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This article is about sexual practices between males. For sexual practices between females, see Lesbian sexual practices.
Gay sexual practices are sexual activities involving men who have sex with men (MSM), regardless of their sexual orientation or sexual identity. Evidence shows that sex between men is significantly underreported in surveys due to social desirability bias.[1][2]
Various sex positions may be performed during sexual activity between men.
Historically, anal sex has been popularly associated with male homosexuality and MSM. Many MSM, however, do not engage in anal sex, and may engage in oral sex, frottage or frot, or mutual masturbation instead.[3][4][5]
Among men who have anal sex with other men, the insertive partner may be referred to as the top, the one being penetrated may be referred to as the bottom, and those who enjoy either role may be referred to as versatile.[6] When MSM engage in anal sex without using a condom, this is referred to as bareback sex. Pleasure, pain, or both may accompany anal sex. While the nerve endings in the anus can provide pleasurable feelings, an orgasm may be achieved through receptive anal penetration by indirect stimulation of the prostate.[7][8] A study by the National Survey of Sexual Health and Behavior (NSSHB) indicated that men who self-report taking a receptive position during anal sex in their last encounter were at least as likely to have reached orgasm as men who adopted an insertive role.[9] A study sampling single people in the U.S. indicated that orgasm rates are similar among men across sexual orientations.[10] With regard to pain or being uncomfortable during anal sex,[11] some research indicates that, for 24% to 61% of gay or bisexual men, painful receptive anal sex (known as anodyspareunia) is a frequent lifetime sexual difficulty.[11]
Reports pertaining to the prevalence of anal sex among MSM have varied over time, with some percentages higher than others.[6][12][13][14] A large percentage of gay and bisexual men self-report lifetime participation in anal sex.[6] Studies among gay men have indicated that percentages are similar when comparing men who prefer to penetrate their partners to those who prefer to be the receptive partner.[6][15] Some men who have sex with men, however, believe that being a receptive partner during anal sex questions their masculinity.[16][17]
There are a variety of non-penetrative sex practices. Frot is a form of male-male sexual activity that usually involves direct penis-to-penis contact.[18] It is a form of frottage. Frot can be enjoyable because it mutually and simultaneously stimulates the genitals of both partners as it tends to produce pleasurable friction against the frenulum nerve bundle on the underside of each man's penile shaft, just below the urinary opening (meatus) of the penis head (glans penis). Intercrural sex is another form of non-penetrative sex that can be practiced between MSM. Docking (the insertion of one man's penis into another man's foreskin) is also practiced.
MSM may use sex toys. According to an online survey of 25,294 men who self-reported a homosexual or bisexual orientation, 49.8% have used vibrators. Most men who had used a vibrator in the past reported use during masturbation (86.2%). When used during partnered interactions, vibrators were incorporated into foreplay (65.9%) and intercourse (59.4%).[19]
MSM may engage in different forms of oral sex, such as fellatio, tea bagging, and anilingus. Wellings et al. reported that "the equation of 'homosexual' with 'anal' sex among men is common among lay and health professionals alike," whereas an online survey of 18,000 MSM in Europe "showed that oral sex was most commonly practised, followed by mutual masturbation, with anal intercourse in third place."[3] A 2011 survey by The Journal of Sexual Medicine found similar results for U.S. gay and bisexual men. Kissing a partner on the mouth (74.5%), oral sex (72.7%), and partnered masturbation (68.4%) were the three most common behaviors, with 63.2% of the sample self-reporting five to nine different sexual behaviors during their last encounter.[20]
A variety of sexually transmitted infections (STIs) can result from sexual activity. A 2007 study reported that two large population surveys found "the majority of gay men had similar numbers of unprotected sexual partners annually as straight men and women."[21][22]
Acquired immune deficiency syndrome (AIDS) is a disease of the human immune system caused by the human immunodeficiency virus (HIV).[23][24][25] Worldwide, an estimated 5–10% of HIV infections are the result of men having sex with men.[26] However, in most of the Western world, more HIV infections are transmitted by men having sex with men than by any other transmission route.[27] In the United States, gay and bisexual men accounted for 70% of 38,739 new HIV diagnoses in 2017.[28] Of the 5,164 people diagnosed with HIV in the UK in 2016, 54% were gay or bisexual men.[29] This statistic is decreasing in London as reported by Public Health England in 2017.[30][31]
Syphilis is passed from person to person through direct contact with a syphilis sore; mainly on the external genitals, the vagina, or anus.[32] In 2006, 64% of the reported cases in the United States were among men who have sex with men.[32] A rise in the incidence of syphilis among MSM has been seen in other developed nations. Contracting syphilis increases the rates of HIV contamination and vice versa, and accordingly a survey in the US has indeed found that half MSM with syphilis also possess HIV.[33] Some studies utilizing convenience samples have concluded that such rise can be attributed to increased rates of sex without a condom among MSM,[34] though at least one study using a nationally representative sample has found that condom use rates among MSM have increased, not decreased, in the last decade, and there has been a steep decline in the frequency of anal sex in the last sexual encounter of active MSM.[35]
According to a US survey, HIV, syphilis, and anal warts are all significantly more common among men who recently had sex with men (MSM) than among men who recently had sex only with women (MSW). On the other hand, genital herpes is less common among MSM than among MSW. Chlamydia, human papillomavirus, gonorrhea, and lice saw no significant difference across the two groups.[36]
^ Turner CF, Ku L, Rogers SM, Lindberg LD, Pleck JH, Sonenstein FL (May 1998). "Adolescent sexual behavior, drug use, and violence: increased reporting with computer survey technology". Science. 280 (5365): 867–73. Bibcode:1998Sci...280..867T. doi:10.1126/science.280.5365.867. PMID 9572724.
