Using a sperm donor: what you need to know

Around 1,300 babies are born each year in the UK from donated sperm. Here’s what you need to know if you’re thinking about starting a family with the help of a sperm donor.

Donor sperm can be used to help couples and individuals become parents, regardless of whether you are heterosexual, lesbian, gay, single, married, divorced or co-habiting.

But making the decision to use donated sperm can be difficult and there are many issues to consider.

How to find donor sperm

There are three main routes:

• You can use sperm from an anonymous donor by going to a fertility clinic. These clinics have their own stock of frozen donated sperm, or they buy it in from a sperm bank.
• You can use a donor you already know, say a friend or a donor you have met through an introduction website. You and the donor can together go to a fertility clinic, or you can have a private arrangement whereby the donor provides a fresh sperm sample directly to you, often in your home.
• You can go abroad for treatment with donor sperm.

How to use donor sperm

Donor sperm is usually used to help a woman become pregnant via donor insemination. It’s a straightforward procedure where a fine tube or syringe with the donor sperm inside is inserted into the vagina, cervix or uterus during the woman’s fertile time of the month. It can also be used as part of IVF if necessary.

Read more about artificial insemination.

Read more about IVF.

Going to a fertility clinic

There is a network of fertility clinics, both NHS and private, across the UK, which are licensed by the Human Fertilisation and Embryology Association (HFEA).

Fertility clinic sperm checks

HFEA-licensed clinics and sperm banks have to conform to strict regulations to ensure the donor sperm they supply is free from infections, such as chlamydia and HIV, and certain genetic disorders. They also have support and legal advice on hand.

If you use a licensed clinic, you won’t know the identity of the sperm donor but you will be able to find out information such as his ethnic group, personal characteristics and so on. Your child will also be able to access this non-identifying information about the donor when they reach 16.

In addition, your child will be able to get information the donor provided (name, last-known address and so on) when they reach 18 years old. This applies if the treatment took place after April 1 2005. Before then, sperm donors were anonymous.

Read the HFEA's information on how grown-up children can get information on their sperm donor.

Fertility clinics, donor sperm and your legal rights

If you use donated sperm from a licensed clinic, you can be reassured that the donor will not:

• be the legal parent of your child
• have any legal obligation to the child
• be named on the birth certificate
• have any rights over how the child will be brought up
• be required to support the child financially

You will have parental responsibility and, if you are married or in a civil partnership, your spouse will automatically be the child’s second legal parent (unless it can be shown that he or she did not consent to treatment).

If you are in a relationship, your partner will be the second legal parent if you both sign the relevant consent form available from your clinic.

Finding a fertility clinic

The waiting lists for donor sperm vary from clinic to clinic, so check waiting times with a number of them before choosing where to have your treatment.

If you're hoping to have fertility treatment on the NHS you will need a referral from your GP. To get a referral you’ll need to meet certain criteria. Ask your GP for further information about this.

Use the HFEA’s choose a fertility clinic search function to locate a fertility clinic near you.

Sperm donation by private arrangement

Using donor sperm from someone you already know, or who you have met via an introduction agency with a private arrangement, can be good for some people (for instance if you want ongoing contact with the donor during the child’s life) but it’s unregulated and potentially risky.

You won’t have the legal and medical protections that a licensed clinic can give you and you can’t be sure the donor has been screened and checked. You may, therefore, decide to go to the clinic together so that you have the necessary legal and medical protections.

If not, and you decide to go through with a private arrangement outside of a fertility clinic, you will always be the child’s mother. However, the law on who will be the child’s other parent is murkier. It’s possible that the sperm donor will be the legal father of your child, depending on:

• whether you are single, married or in a civil partnership
• whether the insemination took place through artificial insemination or sexual intercourse
• who is named on the birth certificate
• whether the donor will have established a relationship with the child

Going abroad for donor sperm

Going overseas for treatment with donated sperm may seem an attractive option if it’s cheaper or the waiting list is shorter.

