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Healthcare Experiences and Needs of Consensually Non-Monogamous People: Results From a Focus Group Study


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Background: Individuals engaged in consensual non-monogamy (CNM) face broad and potentially harmful experiences of sexual stigma in society, yet no published empirical literature has examined the experiences of this population within the healthcare system. Aim: The present investigation sought to explore positive and negative experiences of CNM individuals within the healthcare system, as well as specific needs of these patients regarding inclusive healthcare practices. Methods: 20 CNM-identified adults from a non-profit organization serving CNM individuals completed a brief survey and participated in 1 of 3 focus groups of 70 minutes duration centered on their healthcare needs and experiences. Outcomes: CNM patients report challenges in addressing their healthcare needs related to lack of provider knowledge, inadequate preventative screenings, and stigmatizing behaviors that impact their health and trust in the healthcare system. Clinical implications: Healthcare providers must monitor and work to avoid assumptions and pathologization of individuals who engage in CNM, creating an open, accepting environment to work collaboratively with CNM individuals to meet their unique sexual health needs. Strength & limitations: Although the present sample is diverse with respect to sexual and gender identity and socioeconomic status, it may not represent the experiences of CNM individuals outside of the midwestern United States and those who do not identify as polyamorous. Conclusion: CNM individuals frequently experience sexual stigma in interactions with the healthcare system that interferes with receipt of sensitive, medically accurate care relevant to their unique needs and experiences. Vaughan MD, Jones P, Taylor BA, et al. Healthcare Experiences and Needs of Consensually Non-Monogamous People: Results From a Focus Group Study. J Sex Med 2019;16:42-51.
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Healthcare Experiences and Needs of Consensually
Non-Monogamous People: Results From a Focus Group Study
Michelle D. Vaughan, PhD,
Peyton Jones, BS,
B. Adam Taylor, BS,
and Jessica Roush, BS
Background: Individuals engaged in consensual non-monogamy (CNM) face broad and potentially harmful
experiences of sexual stigma in society, yet no published empirical literature has examined the experiences of this
population within the healthcare system.
Aim: The present investigation sought to explore positive and negative experiences of CNM individuals within
the healthcare system, as well as specic needs of these patients regarding inclusive healthcare practices.
Methods: 20 CNM-identied adults from a non-prot organization serving CNM individuals completed a brief
survey and participated in 1 of 3 focus groups of 70 minutes duration centered on their healthcare needs and
Outcomes: CNM patients report challenges in addressing their healthcare needs related to lack of provider
knowledge, inadequate preventative screenings, and stigmatizing behaviors that impact their health and trust in
the healthcare system.
Clinical Implications: Healthcare providers must monitor and work to avoid assumptions and pathologization
of individuals who engage in CNM, creating an open, accepting environment to work collaboratively with CNM
individuals to meet their unique sexual health needs.
Strength & Limitations: Although the present sample is diverse with respect to sexual and gender identity and
socioeconomic status, it may not represent the experiences of CNM individuals outside of the midwestern
United States and those who do not identify as polyamorous.
Conclusion: CNM individuals frequently experience sexual stigma in interactions with the healthcare system
that interferes with receipt of sensitive, medically accurate care relevant to their unique needs and experiences.
Vaughan MD, Jones P, Taylor BA, et al. Healthcare Experiences and Needs of Consensually Non-
Monogamous People: Results From a Focus Group Study. J Sex Med 2019;16:42e51.
Copyright 2018, International Society for Sexual Medicine. Published by Elsevier Inc. All rights reserved.
Key Words: Social Stigma; Multiple Partners; Consensual Non-Monogamy; Qualitative Research; Culturally
Competent Care
Characterized by an agreement to romantic and/or sexual re-
lationships based on explicit consent of all partners involved,
studies conducted by U.S. researchers indicate that between
3.5% and 5.0% of individuals are currently engaged in
consensual non-monogamy (CNM) or identify as being engaged
in CNM relationships,
with up to 20% of single individuals
reporting experience with CNM.
Incorporating polyamory,
swinging, open relationships, and relationship agreements,
entic literature on CNM has been expanding rapidly in the past
CNM individuals are broadly perceived as emotionally un-
healthy, immoral, and engaged in unhealthy, sexually risky re-
; however, these assumptions have been widely
refuted by empirical research. Across multiple studies, CNM and
non-CNM individuals score similarly on measures of relationship
quality and psychological well-being.
Although CNM in-
dividuals are likely to have more lifetime sexual partners than
their monogamous counterparts,
there is no evidence that this
Received May 20, 2018. Accepted November 7, 2018.
School of Professional Psychology, Wright State University, Dayton, OH,
Aetna Insurance, New Albany, OH, USA;
Wexner Medical Center, The Ohio State University, Columbus, OH, USA
Copyright ª2018, International Society for Sexual Medicine. Published by
Elsevier Inc. All rights reserved.
42 J Sex Med 2019;16:42e51
population has higher rates of sexually transmitted infections
In fact, evidence indicates that CNM individuals more
frequently engage in STI testing.
They are also more likely to
discuss STI testing and partner history with sexual partners,
they report more consistent and correct use of barriers compared
with other sexually active adults.
Individuals who engage in relationships or sexual behaviors
that defy social norms (eg, lesbian, gay, bisexual [LGB]) have
long faced the experience of being stigmatized, devalued, ste-
reotyped, and/or discriminated against for deviating from these
Such experiences may be contextualized as forms of
minority stress and may be a critical factor in health disparities in
LGB populations.
Evidence of sexual stigma via explicit and
implicit biases by healthcare providers toward lesbian and gay
and those who engage in sexually kinky
has been established. Physicians have acknowledged a
reluctance/hesitance to conduct a thorough sexual health history
with patients who may have same-gender attractions.
biases may have deleterious effects on judgments/decisions about
patient care, lack of trust, and poor communication with pro-
viders, especially in the context of stigmatized or sensitive
including sexuality.
As part of their Clinical Prevention Guidance, the Centers for
Disease Control and Prevention (CDC)
has called for in-
terviewers to demonstrate respect, compassion, and a non-
judgmental attitude toward patients to obtain a complete and
accurate sexual history. This history should include questions
about the number and gender of the patients recent sexual
partners (and any additional sexual partners that their partners
may have), sexual behaviors, as well as STI/HIV and pregnancy
prevention practices. They also explicitly recommend gathering
data about the sexual behavior of the patients sexual partners and
providing STI/HIV testing services for all patients with multiple
current sexual partners.
Within the context of CNM, mononormativity is a unique
subtype of sexual stigma that promotes monogamy as the
expectation and the only healthy standard for romantic/sexual
These internally held biases often are expressed
toward CNM individuals, who report judgmental attitudes,
verbal shaming about having multiple partners, and the
assumption by others that they must have or be at elevated risk
for STIs.
However, exceptionally little is known within the
scientic literature about the needs and experiences of this
unique population.
In an unpublished doctoral dissertation,
in a sample of more than 1,220 adults currently
engaged in consensual non-monogamy, found that 20.3% re-
ported at least 1 experience of explicit discrimination from a
medical doctor, 19% reported discrimination from a mental
health provider, and 9% reported discrimination from other
providers associated with their CNM status. Within the domain
of mental health services, another study found that 38% of
CNM individuals concealed their status from their provider
owing to fear of being stigmatized, and 10% of those who had
disclosed their status reported a negative response from their
In the sole (unpublished) study of CNM healthcare experi-
ences, McCrosky et al
interviewed 9 polyamorous women on
their experiences with providers, barriers to access, and adaptive
strategies they used to meet their needs. The women expressed a
strong desire for open, honest relationships with providers and a
commitment to monitoring their sexual health through frequent,
broad-based STI testing. They reported a lack of provider
knowledge about CNM, and a lack of provider interest in/effort
to assess risk-reduction practices (eg, condom use). Most re-
ported experiences of judgment related to CNM, including un-
professional remarks about their sexual behavior, refusal to
provide treatment, and a request to not return to the providers
ofce. Fear and frustration led many participants to prescreen
potential providers, carefully manage decisions about disclosure,
seek services outside of their primary care provider, or delay/
avoid necessary care.