^ Coffman, Katherine B.; Coffman, Lucas C.; Ericson, Keith M. Marzilli (2013). "The Size of the LGBT Population and the Magnitude of Anti-Gay Sentiment are Substantially Underestimated". Management Science. 63 (10): 3168–3186. doi:10.1287/mnsc.2016.2503. S2CID 35207796.
^ a b Kaye Wellings; Kirstin Mitchell; Martine Collumbien (2012). Sexual Health: A Public Health Perspective. McGraw-Hill International. p. 91. ISBN 978-0335244812. Retrieved August 29, 2013.
^ Goldstone, Stephen E.; Welton, Mark L. (2004). "Sexually Transmitted Diseases of the Colon, Rectum, and Anus". Clin Colon Rectal Surg. 17 (4): 235–239. doi:10.1055/s-2004-836944. PMC 2780055. PMID 20011265.
^ Edwin Clark Johnson, Toby Johnson (2008). Gay Perspective: Things Our Homosexuality Tells Us about the Nature of God & the Universe. Lethe Press. p. 139. ISBN 978-1-59021-015-4. Retrieved February 12, 2011.
^ a b c d Steven Gregory Underwood (2003). Gay Men and Anal Eroticism: Tops, Bottoms, and Versatiles. Harrington Park Press. ISBN 978-1-56023-375-6. Retrieved February 12, 2011.
^ Rosenthal, Martha (2012). Human Sexuality: From Cells to Society. Cengage Learning. pp. 133–135. ISBN 978-0618755714. Retrieved September 17, 2012.
^ Komisaruk, Barry R.; Whipple, Beverly; Nasserzadeh, Sara; Beyer-Flores, Carlos (2009). The Orgasm Answer Guide. JHU Press. pp. 108–109. ISBN 978-0-8018-9396-4. Retrieved November 6, 2011.
^ Mona Chalabi (20 August 2015). "The Gender Orgasm Gap". FiveThirtyEight.
^ Garcia Justin R (2014). "Variation in Orgasm Occurrence by Sexual Orientation in a Sample of U.S. Singles". The Journal of Sexual Medicine. 11 (11): 2645–2652. doi:10.1111/jsm.12669. PMC 6035747. PMID 25131299.
^ a b Joel J. Heidelbaugh (2007). Clinical men's health: evidence in practice. Elsevier Health Sciences. p. 273. ISBN 978-1-4160-3000-3. Retrieved October 14, 2011.
^ "Increases in Unsafe Sex and Rectal Gonorrhea Among Men Who Have Sex With Men – San Francisco, California, 1994–1997". Center for Disease Control. January 29, 1999. Retrieved May 1, 2021.
^ Laumann, E., Gagnon, J.H., Michael, R.T., and Michaels, S. The Social Organization of Sexuality: Sexual Practices in the United States. 1994. Chicago: University of Chicago Press (Also reported in the companion volume, Michael et al., Sex in America: A Definitive Survey, 1994).
^ "Anal Sex Safety and Health Concerns". WebMD. Retrieved August 19, 2013.
^ Breyer, Benjamin N.; Smith, James F.; Eisenberg, Michael L.; Ando, Kathryn A.; Rowen, Tami S.; Shindel, Alan W. (July 2010). "The Impact of Sexual Orientation on Sexuality and Sexual Practices in North American Medical Students". The Journal of Sexual Medicine. 7 (7): 2391–2400. doi:10.1111/j.1743-6109.2010.01794.x. PMC 3607668. PMID 20384941.
