Exploring the sexual risk-taking practices of bi+ femmes: a two-wave qualitative study

Bi+ femmes are individuals who identify as women or femmes and are attracted to more than one gender. Despite evidence that bisexual women face higher risks of unintended pregnancy, STIs, sexual violence, and mental health challenges, they are underrepresented in sexual health research.  Little is known about how partner gender, relationship context, and partner-meeting venues shape their sexual risk-taking.

We conducted a two-wave qualitative study with 15 bi+ femme participants aged 18-35 years. Participants completed a sexual agency scale and two in-depth interviews, 1 month apart, using the timeline follow-back method to document recent sexual experiences. Data were analyzed using framework analysis.

Participants demonstrated high sexual agency (M = 127.9/150) but described variability in practice. Three themes emerged: (1) 'Varied approaches to risk assessment by partner gender identity' where participants reported fewer protective behaviors and greater trust with women and non-cis male partners, while past trauma with men shaped cautious engagement with male partners; (2) 'Varied approaches to risk assessment by partner relationship' where protection was more common with casual partners and less consistent in long-term relationships; and (3) 'Evolving sexual risk awareness and intentionality' where participants described greater intentionality, communication, and boundary-setting over the course of the study. Participants did not describe that meeting venues (online vs offline) impacted risk behaviors.

Findings underscore bi+ femme-specific patterns of sexual risk assessment, highlighting the need for more inclusive sexual health research and interventions.