Based on these studies, evidence exists that CNM individuals
frequently experience sexual stigma in a variety of contexts that
may have important implications for healthcare practice and
sexual health outcomes. However, given the dearth of published
literature on the sexual healthcare experiences of CNM in-
dividuals, little is known about the specic needs and experiences
of this population with respect to accessing and receiving high-
quality sexual health care.
The present investigation sought to address this gap in the
literature through a qualitative/focus group study to provide
initial data on the needs and experiences of CNM individuals
within the context of health care. Given the lack of existing
empirical research on CNM health care, the present study was
exploratory in nature, seeking to compare trust in healthcare
providers between our CNM patient sample and other (pre-
sumably monogamous) patient samples and to explore the nature
of CNM individualshealthcare needs, relevant experiences
within the healthcare system, and recommendations for health-
care provider training and practice.
This study was approved by the Institutional Review Board at
Wright State University. The research team included a female
doctoral-level counseling psychologist and researcher, a male
clinical psychologist-in-training with a bachelors degree and
graduate training (both with graduate training in qualitative
methods), and 2 registered nurses (1 male and 1 female) with
bachelors degrees. The initial research question for this project
was proposed to the rst author by a leader of a regional
polyamory-themed non-prot organization, and feedback from
members of this community was solicited during the develop-
ment and renement of focus group questions.
After providing informed consent, participants completed a
demographic survey that included several questions about their
J Sex Med 2019;16:42e51
CNM Healthcare Experiences 43
CNM style, current relationships, and trust in and disclosure of
CNM to healthcare providers. Each participant was asked to
provide a pseudonym to allow their responses on the survey to be
matched with their focus group data. No personally identiable
information was solicited or retained, and participants were free
to not respond to any survey or focus group question or dis-
continue participation at any time. References to names of spe-
cic providers or names of partners were deidentied to protect
participant condentiality. All focus group sessions were audio-
recorded. All data/devices were physically secured by the re-
searchers during the recording/transcription process and stored in
a locked cabinet. All electronic les were maintained in a secure
(private) storage system that was not accessible to individuals
outside of the research team.
Study participants were adults (age 18 years) who self-
identied as CNM individuals or currently practiced any form
of CNM (eg, polyamory, open relationship, swinging) and were
uent in English. Participants were recruited via convenience
sampling from a midwestern polyamory-themed organization
through in-person announcements regarding the study, its goals,
and the background of the researchers at a monthly educational
meeting of the group. 3 focus groups (each with 3e10 partici-
pants, for a total of 20 participants) were held between April and
May 2017, were facilitated by the either the rst or second
author (M.D.V. or P.J.) and were 40e70 minutes in length. 2
focus groups were held in private meeting rooms during a
monthly meeting of the polyamory-themed non-prot organi-
zation. A third focus group was held in a private location at the
request of several members of the organization who were unable
to attend the original focus groups. No other individuals other
than the participants and the interviewers were present during
the focus groups.
The focus groups used a series of 4 semistructured questions
centered on their experiences as a CNM individual relevant to (i)
healthcare needs, (ii) how/where they attempt to get those needs
met, (iii) experiences with healthcare providers, (iv) factors
impacting disclosure of status, and (v) recommendations/needs
from healthcare providers. References to names of specic pro-
viders or names of partners were anonymized to protect partic-
ipant condentiality. Audio recordings were transcribed verbatim
by the second author (P.J.) and reviewed for accuracy by the rst
author (M.D.V.).
Outcome Measures
The Trust in Health Care Providers subscale of the Multi-
dimensional Trust in Health Care Systems Scale
was used to
assess participantslevel of trust in their providers. The subscale
consisted of 10 Likert-type items ranked on a 5-point scale,
with total scores ranging from 10 to 50. The scale demonstrated
high reliability (a¼0.89) and evidence of convergent and
health care provider is usually considerate of my needs and puts
them rst.
Data Analysis
Demographic data and analysis of the Trust in Health
Care Providers scale was summarized and analyzed using SPSS
version 23 (SPSS Corp, Armonk, NY, USA).
A 1-sample t-test
Table 1. Demographic characteristics of the study sample
(N ¼20)
Characteristic n Valid %
18e29 y 8 40
30e44 y 9 45
45e64 y 3 15
Gender identity*
Cisgender man 8 40
Cisgender woman 9 45
Transgender woman 2 10
Genderqueer/gender non-conforming 1 5
Genderuid 1 5
Sexual identity*
Lesbian 2 10
Gay 1 5
Bisexual 5 25
Pansexual/omnisexual 5 25
Queer 2 10
Sexually uid 1 5
Gray/asexual 2 10
Heterosexual/straight 6 30
Sexual orientation*
Attracted to men 14 70
Attracted to women 15 75
Unsure of attraction 1 5
No attraction 1 5
Attracted to folks outside of binary 10 50
African American/black 1 5
Biracial/multiracial 1 5
Caucasian/white 17 85
Other 1 5
Type of CNM
Polyamorous 17 85
Swinger 1 5
Relationship/sexual agreement 2 10
Socioeconomic status
Poor 3 15.8
Working class 4 21.1
Middle class 8 42.1
Upper middle class 4 21.1
Marital status
Single (never married) 7 35
Married 7 35
Divorced 5 25
Separated 1 5
CNM ¼consensual non-monogamy.
*Percentages may exceed 100% because participants could choose more
than 1 option.
J Sex Med 2019;16:42e51
44 Vaughan et al
(1-tailed) was used to examine whether trust in healthcare pro-
viders differed signicantly from those of the standardization
sample for the measure. Power analysis for a 1-sample t-test was
conducted in G*POWER
to determine a sufcient sample size
using an avalue of 0.05 and a power of 0.80, assuming a large
effect size (d¼0.8), and 1-tailed hypotheses. Based on the
aforementioned assumptions, the desired sample size was 12.
The researchers used a thematic analysis approach of Braun
and Clarke
for the analysis of the qualitative data from the
focus group interviews. Open, inductive coding was conducted
independently by the rst 2 authors (M.D.V. and P.J.) in an
iterative process to identify candidate themes and subthemes.
Discrepancies/disagreements were resolved via discussion be-
tween the coders until consensus was reached over the course of 4
coding meetings until data saturation was obtained. Themes and
subthemes were independently applied to participant responses
and discussed in a nal coding meeting until consensus was
reached on codes for each individual response. Themes and
subthemes were shared and discussed with 4 focus group
members for additional validation. All provided conrmation of
these themes as consistent with experiences they heard described
in their respective focus groups.
We collected qualitative and demographic data from 20 par-
ticipants (Table 1). No participants dropped out of the study.
The participants ranged in age from 19 to 60 years (mean age
36.15 ±10.68 years). Most were white (85%), cisgender (90%),
and had at least some college education (85%). The majority of
the sample identied as polyamorous (85%), with a sample
average of 4.47 ±3.08 sexual partners (range 1e12 partners) in
the past 12 months.
90% of the sample reported currently having health insurance.
90% had disclosed their CNM status at least once to a healthcare
provider, with most reporting they had disclosed their CNM
status once or twice (n ¼6; 30%) or several times (n ¼9; 45%).
Participants reported an average level of trust in healthcare pro-
viders of 33.90 ±6.10. Compared with the standardization
sample for this subscale, CNM participants had signicantly
lower trust in healthcare providers [t(17) ¼e4.645; standard
error of the mean 1.405; P<.0001, 1-tailed; 95% CI, e9.493 to
e3.563; Cohensd¼e1.09].