Remember, though, that different safety and legal rules may apply with foreign clinics. If you go to a UK licensed fertility clinic, the donor has no legal responsibility or rights over the child. This is not necessarily the case if you have treatment abroad.

Always do your research before going ahead with treatment abroad, specifically to find out about:

• the clinic’s standards and safety issues
• legal issues surrounding sperm donors and parental responsibility
• the process the foreign clinic uses to recruit and screen sperm donors
• whether there are any limits on the number of families that can be created per donor (in the UK, it is 10 families)
• what information you can access about the sperm donor and what information your child will be able to access

The National Sperm Bank

The National Sperm Bank has opened in Birmingham to tackle the shortage of donor sperm in the UK. It is a central store of sperm for use by both private and NHS fertility clinics.

My homophobic bullying story

Comedy writer and performer, Doug Faulkner, faced homophobic bullying throughout secondary school.

Getting help

Find out where to get help for homophobic bullying

Because of his experience, he's passionate about tackling homophobic bullying in schools. He describes what happened to him.

How did the bullying start?

"I've always been an extrovert, and I was quite effeminate when I started secondary school. At the time, I considered it part of my personality and nothing to do with sex or sexuality. It was just who I was.

"Because I was very confident, the older kids wanted to put me down, and people in my own year group joined in.

"It started with homophobic name calling, such as 'backstabber' and 'shirt lifter'. The first time I heard the word 'gay' was in a hateful context, and I didn't even know what it meant. I just thought I was uncool.

"By the time I was in the third year, I was being bullied a lot. It was always homophobic bullying. It would happen on the way to school on the bus, between lessons, sometimes during lessons, and on the bus home. It wasn't just verbal abuse but physical abuse, too. Once, on the way home, my hair was set on fire.

"It took a lot of strength to get out of the house and face the bullying. Being ridiculed was part of my daily life.

"I was at the bottom of all my classes. My self-esteem was so low that I was almost suicidal. I didn't know who or where I was. All I knew was that nearly everyone had decided that I was loathsome, vile and unnatural."

'After about a year of counselling, I started to get a bit more confident'

Did the school do anything?

"I'm dyslexic, so my school made me do an IQ test in the third year. I had the highest IQ in my year, but I wasn't doing well academically because my self-confidence was so low. So the school sent me for counselling when I was 14.

"After counselling, my mum said to me: 'Do you think it upsets you so much when people call you names because you think what they're saying might be true?'

"I said to Mum: 'I'm 14. That's not a decision I'm prepared to make now. I have the right to experiment and find out about myself. But I'm not being given that right at school. They're telling me what I am, and that it's disgusting.'

"The counselling helped because it gave me a chance to express myself. After about a year or so of counselling I became more confident. I'd find different ways to try to stop the bullying, such as being the class clown or being nice to the right people."

How did the bullying make you feel?

"I'd get a sinking feeling. As soon as I walked along a corridor I knew it was going to happen. It happened a lot in certain areas, such as walking from class to class, or going to and from school.

"It gave me a victim mentality. I either loathed myself, or I loathed everybody else for making me feel like that.

"Leaving school after GCSEs was the only way out. During the five years after I left school, the culture towards homosexuality changed. I came out properly to my friends when I was 19, and to my family when I was 20."

Has your experience at school affected you in later life?

"On the negative side, I find it very difficult to have long-term relationships because it's difficult to trust people. I'm scared they're going to turn around and be hurtful.

"On the positive side, it's helped me understand how different we all are and how that difference makes us stronger.

"Everyone deserves to feel positive and unique, and happy with that uniqueness.

"I also respect people's need to have space to discover who they are, because I didn't have much space."

Where to find help for homophobic bullying

Schools have a legal duty to ensure that homophobic bullying is dealt with. Find out how to stop bullying, who to talk to, and about anti-bullying helplines and organisations.

For further information and advice about homophobic bullying, visit these charities' websites.

EACH
EACH is a charity for young people and adults affected by homophobia and transphobia. It has a telephone helpline for young people who are experiencing homophobic or transphobic bullying. You can call Actionline on 0808 1000 143 on weekdays, 9am to 5pm. Calls are free from landlines and most mobiles.