^ John H. Harvey; Amy Wenzel; Susan Sprecher (2004). The handbook of sexuality in close relationships. Routledge. pp. 355–356. ISBN 978-0805845488. Retrieved March 12, 2011.
^ Odets, Walt (1995). In the Shadow of the Epidemic: Being Hiv-negative in the Age of AIDS. Duke University Press. pp. 191–192. ISBN 978-0822316381. Retrieved July 6, 2013.
^ "The New Sex Police". The Advocate. Here. 2005-04-12. pp. 39–40, 42. Retrieved February 12, 2011.
^ Reece M; Rosenberger JG; Schick V; Herbenick D; Dodge B; Novak DS (2010). "Characteristics of vibrator use by gay and bisexually identified men in the United States". The Journal of Sexual Medicine. 7 (10): 3467–76. doi:10.1111/j.1743-6109.2010.01873.x. PMID 20561168.
^ Rosenberger Joshua G (2011). "Sexual Behaviors and Situational Characteristics of Most Recent Male‐Partnered Sexual Event among Gay and Bisexually Identified Men in the United States". The Journal of Sexual Medicine. 8 (11): 3040–3050. doi:10.1111/j.1743-6109.2011.02438.x. PMID 21883941.
^ "Sexual Behavior Does Not Explain Varying HIV Rates Among Gay And Straight Men - Medical News Today". medicalnewstoday.com. Retrieved February 10, 2015.
^ Goodreau SM, Golden MR (October 2007). "Biological and demographic causes of high HIV and sexually transmitted disease prevalence in men who have sex with men". Sex Transm Infect. 83 (6): 458–462. doi:10.1136/sti.2007.025627. PMC 2598698. PMID 17855487.
^ Sepkowitz KA (June 2001). "AIDS—the first 20 years". N. Engl. J. Med. 344 (23): 1764–1772. doi:10.1056/NEJM200106073442306. PMID 11396444.
^ Weiss RA (May 1993). "How does HIV cause AIDS?". Science. 260 (5112): 1273–1279. Bibcode:1993Sci...260.1273W. doi:10.1126/science.8493571. PMID 8493571.
^ Cecil, Russell (1988). Textbook of Medicine. Philadelphia: Saunders. pp. 1523, 1799. ISBN 978-0-7216-1848-7.
^ "Men who have sex with men (MSM) and HIV/AIDS | AVERT". avert.org. Retrieved February 10, 2015.
^ "2009 AIDS epidemic update". Joint United Nations Programme on HIV/AIDS and World Health Organization. November 2009. Archived from the original on September 28, 2011. Retrieved September 28, 2011.
^ Center for Disease Control (CDC) (12 November 2019). "HIV and Gay and Bisexual Men". www.cdc.gov. Retrieved 28 January 2020.
^ "HIV statistics | Terrence Higgins Trust". www.tht.org.uk. Retrieved 2018-08-23.
^ "Public Health England 2017 Report on HIV/AIDS in UK gay and bisexual men" (PDF).
^ "HIV and AIDS in the United Kingdom (UK)". AVERT. 2015-07-21. Retrieved 2018-08-23.
^ a b "Syphilis & MSM (Men Who Have Sex With Men) – CDC Fact Sheet". Centers for Disease Control and Prevention. Archived from the original on June 17, 2017. Retrieved May 1, 2021.
^ "Reported STDs in the United States — 2014 National Data for Chlamydia, Gonorrhea, and Syphilis" (PDF). Centers for Disease Control and Prevention. 2019-01-16.
^ M Hourihan; H Wheeler; R Houghton; B T Goh (2004). "Lessons from the syphilis outbreak in homosexual men in east London". Sex Transm Infect. 80 (6): 509–511. doi:10.1136/sti.2004.011023. PMC 1744940. PMID 15572625.
^ Andrew E. Grulich; et al. (2014). "Homosexual experience and recent homosexual encounters: the Second Australian Study of Health and Relationships". Sexual Health. 11 (5): 439–50. doi:10.1071/SH14122. PMID 25376997.
^ Thomas W. Gaither; et al. (2015). "The Influence of Sexual Orientation and Sexual Role on Male Grooming-Related Injuries and Infections". J Sex Med. 12 (3): 631–640. doi:10.1111/jsm.12780. PMC 4599875. PMID 25442701.