Analysis of the qualitative data yielded 4 major themes and 5
subthemes (Table 2).
Theme 1: Ignorance of CNM
A common negative experience among individuals in the
sample centered on healthcare providers demonstrating a lack of
awareness regarding the existence of non-monogamous re-
lationships and explicit assumptions that the participants were
monogamous. These participants reported never being asked
about their relationship style or number of partners. This was
reported primarily by cisgender men and women who were le-
gally married to a partner of a different gender:
Mara (married, white, cisgender, bisexual polyamorous
woman): My gynecologist and, you know, she offered up all
the type of tests for everything and then one yearand I
wasnt out to her that I was polyand then one year she
was like, Oh youre in a monogamous relationship with
your husband, you know, we dont really need to give you
this, this, and this.And I was like, Oh, you just assumed
Lack of awareness or knowledge of relevant medical standards
and insurance coverage for preventative care related to the sexual
health of individuals with more than 1 recent sexual partner was
also noted:
Jo (married, white, cisgender, bisexual polyamorous
woman): And I think thats a whole other job. Thatsa
whole other ball of wax. Whats covered? What isnt
covered? They dont always know. Then youre asking and
theyre like, Well if youre monogamous, and thatsnot
going to be covered.”“But Im not [monogamous].”“Well,
I dont know.
Subtheme: Pressure to Educate Providers
Another experience inherently linked to the ignorance of
providers regarding types of non-monogamy was the broad
perception that providers appeared to lack formal education
regarding diverse relationship structures and concepts/terms/ex-
periences related to CNM. This lack of accurate knowledge often
led these patients to feel pressured to/need to take on the role of
educator with their provider:
Tess (married, white, pansexual, genderuid, polyamorous
person): I have pretty much the same thing as Jo said. Um,
Table 2. Thematic analysis results: Healthcare needs/experiences
Theme Subtheme
Ignorance of CNM
Pressure to
educate providers
Inadequate screening
Sexual stigma
Stigma reactions
efforts/seeking CNM-inclusive
Experiences of CNM-inclusive care
and acceptance
Meeting healthcare
CNM ¼consensual non-monogamy.
J Sex Med 2019;16:42e51
CNM Healthcare Experiences 45
just asking for HIV/STD testing its like, Well, you had
one last year, why do you need one now?”“Well, because
theres a possibility there could be other people involved.
Oh, if he tested negative 6 months ago, youre ne.”“Uh,
nooooo. Even if he tested negative, no.
Ann (single, white, transgender, lesbian/queer polyamorous
woman): When we do nd someone at that level, we have
to educate them (nods in agreement from other partici-
pants). So well, whats that mean?or Are you active with
everyone? At the same time or different times?A lot of
times when I disclose that to medical professionals and
others, I end up being an educator.
Subtheme: Inadequate Screening
This lack of knowledge about the existence of multiple sexual
relationships, and CNM relationships in particular, often led to
experiences with providers making inaccurate assumptions
regarding health risks that directly impacted the screening pro-
cess. These included the assumptions that all CNM individuals
always have multiple sexual partners, engage in high-risk sexual
behaviors, and will invariably contract STIs and have other sexual
health problems. These assumptions all directly impacted the
ability to receive a thorough, accurate preventative health
screening, with participants repeatedly noting that their providers
failed to ask them about their safer sex practices (eg, use of
barriers, testing schedule) or the practices of their sexual partners,
even when they disclosed their CNM status:
Luna (single, African American/black, cisgender, hetero-
sexual polyamorous woman): One of my partners, she kept
on having medical issues. None of the doctors could gure
out what it was. So the doctor.assumed it was an STI. We
all got tested. We all came out clean. They were so focused
on saying that its some type of STI than trying to gure out
what the actual reason was. It seemed like they were focused
on that because she told them she was in a poly relation-
ship. Its kind of like they hear risk factorand all medical
knowledge stops until theyre able to factor out the
obviousSTI that actually never existed.they focused so
much energy on proving that it was an STI.
Participants also experienced a lack of provider interest in
gathering relevant sexual health information critical to making
an accurate, informed assessment of their sexual health risks
and related healthcare needs. Several participants noted that
they appeared to have greater knowledge of effective risk
reduction practices regarding STIs than their healthcare pro-
viders (eg, testing, barrier use/agreements, human papilloma-
virus [HPV] vaccines, communication about safer sex practices
among partners and their partners). They were frequently
disappointed that providers failed to ask about or acknowledge
their efforts to maximize their own health and safety and that of
their partners:
Tina (single, white, cisgender, pansexual polyamorous
man): My experience in general is to say, Ive done this,
and Ive had these experiences,and you just get judged for
it or at least go into this talk about Lets talk about the
dangers of STIsor stuff like that, having full knowledge of
the dangers of STIs, and having long conversations with
partners before I do anything with them. So at a certain
point, it would be nice if I could just get tested and not
have to go through these conversations. I feel like I should
go to the doctor and not have to feel like I have to defend
my lifestyle. But oh well.
Kinsey (single, white, cisgender, heterosexual polyamorous
man): Theyre saying like, Well thats risky, and you
shouldnt behave in that manner.And so just being like,
Well this is my thing, and heres the things I do to
minimize it,they dont care that I was using protection or
any of the other kind of stuff.
Theme 2: Sexual Stigma
Explicit and implicit experiences of judgment and shock from
healthcare staff were widely reported by participants and char-
acterized as highly stressful. Several participants described raised
eyebrowsand dirty looksdirected at them and their partners,
avoidance of eye contact, and a condescending tone after the
provider/staff became aware of their CNM status:
Kinsey (single, white, cisgender, heterosexual polyamorous
man): I walked out of that room feeling horribly embar-
rassed, very shamed, very judged, and to be frank, I felt
dirty from it [the visit].
Providersinaccurate assumptions about CNM individuals
and their relationships were also commonly reported, as was
judgmental language. Unsolicited, unwanted advice regarding
participantsrelationship choices and partners were also repeat-
edly discussed:
Gree (single, white, cisgender, heterosexual, grey/asexual
polyamorous man): I go to see my regular doctor, and theyre
like, Well maybe if you came up with a more stableenvi-
ronment, maybe these other symptoms [depression] can go
away.And I was like, No, these dont work like that.-
thank you for your judgment. Lets move on.
Luna (single, African American/black, cisgender, hetero-
sexual polyamorous woman): They [my providers] told me
that if I wasnt so sexually promiscuous, I wouldnt have to
spend so much money to get tested and that maybe I should
just nd a man (laughs), and stop sleeping around.
Subtheme: Stigma Reactions
In the context of these experiences of judgment, immediate
reactions of anger/frustration toward providers and fear about the
J Sex Med 2019;16:42e51
46 Vaughan et al
quality and/or condentiality of their healthcare experiences were
Mischa (married, white, cisgender, pan/omnisexual poly-
amorous woman): I think its especially frustrating when
you come in for your STI test that is part of your safer sex
practice, and you get treated like youve never heard of such
a thing as an STI, or that you dont know that there are
risks to having sex with multiple partners. Of course I know
that, like, we talk about that all the fucking time.
Duchess (married, white, cisgender, heterosexual poly-
amorous man): One of my partners who was taking care of
a patient, shes a healthcare provider. The cardiothoracic
surgeon, the guy that operates on your heart, walked out of
the room and said What a hoe.(Gasps from other par-
ticipants). Because the patient was in there with her hus-
band and her boyfriend.
Such experiences of judgment were frequently followed by
decisions to withhold sexual health information (eg, number of
current partners, status as a CNM individual) from staff in future
visits or reluctance to return to a particular provider/ofce:
Luna (single, African American/black, cisgender, hetero-
sexual polyamorous woman): He [my provider] thought he
was doing me a favor [by telling me to become monoga-
mous]. I guess he thought he was daddingme, but after
that I stopped telling my healthcare providers about my
sexual habits.