Stonewall: Education for All
Stonewall is a charity that campaigns for equal rights for lesbians, gay men and bisexual people. Their Education for All campaign tackles homophobia and homophobic bullying in schools across the UK. On the Education for All website, you can find case studies, facts and figures about homophobic bullying in schools, and advice for young people and teachers.

Schools Out
Schools Out is an organisation that works towards equality in education for lesbian, gay, bisexual and trans people. Find out more about your rights at school with the Schools Out student toolkit.

HIV and AIDS: what are the risks for gay men?

The number of people with HIV in the UK is rising, and gay men are one of the highest risk groups.

Get HIV support

Find your local HIV support services

Around 83,000 people in the UK are living with HIV. According to the Health Protection Agency (now Public Health England), around a quarter (27%) don't know they have the virus.

Dr Valerie Deplech, an HIV expert at the Health Protection Agency, says: "We are seeing an ever-increasing pool of people living with HIV and AIDS in the UK."

HIV attacks the immune system, the body's defence against infection and disease. This means someone with HIV has a higher risk of getting a serious infection or disease, such as cancer.

Take the sexual health self-assessment test to see if your sex life is putting you at risk of contracting HIV.

How do people get HIV?

HIV is spread through bodily fluids, such as semen or blood. It's most commonly passed on during unprotected sex, including oral and anal sex. It can also be passed on through sharing sex toys.

Who gets HIV?

Anyone can get HIV if they have unprotected sex, but gay men are one of the highest risk groups. Women who have only ever had sex with women are at low risk.

Can I get HIV from kissing someone with it?

You can't catch HIV by kissing someone. Nor can you catch it if someone with HIV sneezes on you, from sharing a bath, towels or cutlery with someone who has HIV, or by sitting on a toilet seat someone with HIV has used.

How can I avoid getting HIV?

Using a condom during sex is the best way to avoid getting HIV, as well as other sexually transmitted infections (STIs). Don't use an oil-based lubricant as it can damage the condom, making it more likely to split. Use a water-based lubricant, such as KY Jelly, instead.

If I get HIV, can't I just take a few pills to make me better?

Gary Williams, from Birmingham's Healthy Gay Life Project, says: "The reality of HIV infection is that you need blood tests every six months (sometimes more often) and you could be taking up to 12 pills a day. People are living a long time, but their quality of life is compromised."

How can I get tested for HIV?

A simple blood test can determine whether you have HIV. It can take up to three months after infection to detect the virus, so you may need to have another test to be sure. There are various places you can get tested, including your GP surgery or a genitourinary medicine (GUM) clinic.

When should I get a test?

If you're a gay man and you've had unprotected sex, it's important that you have a test. Public Health England recommends annual HIV testing for gay men who change sexual partners.

What will happen if the test result is positive?

If your test is positive, you'll be referred to an HIV clinic. HIV clinics employ professionals who specialise in helping people living with HIV.

For more information, see the Health A-Z topic about Treatment for HIV.

While there's no cure for HIV, there are medications that can slow its progression and prolong life.

Read the answers to more frequently asked questions about HIV and AIDs.

Now, read an article on sexual health for gay and bisexual men.

Gay health: having children

More and more lesbians, gay men and bisexuals are becoming parents.

'Lesbians, bisexuals and gay men may have had more time to think through exactly how, why and what they're going to do when they have a child'

If you're a gay man or a lesbian, it doesn't mean you have to go through life without having a family of your own. The options available to potential gay and lesbian parents are wider now than ever before.

Dr Justin Varney, a public health consultant in London, says: "Gay men and lesbians are in the wonderful position where getting pregnant is a choice. It's a serious choice, but it is a choice."

But it's important to think through the implications of starting a family, says Dr Varney. "There are good organisations to talk to, or other gay parents who can tell you what having a child is like."

