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Sexuality research has increasingly begun to include gender-diverse people, but a new review suggests that studies still fall short when it comes to representing the experiences of non-binary individuals. Published in the journal Archives of Sexual Behavior, the review examined twelve years of research on sexuality, sexual health, and relationship satisfaction among non-binary people. It found that while non-binary individuals are often grouped with other gender minority populations in studies, their distinct experiences are rarely examined in detail.
Non-binary is an umbrella term used by individuals whose gender identity does not align with the traditional categories of man or woman. Some people may see their gender as fluid, others may not identify with any gender at all. These identities are not new. Across different cultures and historical periods, gender diversity has existed, though the language and recognition of it has varied.
Despite increased visibility in recent years, non-binary individuals remain underrepresented in psychological and health research. When included, they are often analyzed together with binary transgender people, a practice that risks erasing differences between these groups.
“Historically, research has had paid little attention to people that do not fit into the traditional man-woman gender binary. I would argue that this lack of recognition has had real world consequences on non-binary individuals, slowing down societal understanding and leaving important needs unaddressed,” explained study author Fraedan Mastrantonio, a PhD candidate in Health Psychology at the University of Southampton.
“In recent years, more studies have started to include non-binary participants, which is an encouraging step. However, I felt like there was a need to look at the available research and clarify what we actually know about non-binary people’s sexuality and sexual health, and what we are still missing.”
“I also wanted to look at how existing studies were asking their questions. If research tools are not inclusive, if they don’t allow non-binary participants to describe their experiences authentically, we won’t be able to correctly amplify non-binary voices.”
The review looked at quantitative studies published between 2012 and 2024 in English or Italian. A total of 44 articles were selected for analysis, all of which included non-binary participants. The researchers screened more than 26,000 papers across major scientific databases. Most of the included studies were conducted in Western countries, often using online surveys and convenience samples. Despite the growing number of studies that include non-binary individuals, many of them did not report detailed demographic data for this group. Most did not analyze results for non-binary participants separately from binary transgender participants.
“I was actually pleasantly surprised by how many studies I found,” Mastrantonio told PsyPost. “I had expected far fewer papers including non-binary participants. While the research isn’t always perfect (no research ever is!), it was encouraging to see that many scholars are recognizing the importance of including non-binary voices and perspectives. It shows that the field is moving in the right direction.”
One of the central findings was that non-binary people often report sexual identities that fall outside traditional categories. Labels like queer and pansexual were commonly used, suggesting that many non-binary people see their sexual orientation as flexible and not tied to the binary concept of gender. A number of studies found that non-binary individuals were more likely to report attraction to people of multiple genders, including other non-binary individuals.
When it came to sexual and romantic relationships, non-binary participants appeared to experience levels of satisfaction similar to binary transgender individuals. Several studies found that non-binary people were more likely to be in non-monogamous relationships or to report attraction to a wide range of partners. In some samples, non-binary people were also more likely to be sexually active in the past year and to have had sexual partners of more than three different genders in recent years.
However, the researchers found that the way sexuality was measured often did not reflect this diversity. Many studies asked about attraction or behavior in terms that only included men and women. Some used scales that were originally developed for cisgender populations, which may not be appropriate for people with gender experiences that fall outside the binary. A few studies attempted to adjust the language of their surveys, but this was the exception rather than the rule.
The review also noted that measures of sexual satisfaction and relationship quality tended to use gendered language or assume heterosexual experiences. Despite this, the studies that did assess sexual satisfaction generally found no significant differences between non-binary and binary transgender participants.
Only a small number of studies examined issues like sexual assertiveness, consent, fantasies, or sexual function. Among the few that did, some suggested that non-binary participants reported lower arousal to certain types of fantasies and were more likely to emphasize consent. A few studies looked at how body image or sexual self-esteem played a role in sexual well-being, finding that non-binary people reported unique challenges that were not always captured by existing measures.