Many sought supplementary testing services at community
STI/sexual health clinics after a negative experience with another
provider. Others discussed how they created emotional distance
between themselves and providers after experiencing a stigmatizing
interaction and chose to stay with that provider for other reasons:
Jo (married, white, cisgender, bisexual polyamorous
woman): Can I kind of look at you as a medical ATM? Ill
come to you when I need a specic service, and youll spit
that out for me, and it will really be a consumable
Theme 3: Stigma-Avoidance Efforts/Seeking CNM-
Inclusive Providers
Participants discussed a variety of strategies to identify pro-
viders that might accept their CNM status and relationships,
including asking other CNM individuals for recommendations.
Others sought out public health clinics or local Planned
Parenthood ofces to satisfy their agreements within their sexual
network for frequent, broad-based testing. Prescreening of pro-
viders was also a common strategy, including searching provider/
practice websites for information that indicated open-
mindedness/comfort with sexuality, LGBTQþpeople, same-
gender relationships, and/or lack of explicitly religious
language. Others conducted prescreenings to evaluate whether a
provider and their staff was worth the risk:
Darla (single, white, cisgender, grey/asexual polyamorous
woman): Ive been calling around asking people, Well is
this doctor someone thats cool with someone thats poly-
amorous?”“Well what does that mean?”“Well ask the
doctor and nd out, and call me back before I schedule this
appointment.And theyre like, The doctorsnot
comfortable with seeing you as a patient.”“Okay, thanks,
and then I move on.
Theme 4: CNM-Inclusive Care
Specic wants and needs from healthcare providers and staff
were highly consistent across participants in all groups, centering
on the overall interpersonal approach to working with members
of the sexual minority group and the specic services/practical
needs that would allow them to effectively monitor and optimize
their own sexual health as well as the health of members of their
sexual network.
Subtheme: Open-Mindedness and Acceptance
As an overarching theme across nearly all CNM participants in
the sample was a strong desire for accepting, non-judgmental
interactions from healthcare providers and staff to establish a
trusting, collaborative relationship with their providers:
Jo (married, white, cisgender, bisexual polyamorous
woman): [If you are] asking me an open-ended question,
then I dont feel like youre prejudging already.youre
letting me tell you about my life. I think thats really
helpful. That made me feel like, Oh, hes really interested
in me. Hell listen. He wont judge.
How staff reacted to disclosures of CNM was also seen as an
indicator of open-mindedness and respect, incorporating tone
and non-verbal cues around discussion of partners/relationship
status, sexual behaviors, and related healthcare needs as well as
thoughtful choice of language:
Abigail (divorced, white, cisgender, heterosexual poly-
amorous woman): I think just an open mind [is critical].
And even if you have judgment, you have those thoughts
of, like, I could never do that,or That isnt right,or I
really dont agree with this,not letting that come out in
your actions, not letting that come out in your tone of
voice, or even the look that you give, because people pick
up on things like that. You can really shut a conversation
down, like a conversation that needs to happen.
When these needs were met, participants described experi-
ences of genuine interest, curiosity, and commitment to
expanding their own knowledge/skills about CNM relationships
from providers, even when the terms and concepts were unfa-
miliar to them:
J Sex Med 2019;16:42e51
CNM Healthcare Experiences 47
Ann (single, white, lesbian/queer transgender polyamorous
woman): I disclosed that Im poly, and she just stopped and
she was like, Okay, Im not quite sure what that means.
Can you explain it to me?And I discussed on how it went,
and she was like, Okay, alright, so Ill want to do this.Its
the fact that she paused and asked.
Darla (single, white, cisgender, asexual polyamorous
woman): The old OBGYN that I used to see, she stopped
seeing patients and started doing premi [premium] health-
care, which is great for her and her practice. She was like, I
dont really care what yall do as long as youre honest with
me about doing it, because I dont want to treat you for
something and then nd out you have something else.
Because that would totally suck.
Subtheme 5: Meeting Healthcare Needs/Requests
Participants repeatedly voiced the specic need for providers to
work with them to provide frequent, customized STI testing to
fulll agreements made within their sexual networks. Protection of
condentiality as well as easy access to sharing ofcial copies of
testing results for members of participantssexual networks was also
repeatedly mentioned as part of this inclusive approach to care:
Red (single, white, transgender pansexual woman): Actually,
I think I have a little bit different side of that. So every 6
months, I get bloodwork for other issues, but the nice part
about it is.[that] when my doctor sends my bloodwork, Im
like, Okay, I need all of this [STI tests] extra.Theyre aware
of my relationship status, and theyre like, Okay! Whatever.
Kinsey (single, white, cisgender, heterosexual polyamorous
man): Sexual health tends to be of a premium concern of
making sure, not just for myself, but for all of my partners,
not just that I am.but being able to verify and provide
that type of information and security that everything is
good with my sexual health.
Incorporating a strong desire for an open and collaborative
relationship with providers about their sexual health, participants
repeatedly requested that providers conduct a comprehensive
assessment of their actual STI risk (eg, type/frequency of sexual
behaviors, barrier use, STI status of partners) and work with
them to access affordable coverage of frequent testing and/or
relevant vaccines (eg, HPV):
Kinsey (single, white, cisgender, heterosexual polyamorous
man): Become a better advocate for me, to help assist me in
terms of Im gonna make my life choices, help me make my
health choices. So instead of saying, Well, dontbe
involved with a particular behavior,say How can we
make healthier choices within those behaviors?Since this is
going to be my lifestyle, how can we do that [prevent
transmission of infections]?
The present empirical study provides critical insight into the
impact of mononormativity and sexual stigma on the healthcare
experiences of CNM patients. Consistent with ndings from
other sexually stigmatized populations,
our CNM participants
were committed to promoting the health of their sexual health
network through a collaborative relationship with providers who
demonstrated respect and open-mindedness for their relation-
ships and sexual choices. Experiences of mononormativity and
sexual stigma from providers and staff served as major obstacles
to these goals. These experiences of minority stress produced
negative emotional and behavioral reactions in the CNM par-
ticipants that compromised their relationships with providers and
their access to sexual health services. These instances of antici-
pated and experienced stigma have been identied as predictors
of negative health outcomes in individuals with other concealable
stigmatized identities,
including LGBT-identied
and kink-
oriented patients.
These results demonstrate a critical need for training and
recommendations about CNM-inclusive practices/skills for
healthcare providers and staff. Foundational training on human
sexuality/relationships within healthcare curricula must include
CNM and relevant subgroups (eg, polyamory, open relation-
ships, swingers, relationship agreements, relationship anarchy)
and explicitly address CNM myths and other mononormative
assumptions regarding STIs, sexual behavior, safer sex practices,
and relationship dynamics. Incorporation of scientic research
refuting these myths and addressing widespread implicit bias
against CNM people/relationships is critical,
as is work
that highlights the potential strengths and benets of CNM
relevant to health and well-being.
Given that higher levels of provider knowledge and more
positive attitudes toward sexual minorities predict the likelihood
of conducting comprehensive sexual health histories in LGBT
CNM-specic education in these domains is war-
ranted. Exposure to CNM individuals during professional
training may also be highly benecial to develop a base of
scientically accurate knowledge and reduce implicit bias and
stigmatizing reactions,
while maintaining the responsibility on
providers and their supervisors (as opposed to patients) for
enhancing their education.
Promoting sexual health is a shared responsibility between
providers and patients. According to Kitts,
physicians should
routinely obtain a comprehensive sexual history from patients to
help those who identify as a sexual minority feel more
comfortable disclosing certain identities and behaviors. Recom-
mendations from both Sabin et al
and Zestcott et al
more education on sexual minorities and their specic health
concerns in clinical training programs to reduce the likelihood of
implicit biases. Physicians also should gain greater familiarity
with members of marginalized groups through community
outreach (eg, local CNM organizations, speakers panels),
J Sex Med 2019;16:42e51
48 Vaughan et al
because personal contact has been found to foster accepting at-
titudes and diminish prejudice.