Some lesbian, gay or bisexual parents had children when they were in straight relationships that have ended. Otherwise, there are four main ways to have a child:

• donor insemination
• co-parenting
• adoption
• surrogacy

Donor insemination

This is where a man donates sperm so a woman can inseminate herself. She can be single or in a relationship.

Donor insemination can be performed at home using sperm from a friend or an anonymous donor, or at a fertility clinic using an anonymous donor.

If you decide to look for donor insemination, it's generally better to go to a licensed clinic where the sperm is screened to ensure it's free from sexually transmitted infections and certain genetic disorders. Fertility clinics also have support and legal advice on hand.

Thanks to recent changes in the law, lesbian couples who are civil partners at the time of conception and conceive a child through donor insemination – either at a licensed clinic or by private arrangement at home – will now both automatically be treated as their child's legal parents.

So too will couples who aren't civil partners at the time of conception but who conceive through donor insemination at a licensed clinic.

However, when non-civil partners conceive through donor insemination by private arrangement at home, the non-birth mother has no legal parenthood and will have to adopt the child to obtain parental rights.

Read more about artificial insemination.

Co-parenting

This is typically when a lesbian and a gay man team up to have children together, although one or the other may also be straight or bisexual. The man donates the sperm and both parties share responsibility for and custody of their child.

As a co-parent, you won't have sole custody of the child. It's vital to get legal advice beforehand. There are many details to be worked out, such as what role each parent will take, how financial costs will be split, and the degree of involvement each will have with the child.

Adoption for same-sex couples

It's now possible for same-sex couples in the UK to adopt a child together.

Couples can apply to adopt through a local authority or an adoption agency. You don't have to live in the local authority you apply to.

Find out more about adopting or fostering a child from the care system in England and Wales.

Surrogacy

Surrogacy is where another woman has a baby for a couple who can't have a child themselves. It's an option if you're a gay man, where the surrogate mother's egg can be fertilised by either you or your partner's sperm.

In reality, surrogacy is rare because it's difficult to arrange. Although it's legal in the UK, no money other than "reasonable expenses" can be paid to the surrogate, and there's nothing to stop her keeping the baby after it's born. It's also illegal to advertise for surrogates.

For more information on the legal position in the UK, visit the COTS website.

Now, read how to protect your fertility.

Sexual health for lesbian and bisexual women

Women who have sex with other women can pass on or get STIs. Know how to protect yourself.

Lesbians and bisexual women are not immune from sexually transmitted infections (STIs), and it's important not to be complacent about getting tested for them, according to Ruth Hunt at the charity Stonewall.

Sometimes, lesbian and bisexual women are told they don't need to be tested for STIs. This is not the case.

A survey of lesbian and bisexual women by Stonewall revealed half of those who have been screened had an STI.

"Women can catch STIs such as herpes, genital warts and chlamydia when exchanging bodily fluids," says Hunt.

"Any one-on-one contact, such as oral sex or using the same hand when touching yourself and then your partner, can put you at risk. Two women that are both menstruating are at a higher risk, too."

Tips for safer sex between women

• If you're using sex toys, use a new condom for each partner or between penetration of different orifices (body openings). Sex toys should be washed with soap and water between sessions. Find out more about cleaning sex toys.
• Avoid oral sex if either of you has any cuts or sores in the mouth or on the lips, or use a dental dam. A dental dam is a latex or polyurethane (very thin, soft plastic) square, of about 15cm by 15cm, which you can use to cover the anus or female genitals during oral sex. It acts as a barrier to help prevent sexually transmitted infections passing from one person to another.
• Some infections can be transmitted by hands, fingers and mutual vulval rubbing. Wash your hands before and after sex.
• Wear latex gloves and use plenty of water-based lubricant for vaginal and anal fisting.

Tips for bisexual women on safer sex with men

If you have vaginal, anal or oral sex with a man, use a condom. When used correctly, condoms protect against unintended pregnancy and STIs. In addition to using condoms, find out about the form of contraception that suits you best.

