multiple relationships.
“It is of particular importance in OB/GYN given the risk of STI transmission, and its consequences such as infertility, vaginal discharge, and systemic illness,” says Cheruba Prabakar, MD, the CEO of Lamorinda Gynecology and Surgery in Lafayette, CA. “Disclosing information will allow the provider to think about the patient more holistically.”
Ebba does not tell her doctors 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.
“Primarily, I don’t let my providers know because I’ve already in the past faced discrimination and awkwardness for being queer; I don’t want that for being poly as well,” she says. “If I can avoid it, I will.”
A study from 2019 of 20 people in consensual non-monogamous relationships – which can include polyamory – found most of them reported challenges in addressing their health care needs related to lack of provider knowledge, not enough preventive screenings, and stigmas that impacted their health and trust in the medical system.
“Polyamorous people often have trouble seeking out health care because they fear being judged by their doctor or other clinicians who don’t understand or respect their lifestyle choices,” says Akos Antwi, a psychiatric mental health nurse practitioner and co-owner of Revive Therapeutic Services in Rhode Island and Massachusetts. “They may also be reluctant to share information about their relationships with providers who aren’t familiar 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 worried about discussing the topic of multiple relationships with their health provider.
“Health care providers’ interactions with patients are often shaped by their mono-normative assumptions, that monogamy is ideal and deviations from that ideal is pathological,” she says. “Non-disclosure presents a barrier to sensitive care that meets the individualized needs of the patient.”
Flicker says health care professionals can seek training to reduce their biases, and to better understand and address the unique needs of people involved in consensually non-monogamous relationships. In addition, offering to answer any questions that a doctor might have after disclosure can open the door to dialogue, according to Prabakar.
“They may be simply embarrassed to ask, as many may not be familiar with” polyamory, Prabakar says.
People in polyamorous relationships also can look for affirming language on the websites of health providers, which may mention welcoming patients of all sexual orientations or gender identities. A first appointment can serve as an interview to find out what kind of terms a provider uses when referring to non-monogamy.
Safely Navigating Sexy Time With Multiple Partners
Prabakar says sexual health and safety is at the forefront for her patients in polyamorous relationships because they are engaging with multiple partners.
She recommends anyone who has multiple partners use condoms and dental dams for the prevention of STIs, like herpes and gonorrhea, in addition to receiving regular screening tests for the diseases.
Tikva Wolf, from Asheville, NC, says she’s been in polyamorous relationships for 20 years. She says she has strict boundaries for engaging in new romantic relationships to protect her sexual health: She has sex only with people who know their current STI status, are clear communicators, and use protection.
“If the conversation feels awkward, or they don’t seem to know what they’ve been tested for, I don’t engage in sex with them,” she says. “I don’t start romantic partnerships with people unless they’re on the same page about relationships, and I don’t have casual sex.”
Wolf says her actions toward transparency mirror the greater community of people who engage in polyamorous relationships.
“Monogamy is the default setting, so there’s a tendency to be more transparent about specific preferences upfront in any relationship that doesn’t quite fit into that standard box,” she says.
Some research backs up Wolf’s hypothesis. A 2015 study in The Journal of Sexual Medicine found that polyamorous people reported more lifetime sexual partners than people in monogamous relationships, but were more likely to report using condoms and be tested for STIs. About one-quarter of monogamous partners reported having sex outside of their primary relationship but not informing their primary 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 are interested in maintaining steady primary and secondary relationships.
“These systems are always different, and without clear boundaries, honesty, and communication – for example around the use of protection – the potential to contract an STI within the system increases,” and the potential for the polyamorous relationship to not work increases, he says.
Taking Care of Mental Health
Not only does a polyamorous lifestyle require talking about sexual health and romantic boundaries, it demands an openness with feelings as they come up.
“Couples in a polyamorous relationship don’t fully anticipate the emotional response they might have to their partner being with another person,” says David Helfand, PsyD, a therapist in St. Johnsbury, VT, who has worked with many polyamorous couples.
People may have feelings of insecurity or jealousy, which can lead to anxiety in navigating the complexity of multiple relationships.
“The first time your spouse goes on a date with another person, or you hear them in the bedroom with someone else, it can create an intense emotion that you might not know how to process or have been prepared for,” Helfand says.
Seeing a therapist can help with processing emotions raised by dating multiple people. Ebba says she sees a therapist regularly, in part for help setting boundaries on how much time to spend with different partners.
“Poly relationships can be great because you have more support people in your life,” she says. “But you’re also giving more of your time and energy away too.”