Consistent with the descriptions of inclusive and afrming
provider behaviors among those with little CNM training or
experiences, training rooted in development of cultural humility
may be particularly valuable for healthcare providers serving this
Built on mutual respect and collaboration, this
framework focuses explicitly on valuing the patientsexpertise,
acknowledging the power imbalance between provider and pa-
tient, and cultivating a commitment to lifelong self-reection
and self-critique on behalf of the provider.
Cultural humility
training has been successfully incorporated into training for
medical residents, with evidence of increased provider atten-
tiveness to patient experience and patient involvement in care.
Given that numerous studies have found a positive relationship
between collaborative, patient-centered communication (eg,
empathic physician responses, providerepatient agreement,
shared decision making), patient satisfaction with care,
health outcomes (eg, symptoms, functioning, physiological
approaches centered in cultural humility may be
particularly useful in building trust between CNM patients and
their providers and promoting relevant health outcomes.
Provider and staff commitment to inclusive language and
respect for diverse relationship structures is also essential, as is
sexual history-taking practices that promote open, honest
Consistent with the aforementioned published
recommendations from the CDC,
the National Coalition
for Sexual Health,
and others,
explicit, open-ended questions
regarding sexual behaviors, number and gender(s) of sexual
partners, and the use of risk-reduction/safer sex strategies should
be included. Because having multiple sex partners or having a
partner with multiple other partners is considered a de facto risk
factor for STIs by the CDC,
providers should work with CNM
individuals to support their commitment to frequent, broad-
based STI testing to maximize sexual health. Explicit, non-
judgmental questions regarding the sexual behaviors, safer sex
practices, and testing practices of other members of the sexual
health network may also be benecial to ensure more accurate
risk assessment.
Other CNM-inclusive healthcare practices
may include secure sharing of test results with members of the
patients sexual health network, identifying multiple emergency
contacts, and exploring needs for long-term highly effective birth
control, preexposure prophylaxis, and/or HPV vaccines
depending on the gender of their partners and specic risk factors
and needs.
This largely qualitative investigation relied on a small sample
from a single geographic area, with predominantly white,
polyamorous-identied participants. Moreover, because the
sample was drawn from a polyamory-themed social/educational
non-prot in a larger Midwestern city, these participants
experiences might not be representative of individuals practicing
types of all types of CNM (eg, swingers, those in open re-
lationships), those who are less outabout their CNM status,
those in rural settings, or those in other areas of the United
States. Signicant caution should be exercised in any attempts to
generalize these results to all CNM individuals.
Future Research
Research on providersattitudes, knowledge, training, and
experience with CNM patients and their behaviors will be
essential for documenting their ability to provide inclusive/
competent care. Foundational literature identifying possible
health disparities that may exist in CNM individuals is needed to
provide a wider context to the healthcare needs of this popula-
tion. Quasi-experimental work may be particularly useful in
investigating the degree to which providers can accurately
perceive/assess the sexual health risks of mock CNM patients
and identify predictors of CNM-inclusive providers/behaviors.
Work in this area should seek to explore healthcare experi-
ences engaged in other geographic areas, those practicing other
forms of CNM (eg, open relationships, swinging), and CNM
individuals who are members of other stigmatized groups. In
particular, it may be highly valuable to conduct qualitative in-
vestigations of the needs/experiences of CNM individuals who
are people of color, transgender, and/or of lower socioeconomic
status to understand how intersecting factors impact their
healthcare needs and experiences. Explicit use of the minority
stress model
and literature on sexual stigma and mono-
normativity may be particularly useful in this context.
CNM patients have unique healthcare needs that can be
addressed through a commitment to an open, collaborative
relationship rooted in a foundational understanding of CNM
individuals and relationships while incorporating existing
evidence-based recommendations for inclusive sexual health
assessments and services. Healthcare ofces will enhance the
education of their providers and staff by providing training that
includes information about CNM and exposure to CNM in-
dividuals. Healthcare providers and staff should commit to
using respectful, non-judgmental language while discussing
sexual behaviors, number and gender of sexual partners, and
safer sex strategies with patients.Additionally,askingopen-
ended questions provides patients with opportunities to
advocate for themselves and fosters a collaborative, open
providerepatient relationship. As scientic research on CNM
continues to rapidly expand, more patients may disclose
CNM relationships or behaviors to their healthcare providers.
Providers have a duty to educate themselvesonthispopulation
and implement evidence-based practices to better serve CNM
J Sex Med 2019;16:42e51
CNM Healthcare Experiences 49
Corresponding Author: Michelle D. Vaughan, PhD, School of
Professional Psychology, Ellis Human Development Institute,
Wright State University, 9 N Edwin C. Moses Blvd, Dayton,
OH 45402-8470. Tel: 937-775-4300; Fax: 937-775-4323;
Conicts of Interest: None to report.
Funding: None.
Category 1
(a) Conception and Design
Michelle Vaughan; Peyton Jones
(b) Acquisition of Data
Michelle Vaughan; Peyton Jones
(c) Analysis and Interpretation of Data
Michelle Vaughan; Peyton Jones
Category 2
(a) Drafting the Article
Michelle Vaughan; Peyton Jones; Adam Taylor; Jess Roush
(b) Revising It for Intellectual Content
Michelle Vaughan; Peyton Jones
Category 3
(a) Final Approval of the Completed Article
Michelle Vaughan; Peyton Jones
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CNM Healthcare Experiences 51
... The sources included in this scoping review referenced sexual health needs and services widely across region and non-monogamies. This data suggests a tremendous need for frequent and adaptable STI testing, treatment, and contact tracing services, which better center group risk reduction as opposed to individual risk-reduction approaches (Dukers-Muijrers et al., 2017;Scoats, 2017;Smith, 2017;Vaughan et al., 2019;Frank, 2019a). In particular, several sources indicate the importance of regular testing, which may exceed that commonly recommended by healthcare providers or offered by insurance coverage (Copen et al., 2019;Niekamp et al., 2021;Scoats, 2017;Smith, 2017;Tang et al., 2016;Vaughan et al., 2019). ...
... This data suggests a tremendous need for frequent and adaptable STI testing, treatment, and contact tracing services, which better center group risk reduction as opposed to individual risk-reduction approaches (Dukers-Muijrers et al., 2017;Scoats, 2017;Smith, 2017;Vaughan et al., 2019;Frank, 2019a). In particular, several sources indicate the importance of regular testing, which may exceed that commonly recommended by healthcare providers or offered by insurance coverage (Copen et al., 2019;Niekamp et al., 2021;Scoats, 2017;Smith, 2017;Tang et al., 2016;Vaughan et al., 2019). For example, while HIV and HSV (herpes simplex virus) tests were in particularly high demand, several qualitative studies noted difficulties non-monogamous patients faced in persuading healthcare providers to perform these tests (Smith, 2017;Vaughan et al., 2019). ...
... In particular, several sources indicate the importance of regular testing, which may exceed that commonly recommended by healthcare providers or offered by insurance coverage (Copen et al., 2019;Niekamp et al., 2021;Scoats, 2017;Smith, 2017;Tang et al., 2016;Vaughan et al., 2019). For example, while HIV and HSV (herpes simplex virus) tests were in particularly high demand, several qualitative studies noted difficulties non-monogamous patients faced in persuading healthcare providers to perform these tests (Smith, 2017;Vaughan et al., 2019). Ultimately, this scoping review finds that testing services ought be paired with contextually tailored counseling, which should to support a range of non-monogamy-friendly biomedical, behavioral, and communication-based sexual health strategies (Brady et al., 2013;Grov et al., 2013;Mmanyi Mtenga et al., 2016;O'Byrne & Haines, 2021). ...