If you think you could be at risk of unintended pregnancy, you have the option of using emergency contraception (the "morning after" pill or an IUD).

The emergency pill is available from some pharmacies, GPs, contraception (family planning) clinics and some sexual health clinics. The IUD is available from contraception clinics, some sexual health clinics and some GPs.

Symptoms of STIs in women

Thrush

Thrush is caused by an overgrowth of yeast called candida. Symptoms may include vulval and vaginal itching, pain and soreness on penetration, burning when passing urine, and a thick, white discharge.

It's possible for women to transmit thrush during sex through touching and sharing sex toys. Thrush can be treated with medicated cream, pessaries and tablets, which can be bought from a chemist.

Go to your GP if your symptoms persist. Read more about thrush.

Genital herpes

This is caused by a virus, which can spread if you have vaginal, anal or oral sex, or share sex toys. It can also cause cold sores on the mouth and nose.

Symptoms include painful blisters and ulcers around the genital area, although some women may have no symptoms.

Antiviral tablets can help the healing process. Read more about genital herpes.

Genital warts

These are fleshy growths in the vulval and anal region. They may be itchy, but are usually painless.

They are caused by certain strains of the human papilloma virus (HPV), which are usually sexually acquired through skin contact, such as rubbing vulvas together.

Women with genital warts do not need more regular smear tests than those without them. There are a variety of treatment options, including freezing and medicated creams. Read more about genital warts.

Trichomoniasis

Trichomoniasis can be passed between women during any sexual activity that involves the exchange of vaginal fluid.

Symptoms include a frothy discharge, discomfort when passing urine, vulval soreness, and sometimes an unpleasant vaginal odour. Some women don't have any symptoms. It is treated with antibiotics.

Read more about trichomoniasis.

Chlamydia and gonorrhoea

These STIs are caused by bacteria, which can infect the cervix, rectum, throat and urethra. There may be a discharge, but usually there are no symptoms.

If the conditions are not treated, the bacteria may lead to an infection in the fallopian tubes and infertility.

Chlamydia and gonorrhoea can be passed between women through shared sex toys, hands, and by rubbing vulvas together. Treatment is with antibiotics.

Read more about chlamydia and gonorrhoea.

Syphilis

Syphilis is a bacterial infection that causes a painless ulcer, usually in the genital area. It will disappear on its own, but other symptoms may appear. These can include a rash on the body and swollen glands.

If it is not treated, syphilis can cause serious nerve and body organ damage later in life.

In its early stages, syphilis is extremely infectious and can be passed on by close skin contact during sex. Treatment is with antibiotic injections or tablets.

Read more about syphilis.

Sexual health for gay and bisexual men

Having unprotected penetrative sex is the most likely way to pass on a sexually transmitted infection (STI).

Go directly to:

Hepatitis A

Hepatitis B

Hepatitis C

Gonorrhoea ('the clap')

Non-specific urethritis (NSU)

Chlamydia

Shigella

Genital herpes

Syphilis

Genital warts

Pubic lice ('crabs')

Scabies

Using a condom helps protect against HIV and cuts the risk of getting many other STIs.

A survey of gay and bisexual men by Stonewall revealed that one in three men had never had an HIV test, and one in four had never been tested for any STI.

Gay and bisexual men should have a check-up at least every six months at a sexual health or genitourinary medicine (GUM) clinic. This is important, as with some STIs there are no symptoms.

Find your local sexual health service.

Screening for hepatitis C isn't routine, but if you think you're at risk or have been exposed, speak to your GP

Hepatitis A

Hepatitis A is a liver infection that's spread by a virus in faeces (poo).

It is spread mainly through contaminated food or poor hand-washing, but also passes on easily through sex, including oral-anal sex ("rimming") and giving oral sex after anal sex. Gay and bisexual men with multiple partners are particularly at risk.

Symptoms of hepatitis A can appear up to eight weeks after sex, and include tiredness and nausea.

Hepatitis A is not usually life-threatening and most people make a full recovery within a couple of months.