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Sexual violence is one of the most horrific weapons of war, an instrument of terror used against women. Yet huge numbers of men are also victims. In this harrowing report, Will Storr travels to Uganda to meet traumatised survivors, and reveals how male rape is endemic in many of the world's conflicts
Dying of shame: a Congolese rape victim, currently resident in Uganda. This man’s wife has left him, as she was unable to accept what happened. He attempted suicide at the end of last year. Photograph: Will Storr for the Observer
Of all the secrets of war, there is one that is so well kept that it exists mostly as a rumour. It is usually denied by the perpetrator and his victim. Governments, aid agencies and human rights defenders at the UN barely acknowledge its possibility. Yet every now and then someone gathers the courage to tell of it. This is just what happened on an ordinary afternoon in the office of a kind and careful counsellor in Kampala, Uganda. For four years Eunice Owiny had been employed by Makerere University's Refugee Law Project (RLP) to help displaced people from all over Africa work through their traumas. This particular case, though, was a puzzle. A female client was having marital difficulties. "My husband can't have sex," she complained. "He feels very bad about this. I'm sure there's something he's keeping from me."
Owiny invited the husband in. For a while they got nowhere. Then Owiny asked the wife to leave. The man then murmured cryptically: "It happened to me." Owiny frowned. He reached into his pocket and pulled out an old sanitary pad. "Mama Eunice," he said. "I am in pain. I have to use this."
Laying the pus-covered pad on the desk in front of him, he gave up his secret. During his escape from the civil war in neighbouring Congo, he had been separated from his wife and taken by rebels. His captors raped him, three times a day, every day for three years. And he wasn't the only one. He watched as man after man was taken and raped. The wounds of one were so grievous that he died in the cell in front of him.
"That was hard for me to take," Owiny tells me today. "There are certain things you just don't believe can happen to a man, you get me? But I know now that sexual violence against men is a huge problem. Everybody has heard the women's stories. But nobody has heard the men's."
It's not just in East Africa that these stories remain unheard. One of the few academics to have looked into the issue in any detail is Lara Stemple, of the University of California's Health and Human Rights Law Project. Her study Male Rape and Human Rights notes incidents of male sexual violence as a weapon of wartime or political aggression in countries such as Chile, Greece, Croatia, Iran, Kuwait, the former Soviet Union and the former Yugoslavia. Twenty-one per cent of Sri Lankan males who were seen at a London torture treatment centre reported sexual abuse while in detention. In El Salvador, 76% of male political prisoners surveyed in the 1980s described at least one incidence of sexual torture. A study of 6,000 concentration-camp inmates in Sarajevo found that 80% of men reported having been raped.
I've come to Kampala to hear the stories of the few brave men who have agreed to speak to me: a rare opportunity to find out about a controversial and deeply taboo issue. In Uganda, survivors are at risk of arrest by police, as they are likely to assume that they're gay – a crime in this country and in 38 of the 53 African nations. They will probably be ostracised by friends, rejected by family and turned away by the UN and the myriad international NGOs that are equipped, trained and ready to help women. They are wounded, isolated and in danger. In the words of Owiny: "They are despised."
But they are willing to talk, thanks largely to the RLP's British director, Dr Chris Dolan. Dolan first heard of wartime sexual violence against men in the late 1990s while researching his PhD in northern Uganda, and he sensed that the problem might be dramatically underestimated. Keen to gain a fuller grasp of its depth and nature, he put up posters throughout Kampala in June 2009 announcing a "workshop" on the issue in a local school. On the day, 150 men arrived. In a burst of candour, one attendee admitted: "It's happened to all of us here." It soon became known among Uganda's 200,000-strong refugee population that the RLP were helping men who had been raped during conflict. Slowly, more victims began to come forward.
I meet Jean Paul on the hot, dusty roof of the RLP's HQ in Old Kampala. He wears a scarlet high-buttoned shirt and holds himself with his neck lowered, his eyes cast towards the ground, as if in apology for his impressive height. He has a prominent upper lip that shakes continually – a nervous condition that makes him appear as if he's on the verge of tears.
Jean Paul was at university in Congo, studying electronic engineering, when his father – a wealthy businessman – was accused by the army of aiding the enemy and shot dead. Jean Paul fled in January 2009, only to be abducted by rebels. Along with six other men and six women he was marched to a forest in the Virunga National Park.
Later that day, the rebels and their prisoners met up with their cohorts who were camped out in the woods. Small camp fires could be seen here and there between the shadowy ranks of trees. While the women were sent off to prepare food and coffee, 12 armed fighters surrounded the men. From his place on the ground, Jean Paul looked up to see the commander leaning over them. In his 50s, he was bald, fat and in military uniform. He wore a red bandana around his neck and had strings of leaves tied around his elbows.
"You are all spies," the commander said. "I will show you how we punish spies." He pointed to Jean Paul. "Remove your clothes and take a position like a Muslim man."
Jean Paul thought he was joking. He shook his head and said: "I
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