Full-text available
Background: Recent years have seen a wave of critical thought applied to intimacy studies, particularly in the realm of relational numeracy. Such research critiques mononormativity— the viewpoint that monogamy is the only valid and acceptable form of relating—across a range of academic disciplines. In global health, this critique primarily problematizes the “multiple concurrent partnership” (MCP) paradigm, which has positioned non-monogamy as the site of health intervention. New research calls for more nuanced considerations of non/monogamies in global health. Objectives: This scoping review aims to provide an overview of emerging non-monogamies research in global health by mapping key concepts, highlighting limitations, and tracking future directions. Using critical discourse analysis and reflexivity, the scoping review methodology is made polyqueer, thereby attempting to confront systematic power dynamics within the academy. Methods: Three databases were searched for studies linking non-monogamies to human health and wellbeing. Eligible sources included peer-reviewed and gray scientific literature published in English, starting in 2012. A single reviewer charted data from N=158 sources, with assistance from a secondary reviewer when necessary. Researcher reflexivity was employed to analyze systematic power dynamics and improve transparency in the research process. Results: Quantitative trends point to a recent significant increase in health-related non/monogamies publications, indicating growing recognition of the role of relational numeracy on health. These results also revealed several gaps, including a lack of information on trans+ folks, women who have sex with women, and the role of race and ethnicity on health within non/monogamies. Using critical discourse analysis, four qualitative themes emerged: sexual health, reproductive health, mental health, and stigma and discrimination. These themes were particularly salient in terms of accessibility and acceptability of clinical care, highlighting a need for non-monogamy affirming health and wellness options. Conclusions: This scoping review adds to an emergent discussion regarding the role of intimate relationships on health. The findings suggest that non/monogamies have a distinct impact on individual and community level systems of health, which often require different solutions than those imagined through the heuristics of hegemonic monogamy. Moving forward, intimate relationship dynamics—non/monogamies in particular—should be considered more thoroughly when designing global health research and interventions. Since such considerations will necessarily result in an upheaval of the foundations of the global health field, this research eventually calls for a decolonization and queerification of the academy. Key words: polygamy, consensual non-monogamy, group sex, scoping review, mental health, sexual health, reproductive health, stigma, clinical care
... A central component of STD stigma is stigma about promiscuity, likely fueled in part by these same monogamy directives. Within the past decade, researchers have unearthed a strong bias against non-monogamy-that is, non-monogamous people are perceived negatively on a variety of dimensions: people judge them more poorly globally, they are thought to have weaker relationships (e.g., Balzarini et al., 2018;Conley et al., 2013;Hutzler et al., 2015;Moors et al., 2013;Rodrigues et al., 2018;Vaughan et al., 2019;Vil et al., 2022), and they are even perceived more negatively on traits completely irrelevant to their monogamy status-such as being responsible about daily dog-walking . These negative judgments are often driven by the stigma surrounding STDs themselves. ...
... We also find evidence that the stigma of non-monogamy (Rodrigues et al., 2018;Vaughan et al., 2019) colors people's perceptions of individuals' characteristics from a public health perspective, such as how responsible, safe, and intelligent they consider the individuals. In other words, people erroneously used James' numerical monogamy as an indicator of his COVID risk. ...
... Although the cooperation of two people is required for monogamy, physicians typically counsel patients individually and many practices in medical establishments regularly assume that patients who report being married or in a long-term, committed relationship do not need to be screened for STDs (Treas & Giesen, 2000). Thus, even healthcare providers themselves appear to misunderstand health messages surrounding monogamy (Fischhoff et al., 2011;Vaughan et al., 2019;Warren et al., 2012). We see this misunderstanding of how effective monogamy is at protecting against STDs as a parallel to the misunderstandings we observed of how effective it is to use close relationships as criteria for protecting against COVID-19. ...
Full-text available
COVID‐19 public health messages largely communicated that Americans were “safer at home.” Implicit in this advice are messages about protections ostensibly also offered by monogamy–that having more relationships is always more dangerous than having fewer relationships and that closer relationships are always safer–from a disease transmission perspective–than unfamiliar relationships. These heuristics may have led people to discount other COVID‐19 dangers (such as spending more time with others of unknown infection status) and to ignore COVID‐specific safety measures (such as mask‐wearing, and ventilation). We conducted three studies in which we used experimental vignettes to assess people's perceptions of COVID‐risky targets in monogamous relationships with a close, committed partner versus targets who were described as non‐monogamous with casual partners but relatively COVID‐safe. Participants perceived monogamous‐but‐COVID‐riskier targets as more responsible and safer from COVID‐19. Non‐monogamy stigma seems to extend analogously to COVID‐19 risk. Public health messages that fail to attend to the specifics and nuances of close relationships risk contributing to this stigma and ultimately undermining the goals of reducing the spread of infectious disease.
... CNM-affirmative counselling is a relatively new field, and many counsellors may feel unprepared for working with this population. CNM individuals frequently report experiences of stigma when interacting with the healthcare system and consequentially may avoid seeking medical or mental health care (Vaughan et al., 2019). In one case study, a woman with worsening depression and recent engagement in self-harm chose to discontinue treatment because her psychiatrist blamed all of her issues on polyamory, and stated that her only local social supports were members of the polyamorous community (Graham, 2014). ...
... The prevalence of responses mentioning experiences of discrimination and stigma, and a desire for support navigating the "coming out" process align with the minority stress effects described and considered by past research (e.g., Borgogna et al., 2021;Schechinger et al., 2018;Vaughan et al., 2019;Witherspoon & Theodore, 2021). Feeling pressure to conceal something important about one's identity is distressing (Meyer, 2003), and clinicians should be aware of both distal stressors (e.g., anti-CNM legislation) and proximal stressors (e.g., internalized CNM negativity) when working with marginalized populations. ...
Full-text available
This study used a mixed methods design to explore characteristics associated with attitudes towards counselling, and perceived priorities for therapists, among consensually non-monogamous (CNM) adults. Data were collected via an anonymous online survey from an international sample of 318 adults currently or previously interested or engaged in CNM. There were small to medium significant and positive correlations between accepting attitudes of CNM and both attitudes towards seeking counselling (ρ = .19, p = .003) and self-reported likelihood to seek relationship/partners/couples therapy for CNM-related concerns (ρ = .12, p = .029). There were no significant correlations between accepting attitudes of CNM and self-reported likelihood to seek individual therapy (ρ = .09, p = .114) or family therapy (ρ = .04, p = .514) for CNM-related concerns. Reflexive thematic analysis suggested (a) it is helpful for therapists to be non-judgmental, non-directive, and familiar with CNM; (b) it is unhelpful for therapists to pathologize CNM, be dismissive, or make assumptions; (c) it is important to consider attachment theory, how each relationship is unique, other types of diversities, and access to CNM-affirmative therapy; and (d) possible reasons for seeking therapy include concerns not related to CNM, discrimination and stigma, changes in relationships, communication issues, and issues regarding relationship quality. The results were integrated to assess convergence, and discussed. The results are formatted into two manuscripts: an empirical article and a summary of implications. There are numerous practical steps therapists can take to better support CNM clients, and reduce barriers they face when seeking counselling.
... Much like other groups that are dehumanized, CNM people are also at risk of negative psychological, physical, and social outcomes. For example, the experience of stigma may affect whether CNM people disclose their identity to close others (Valadez et al., 2020), trust the healthcare system to address their specific health needs (e.g., increased sexual health screening; Vaughan et al., 2019), or maintain their therapeutic relationships after seeking psychological help (Schechinger et al., 2018). Stigma may thereby shape whether or how someone engages in CNM. ...