Men can avoid getting hepatitis A by:

• washing hands after sex (ideally buttocks, groin and penis too)
• changing condoms between anal and oral sex
• using a barrier (such as a condom cut into a square) for rimming
• using latex or non-latex gloves for fingering or fisting
• not sharing sex toys
• asking about the hepatitis A vaccine at a sexual health or GUM (genitourinary medicine) clinic

If you think you might have hepatitis A, or have any questions, visit a sexual health clinic or GP. The hepatitis A vaccine is available for people travelling to countries where the disease is common. Find out more about travel vaccinations.

Hepatitis B is a viral infection that causes inflammation of the liver. It often doesn't cause any obvious symptoms but can lead to a persistent infection. This can eventually cause serious liver disease, including cirrhosis and liver cancer.

Hepatitis B is spread through contact with an infected person's blood or body fluids. Men who have sex with men (MSM) are at risk of hepatitis B but they can be protected by the hepatitis B vaccination.

Vaccination for MSM is available from sexual health clinics, genitourinary medicine (GUM) clinics or from GPs.

Read more about hepatitis B.

Hepatitis C

Hepatitis C is a viral infection that causes inflammation of the liver. It often doesn't cause any obvious symptoms, but can lead to a persistent infection. This can eventually cause serious liver disease, including cirrhosis and liver cancer.

It is spread through contact with an infected person's blood or body fluids. Men who are concerned they are at risk should consult their doctor or sexual health clinic.

Hepatitis C can be treated and is curable in many cases. Find your local hepatitis C support service.

Read more about hepatitis C.

Gonorrhoea ('the clap')

This bacterial infection can cause stinging when urinating or the feeling that you want to urinate but can't. It's passed on through anal, oral or vaginal sex with an infected person.

Gonorrhoea is treated with antibiotics.

Read more about gonorrhoea.

Non-specific urethritis (NSU)

This is an inflammation of the urethra caused by bacteria. It is also known as non-gonococcal urethritis (NGU) when the condition is not caused by gonorrhoea.

NSU is passed on in the same way as gonorrhoea and often has similar symptoms.

It can also be caused by having lots of sex or masturbating a lot, which can cause the urethra to become inflamed. It can be treated using antibiotics.

Read more about non-specific urethritis.

Chlamydia

This is a bacterial infection of the urethra, rectum or throat. There may be a discharge and pain when passing urine, or pain in the testicles (although chlamydia can be symptom-free).

It can be passed on during sex with an infected person in the same way as gonorrhoea and NSU. It's treated with antibiotics.

Read more about chlamydia.

Shigella

This is a bacterial infection of the intestine that causes severe diarrhoea and stomach cramps. It is often mistaken for food poisoning.

It can be caught during sexual activity, including anal-oral sex ("rimming") and giving oral sex after anal sex. It is spread very easily – all it takes is a tiny amount of infected poo (faeces) getting into your mouth.

A person with shigella can be infectious for up to a month. It can be treated with antibiotics. Men who suspect they have shigella should visit their GP or sexual health clinic to get tested.

Men can avoid getting shigella by washing hands after sex (buttocks, groin and penis too, if you can by taking a shower), and changing condoms between anal and oral sex.

Using latex or non-latex gloves for fingering or fisting offers protection. And don't share sex toys or douching equipment.

You'll find more information on shigella in this leaflet (PDF, 2.13Mb).

Genital herpes

Genital herpes is a viral infection. Symptoms can include painful blisters and ulcers on or around the penis or anus, although some men have no symptoms.

The virus remains in the body and can cause recurrent episodes of blisters.

Genital herpes can be passed on through oral sex with someone with a cold sore around or in their mouth, or by close, skin-to-skin genital contact with someone who has genital herpes.

Antiviral tablets can help the healing process. A GP can prescribe tablets or cream.

Read more about genital herpes.

Syphilis

Syphilis is a bacterial infection that causes a painless ulcer, usually in the genital area. The ulcer will disappear on its own but other symptoms may appear, such as a rash on the body and swollen glands.