The review also pointed to disparities in access to gender-affirming care. Non-binary individuals were less likely than binary transgender individuals to receive or seek medical interventions such as hormone therapy or surgery. Some reported being denied access to gender-affirming services altogether. These findings reflect ongoing issues in healthcare systems that may not recognize or validate non-binary identities.
A small number of studies examined experiences in sexual healthcare. These studies indicated that non-binary people were more likely to report discrimination or discomfort in medical settings, particularly in hospitals. Some sought out community-based healthcare providers instead, which were viewed as more inclusive.
The review also identified that while many studies allowed participants to self-identify their gender, they often grouped all non-binary labels together. In several cases, participants who selected “other” were asked to describe their gender identity in a text box. Even when more expansive options were offered, researchers often merged them into a single non-binary category for analysis, limiting the ability to examine variation within this group.
“We need to recognize that non-binary people are not monolith or a completely uniform group,” Mastrantonio said. “They have complex identities that need to be accounted for within research. Many studies failed to include basic demographic details for non-binary participants, making it hard to understand how factors like age, race, disability or socioeconomic background might shape sexuality and sexual health outcomes and experiences.”
“We need to make an effort to better represent non-binary individuals from minoritized ethnic/racial backgrounds, non-binary people that are disabled or neurodivergent, non-binary people that are of older age or from lower socio-economical background within our research.”
“Additionally, there still work to do to improve representation within research,” Mastrantonio continued. “That means asking more expansive questions as well as ensuring that enough non-binary people are included in studies, so that non-binary people’s experience can be meaningfully understood.”
“The good news is that sex research, is moving forward and making space for non-binary people. However, sexual wellbeing is still under-researched in this population, and a more clear focus on this aspect could shift the conversation from risk, stigma and negative sexual experiences towards pleasure, satisfaction and community.”
The current review focused exclusively on Western contexts, which means the findings may not apply to non-binary individuals in other parts of the world where gender diversity is understood differently.
“For this review, I chose to focus on studies based in Western contexts, reflecting Western understandings of what it means to be non-binary,” Mastrantonio said. “I made that decision to avoid misinterpreting or oversimplifying non-Western gender identities, which may have very different cultural meanings. As a result, the findings don’t capture non-binary experiences outside Western societies, and that’s an important limitation to keep in mind.”
The researchers suggest that future work should focus on developing better survey tools and adopting language that is inclusive of all gender identities. More studies should aim to recruit larger numbers of non-binary participants and analyze their experiences separately from other gender minority groups. Importantly, future research should explore topics beyond risk and discrimination. There is also a need to better understand how non-binary people form and maintain intimate relationships and how community support and acceptance shape their sexual experiences.
“I would like to see research continuing to move towards the de-medicalization of trans and non-binary identities, shifting towards more holistic approaches to sexuality, with greater attention on sexual wellbeing, pleasure, satisfaction,” Mastrantonio told PsyPost. “I would also like to see research that looks at intimate and romantic partnerships and the impact of community acceptance and solidarity on sexual outcomes. I am also interested in seeing more studies that explore how intersecting minoritized identities shape non-binary people’s experiences when in comes to sexual wellbeing and health. Understanding this is essential for quantitative literature to reflect more diversity and the complexity of non-binary people’s lived experiences.”
“In many countries, the socio-political climate is becoming overall less accepting of non-binary and trans identities, and resources for this kind of research are increasingly limited. As a non-binary person myself, I also see the barriers that trans and non-binary researchers themselves continue to face within and outside academia. Even so, doing this review reminded me how many researchers (trans/non-binary researchers as well as allies) are committed to trying making a difference and to representing gender-diverse experiences within their work. That makes me happy and gives me hope for the future of the field.”
The study, “Non-Binary People’s Sexuality, Sexual Health, and Relationship Satisfaction: A Review of 12 Years of Quantitative Research (2012–2024),” was authored by Fraedan Mastrantonio, Hanna Kovshoff, and Heather Armstrong.