Full-text available
Evolutionary social science is having a renaissance. This volume showcases the empirical and theoretical advancements produced by the evolutionary study of romantic relationships. The editors assembled an international collection of contributors to trace how evolved psychological mechanisms shape strategic computation and behavior across the life span of a romantic partnership. Each chapter provides an overview of historic and contemporary research on the psychological mechanisms and processes underlying the initiation, maintenance, and dissolution of romantic relationships. Contributors discuss popular and cutting-edge methods for data analysis and theory development, critically analyze the state of evolutionary relationship science, and provide discerning recommendations for future research. The handbook integrates a broad range of topics (e.g., partner preference and selection, competition and conflict, jealousy and mate guarding, parenting, partner loss and divorce, and post-relationship affiliation) that are discussed alongside major sources of strategic variation in mating behavior, such as sex and gender diversity, developmental life history, neuroendocrine processes, technological advancement, and culture. Its content promises to enrich students’ and established researchers’ views on the current state of the discipline and should challenge a diverse cross-section of relationship scholars and clinicians to incorporate evolutionary theorizing into their professional work.
... In terms of physical health, intimate relationship status becomes particularly important when accessing reproductive healthcare. For example, when accessing pregnancy care [46] or sexual health services [47,48]. ...
Full-text available
Recent years have seen considerable interest in consensual non-monogamy from both public and academic perspectives. At least 5% of the North American population is currently in a consensually non-monogamous relationship of some form and there is little difference in measures of relationship quality compared to monogamous relationships. Despite increasing levels of understanding and engagement many practitioners of consensual non-monogamy still experience stigma (and minority stress) which is exacerbated by context (e.g. parenting, healthcare settings), type of consensual non-monogamy (e.g. polyamory vs swinging) and intersects with other identities (e.g. race, sexuality). This review outlines what is currently understood about consensual non-monogamy and argues that relationship diversity has a place alongside gender and sexuality when studying sexual behaviours, romantic relationships, and well-being.
... Recent estimates suggest that approximately 4-5% of US Americans are currently involved in consensually non-monogamous (CNM) relationships (Levine et al., 2018; i.e., relationships with explicit agreements that allow for extradyadic intimate involvements), and around 20% of single US Americans have been involved in CNM relationships at some point in their lifetime (Haupert et al., 2017). Substantial prior research has documented the stigmatization and discrimination faced by individuals in CNM relationships (e.g., Hutzler et al., 2016;Moors et al., 2013;Scheshinger et al. 2018;Vaughan et al., 2019), and we know that these experiences can undermine both psychological and physical health (see Major & O'Brien, 2005, for a review). Yet we know little about individual differences in prejudicial attitudes toward relationships that exist outside of the norms of monogamy. ...
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Personality variables, including sensation-seeking, interpersonal trust, avoidance of uncertainty, endorsement of social conformity, and love styles (Ludus, Eros, Pragma, Storge, Mania, and Agape), were examined as predictors of prejudicial attitudes toward individuals who practice polyamory and personal interest in engaging in consensual non-monogamy (CNM) among 1831 participants who completed anonymous surveys online. Personality characteristics were also compared between individuals who currently practice CNM (n = 67) and case-matched controls involved in monogamous relationships. As predicted, prejudicial attitudes and willingness to engage in CNM were positively and moderately correlated and there was substantial overlap in the predictors of both variables. However, the strongest predictors differed: prejudicial attitudes were best predicted, in a positive direction, by endorsement of social conformity and, to a lesser extent, Pragma love style, while willingness to engage in CNM was best predicted by the Ludus (positive) and Eros (negative) love styles. Individuals who practice monogamy and CNM were more similar than different: only two of the 12 variables tested significantly differed. CNM individuals are more ludic and more tolerant of cognitive uncertainty. Difficulty interpreting some of the results laid bare the need for relationship measures that are valid for individuals who practice CNM. Improving our understanding of the relation between personality traits and CNM may help us develop better interventions for clients who seek to transition from monogamy to CNM but struggle to adapt to the new challenges as well as design better efforts to increase acceptance and reduce discrimination against those who practice CNM.
... In sharp contrast with this empirical evidence, CNM individuals are heavily stigmatized, not only by others but also in the eyes of experts (Grunt-Mejer & Chańska, 2020) and by society in general (Vaughan et al., 2019). For example, CNM individuals are perceived to have lower cognitive abilities, to be untrustworthy and unreliable, to have lower relationship quality, and to be more unfaithful Grunt-Mejer & Campbell, 2016;Hutzler et al., 2016;Mitchell et al., 2020;Moors et al., 2013). ...
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Studies have shown that romantic partners in consensual non-monogamous (CNM) relationships are targets of stigmatization. However, little is known about the underlying mechanisms and the conditions under which such stigmatization occurs. In two experimental studies (combined N = 772), we asked participants to read the description of two partners in a relationship (monogamous vs. open relationship vs. polyamorous) and make a series of judgments about those partners. Overall results showed that CNM (vs. monogamous) partners were perceived as less trustworthy and as having more sexual health concerns (Studies 1 and 2), and as being less committed and less sexually satisfied (Study 2). Results from a conditional mediation analysis (Study 2) further showed that participants with negative attitudes toward consensual non-monogamy perceived CNM (vs. monogamous) partners as having less conservation and more openness to change values, which was then associated with more stigmatization. In contrast, participants with positive attitudes toward consensual non-monogamy perceived CNM (vs. monogamous) partners as having more openness to change values, which was then associated with less stigmatization. Taken together, these results extended the literature focused on prejudice, discrimination, and stigmatization of minority groups and highlighted key elements that can be used to buffer stigmatization.
Consensually non-monogamous (CNM) romantic and sexual relationships tend to be stigmatized. The present research examined this stigma across two studies. First, we qualitatively explored the specific ways that people in CNM relationships report experiencing stigma using thematic analysis and identified the following four themes: Expressions of discomfort/disapproval of CNM, Loss of resources/threatening behaviors, Character devaluation, and Relationship devaluation (Study 1; N = 372). Second, we examined the relationship between experienced stigma and psychological well-being for people in CNM relationships, using the framework of minority stress theory. We found that experienced stigma was positively associated with psychological distress and that this association was partially statistically mediated by anticipated stigma and internalized stigma (Study 2; N = 383). Overall, this research strives to achieve a better understanding of the processes and potential consequences of stigma toward CNM relationships and individuals.
Polyamory and other forms of consensual non-monogamy (CNM) represent a limited yet increasingly common approach to intimate relationships. This article opens with definitions and estimated prevalence of CNM. It summarizes recent research on attitudes toward polyamory among both mental health clinicians and the public, including how these attitudes impact polyamorous people. The article includes recommendations for counselors that are grounded in the principles of Relational-Cultural Therapy: increasing knowledge of polyamory, examining personal bias, practicing affirmatively, and avoiding inappropriate focus on clients’ relationship styles. The article concludes with a call for further research and development of competencies for counseling polyamorous clients.
