The Health Profiles of Mostly Heterosexual Women: A Scoping Review

Background and Purpose: Based on previous research focused on measuring sexual orientation, we know that an individual’s identity, attraction, and behavior patterns do not perfectly overlap. Studies documenting health disparities by sexual orientation have often limited their gaze to solely comparing heterosexual and sexual minority experiences, rather than considering the nuances that exist within and across these groups. However, recent research has used a five-category measure for sexual orientation, allowing participants to identify as mostly heterosexual (MH). Broadly, MH people can be defined as those who experience a degree of same-gender attraction or have same-gender partners but do not identify as lesbian, gay, bisexual, queer (LGBQ), or a related identity category. Indeed, when presented with this option, more participants select the “mostly heterosexual” option than any other sexual minority category. Most research on MH people has examined various facets of their health. The purpose of this scoping review was to expand our understanding regarding the health profiles of MH women to inform culturally responsive research and clinical practice.

Methods: We completed a scoping review to assemble the available, peer-reviewed literature on MH women. Using Covidence software, we conducted a comprehensive search of Web of Science, PubMed, and Psych Info. Our inclusion criteria were that the studies must comprise a sample of MH women. We extracted and synthesized study findings on health outcomes among this population. From the initial pool of 272 studies, 44 met inclusion criteria and were retained for review.

Results: Across studies, five health foci emerged: sexual/reproductive health, sexual victimization, substance use, mental health, and diet (including nutrition and body image). Nearly half of the included articles looked at MH women’s sexual/reproductive health and sexual victimization. Overall, MH women’s health profiles were more similar to sexual minority women than exclusively heterosexual women. MH women reported higher rates of sexual victimization and substance use than their exclusively heterosexual counterparts and, often, these rates were also higher than those reported for other sexual minority women. MH women were also more likely than exclusively heterosexual women to report having a sexually transmitted infection and an earlier age of sexual intercourse. The few studies on mental health and diet suggested that MH women also have lower health outcomes for these domains.

Conclusions and Implications: This study demonstrates that MH women have health profiles that are distinct from their exclusively heterosexual counterparts. It is imperative for researchers to include them in their studies and continue to understand how and why this is a distinguishable group. We also need to expand our understanding of MH women from a theoretical perspective, as minority stress theory seemingly fails to fully explain their experiences. Overall, social work research and practice would benefit from a more nuanced understanding of the experiences of sexual minority women, with particular attention to how intersections of identity, behavior, and attraction yield distinct health profiles among this heterogeneous population.