In its early stages, syphilis is very infectious and can be passed on by close skin contact during sex. If it's left untreated for years, it can spread to the brain or other parts of the body and cause serious, long-term problems.

Treatment is with antibiotic injections or tablets.

Read more about syphilis.

Genital warts

This is a common viral infection that appears a few weeks or months after sex with an infected person. It can cause pinhead-sized growths, mostly on or around the head of the penis but also in and around the anus.

The sooner warts are treated, the easier they are to deal with. You can't treat genital warts with the same cream you use for warts on the hands. A doctor will freeze them or use a cream to remove them.

Read more about genital warts.

Pubic lice ('crabs')

Public lice (also known as 'crabs') are small, parasitic insects that live in body hair. They are the most common STI .

They only grow to pinhead size so can be difficult to spot, although their tiny dark eggs can be seen stuck to hair.

Pubic lice prefer pubic hair (hair around your testicles and anus) but can also be found in body hair (but not head hair). The lice can also be picked up from clothes, towels and bedding, and symptoms include itching or a rash.

Treatment can be done at home with lotions or creams bought at a chemist (no prescription is needed).

Read more about pubic lice.

Scabies

This is an infection caused by tiny mites that burrow under the skin. It causes intense itching for most people (though some hardly notice it).

Itching usually starts two or more weeks after sex with an infected person. You can get scabies from sharing beds and towels, but this is less common.

Treatment is similar to treating pubic lice, although you may continue to itch for a few weeks after the mites have been eradicated.

Read more about scabies.

Get tested

If you have any of the symptoms above or are worried you may have an STI, speak to your GP or visit a genitourinary medicine (GUM) clinic.

Getting tested regularly is a good idea to ensure you have a healthy sex life. NHS services are free.

Find your local sexual health service.

Find your local GUM clinic.

Mental health issues if you're gay, lesbian or bisexual

Studies show that lesbian, gay and bisexual people show higher levels of anxiety, depression and suicidal feelings than heterosexual men and women.

Find an NHS therapist

Find therapy and counselling services near you

Rates of drug and alcohol misuse have also been found to be higher. But the real picture is uncertain because of the reluctance of some patients to disclose their sexuality, and some healthcare staff feeling uncomfortable asking the question.

Poor levels of mental health among gay and bisexual people have often been linked to experiences of homophobic discrimination and bullying.

It may not be easy, but getting help if you're feeling stressed, depressed, anxious or suicidal is one of the most important things you can do.

Dominic Davies from Pink Therapy, a mental health support service for lesbian, gay and bisexual people, says: "As LGB people, our mental health is often under attack from various quarters, and sometimes we can find ourselves being our own worst enemy.

"Counselling or psychotherapy can be a place to take stock and figure out what's going on, and how to better handle the various stresses and strains that surround our lives."

Read about different types of talking therapy and how they can help.

Although society has changed and homophobic prejudice is less common than it used to be, most lesbian, gay and bisexual people have experienced a range of difficulties in their lives. These can contribute to mental health problems.

For some, other factors such as age, religion or ethnicity can further complicate mental distress.

Many gay people have experienced:

• hostility or rejection from family, parents and friends
• bullying and name calling at school
• rejection by most mainstream religions
• danger of violence in public places
• harassment from neighbours and other tenants
• casual homophobic comments on an everyday basis
• embarrassed responses (and occasionally prejudice) from professionals, such as GPs
• no protection against discrimination at work
• negative portrayal of gay people in the media

The effect on your mental health

Experiencing these difficulties can mean many gay and bisexual people face mental health issues, including:

• difficulty accepting their sexual orientation, leading to conflicts, denial, alcohol abuse and isolation
• trying to keep their sexuality a secret through lying, pretending or leading a double life
• low self-esteem
• increased risk of self-harm and suicide attempts
• damaged relationships or lack of support from families
• post-traumatic stress disorder and depression from long-term effects of bullying

If you think you need help, ask your GP to refer you to the appropriate service.

Now, read how to access talking therapies on the NHS.