Consensual non-monogamy (CNM ) is an umbrella term for sexual, romantic, and/or intimate relationships involving more than two people, in which the non-monogamous aspect of these relationships is consented to by all people involved. Public awareness and incidence of CNM is growing, and there are many opportunities for research in this domain. This chapter addresses developmental factors in CNM relationships with a focus on swinging, polyamory, open relationships, and multipartner sex. There is very limited research on developmental components of CNM relationships, so we use existing relationship development theories to discuss where CNM may fit (or not) into the existing models. We also review the existing research on parenting and being raised in CNM families, specifically in polyamorous families. CNM relationships are commonly stigmatized and participating in these stigmatized relationship styles carries with it the risks associated with minority stress, but CNM relationships can also be a source of resilience. Recommendations are made for how to move research on the developmental aspects of CNM relationships forward.KeywordsConsensual non-monogamy Polyamory Swinging Non-monogamy Relationships Adult attachment Human sexuality
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Polyamory is a type of consensual non-monogamy (CNM) in which participants engage in multiple simultaneous romantic and often sexual relationships with the knowledge and consent of all involved. CNM practitioners in general, and polyamorous people in specific, appear to be highly stigmatized due to their relational practices, and to frequently encounter CNM-related discrimination, harassment, and violence (DHV). Conceptualizing this dynamic via minority stress theory predicts that this stigma and DHV will lead to negative mental health outcomes for polyamorous individuals. However, recent research has begun to identify possible sources of resilience and strength within polyamorous populations, which may ameliorate these negative effects, as well as enhance satisfaction with CNM and quality of life. This study investigated these hypotheses in a sample of 1,176 polyamorous American adults utilizing structural equation modeling (SEM). Two structural models were proposed and tested, one for polyamorous resilience and one for polyamorous strengths. Four constructs were assessed as potential resilience and strength factors: mindfulness, cognitive flexibility, a positive CNM identity, and connection to a supportive CNM community. Results indicate that CNM-related minority stress was positively related to increased psychological distress, such as higher self-reported depression and anxiety symptoms. Mindfulness was found to have both direct and moderating effects on the relationship between minority stress and psychological distress, such that higher mindfulness attenuated the negative impact of minority stress. Cognitive flexibility also displayed direct and moderating effects, but in the opposite than predicted direction. Regarding polyamorous strengths, mindfulness was found to positively impact overall satisfaction with CNM as well as life satisfaction. In addition, greater connection to a supportive CNM community correlated with having a more positive sense of CNM identity, which in turn was related to higher satisfaction with CNM. Overall satisfaction with CNM was related to greater life satisfaction. Clinical and research implications of these findings are discussed, with an emphasis on improving cultural competence for clinicians working with this unique and under-served population.
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The purpose of this study was to explore prevalent health issues, perceived barriers to seeking healthcare, and utilization of healthcare among lesbian, gay, bisexual and transgender (LGBT) populations in New Jersey. A cross-sectional online survey was administered to 438 self-identified LGBT people. Results identified health needs which included management of chronic diseases, preventive care for risky behaviors, mental health issues and issues related to interpersonal violence. Barriers to seeking healthcare included scarceness of health professionals competent in LGBT health, inadequate health insurance coverage and lack of personal finances, and widely dispersed LGBT inclusive practices making transportation difficult. There is a need for better preparation of healthcare professionals who care for LGBT patients, to strengthen social services to improve access and for better integration of medical and social services.
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Introduction: The term kink describes sexual behaviors and identities encompassing bondage, discipline, domination and submission, and sadism and masochism (collectively known as BDSM) and sexual fetishism. Individuals who engage in kink could be at risk for health complications because of their sexual behaviors, and they could be vulnerable to stigma in the health care setting. However, although previous research has addressed experiences in mental health care, very little research has detailed the medical care experiences of kink-oriented patients. Aim: To broadly explore the health care experiences of kink-oriented patients using a community-engaged research approach. Methods: As part of the Kink Health Project, we gathered qualitative data from 115 kink-oriented San Francisco area residents using focus groups and interviews. Interview questions were generated in collaboration with a community advisory board. Data were analyzed using a thematic analysis approach. Main outcome measures: Themes relating to kink-oriented patients' experience with health and healthcare. Results: Major themes included (i) kink and physical health, (ii) sociocultural aspects of kink orientation, (iii) the role of stigma in shaping health care interactions, (iv) coming out to health care providers, and (v) working toward a vision of kink-aware medical care. The study found that kink-oriented patients have genuine health care needs relating to their kink behaviors and social context. Most patients would prefer to be out to their health care providers so they can receive individualized care. However, fewer than half were out to their current provider, with anticipated stigma being the most common reason for avoiding disclosure. Patients are often concerned that clinicians will confuse their behaviors with intimate partner violence and they emphasized the consensual nature of their kink interactions. Conclusion: Like other sexual minorities, kink-oriented patients have a desire to engage with their health care providers in meaningful discussions about their health risks, their identities, and their communities without fear of being judged. Additional research is needed to explore the experiences of kink-oriented patients in other areas of the country and internationally.
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Recent evidence suggests that one possible cause of disparities in health outcomes for stigmatized groups is the implicit biases held by health care providers. In response, several health care organizations have called for, and developed, new training in implicit bias for their providers. This review examines current evidence on the role that provider implicit bias may play in health disparities, and whether training in implicit bias can effectively reduce the biases that providers exhibit. Directions for future research on the presence and consequences of provider implicit bias, and best practices for training to reduce such bias, will be discussed.
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In this article the author reviews research evidence on the prevalence of mental disorders in lesbians, gay men, and bisexuals (LGBs) and shows, using meta-analyses, that LGBs have a higher prevalence of mental disorders than heterosexuals. The author offers a conceptual framework for understanding this excess in prevalence of disorder in terms of minority stress— explaining that stigma, prejudice, and discrimination create a hostile and stressful social environment that causes mental health problems. The model describes stress processes, including the experience of prejudice events, expectations of rejection, hiding and concealing, internalized homophobia, and ameliorative coping processes. This conceptual framework is the basis for the review of research evidence, suggestions for future research directions, and exploration of public policy implications.
We proposed that the premise that monogamy is the exemplary form of romantic partnership underlies much theory and research on relationship quality, and we addressed how this bias has prompted methodological issues that make it difficult to effectively address the quality of nonmonogamous relationships. Because the idea that consensually nonmonogamous (CNM) relationships are functional (i.e., satisfying and of high quality) is controversial, we included a basic study to assess, in a variety of ways, the quality of these relationships. In that study, we found few differences in relationship functioning between individuals engaged in monogamy and those in CNM relationships. We then considered how existing theories could help researchers to understand CNM relationships and how CNM relationships could shed light on relationship processes, and we proposed a model of how CNM and monogamous relationships differ. Finally, in a second study, we determined that even researchers who present data about CNM are affected by the stigma surrounding such relationships. That is, researchers presenting findings favoring polyamory were perceived as more biased than researchers presenting findings favoring monogamy.
This study provides a content analysis of peer-reviewed journal articles about consensual nonmonogamy (CNM) from a social scientific lens published from 1926 through 2016, excluding articles specific to polygamy or other faith-based relational practices. The content analysis yielded 116 articles, with most of the articles being nonempirical research (n = 74) rather than empirical studies (n = 42). Although the number of published articles about CNM has increased significantly in recent decades (n = 26 from 1926 to 2000 compared with n = 90 from 2001 to 2016), the topics discussed in CNM literature were narrow in scope and focused on (a) relationship styles, (b) CNM stigma, and/or (c) LGBTQ issues. Content analysis data showed that the vast majority of articles were published in journals about sexuality, suggesting that CNM remains an underexamined topic in psychological science. Additionally, only a handful of the total articles centered on topics related to family concerns (n = 5) or training and counseling (n = 2). Findings from this content analysis suggest that individuals and families who practice CNM are an underserved and understudied group that would benefit from advancements in psychological scholarship specific to their experiences.
Although academic and popular interest in consensual non-monogamy (CNM) is increasing, little is known about the prevalence of CNM. Using two separate nationally representative samples of single adults in the U.S. (Study 1: n = 3905; Study 2: n = 4813), the present studies find that more than one in five (21.9% in Study 1; 21.2% in Study 2) participants report engaging in CNM at some point in their lifetime. This proportion remained constant across age, education level, income, religion, region, political affiliation, and race, but varied with gender and sexual orientation. Specifically, men (compared to women) and people who identify as gay, lesbian, or bisexual (compared to those who identify as heterosexual) were more likely to report previous engagement in CNM. These findings suggest that a sizable and diverse proportion of U.S. adults have experienced CNM, highlighting the need to incorporate CNM into theoretical and empirical therapy and family science work.