madman
Super Moderator
ABSTRACT
Introduction: Historically, sexual health research has focused on men who have sex with women (MSW), and most research examining the sexual health of men who have sex with men (MSM) has focused on HIV transmission. Despite a high prevalence of sexual health disorders among MSM, there is limited research that has evaluated the diversity of sexual issues in these patients.
Objectives: The purpose of this review is to describe the unique sexual behaviors, concerns, and dysfunctions of MSM by evaluating the literature on sexual health in this specific patient population. Methods: A PubMed literature search was conducted through December 2020 to identify all relevant publications related to the sexual health, sexual practices, and sexual dysfunction of MSM. Original research, review articles, and meta-analyses were reviewed, including comparisons of sexual behavior and dysfunction between MSM and non-MSM populations and between gay/bisexual men and heterosexual men. Approximately 150 relevant articles were reviewed and 100 were included in the manuscript.
Results: Minority stress can lead to an increase in high-risk sexual behavior, sexual dysfunction, and mental health disorders in MSM. MSM engage in a variety of sexual behaviors, which can lead to differences in sexual dysfunction, such as anodyspareunia during receptive anal intercourse. MSM have higher rates of erectile dysfunction than non-MSM counterparts. MSM has unique activators of sexual pathologies, such as insertive anal intercourse for Peyronie’s disease. Prostate cancer treatment may cause MSM to change sexual roles and practices following treatment due to ED, anodyspareunia, or decrease in pleasure from receptive anal intercourse after prostatectomy.
Conclusion: MSM has been neglected from sexual medicine research, which translates to disparities in health care. Further research that focuses on the MSM population is necessary to better educate healthcare practitioners so that MSM patients can receive adequate care that is tailored to their specific needs.
INTRODUCTION
Data from the 2009 National Survey of Sexual Health and Behavior showed that 4.2% of adult men in the United States (U.S.) identified as gay, 2.6% as bisexual, and 1.0% as other.1 The National Health and Nutrition Examination Surveys in 2001−2006 revealed that 5.2% of male respondents had sex with men, while only 44.5% of those men identified as homosexual or gay.2 Since sexual identity does not necessarily correlate with the gender of recent or lifetime sexual partners, this article will use the term men who have sex with men (MSM) and men who have sex with women (MSW) rather than homosexual, gay, bisexual, and heterosexual unless that terminology was used in the original cited studies. Historically, sexual health research on men have focused on MSW and most research examining the sexual health of MSM has focused on the HIV-positive population and HIV transmission risk. Recently, more studies have evaluated the diversity of sexual health issues among MSM, as the prevalence of sexual disorders among HIV-negative MSM ranges from 42.5% to 79%.3,4 Commonly reported sexual symptoms include low sexual desire, erectile dysfunction (ED), premature ejaculation (PE), performance anxiety, and anorgasmia.3 This article will review the different types of sexual behavior of MSM and summarize the different forms of sexual dysfunction in MSM, including sexual desire disorders, mental health disorders, ED, ejaculatory dysfunction, anodyspareunia, the effects of prostate cancer and its treatment, Peyronie’s disease (PD), and penile fracture.
*HEALTHCARE DISPARITIES AND EVALUATION OF MSM
*SEXUAL BEHAVIOR
*SEXUAL DESIRE
*HIV AND SEXUALLY TRANSMITTED INFECTIONS
*MENTAL HEALTH
*ERECTILE DYSFUNCTION
*EJACULATORY DYSFUNCTION
*ANODYSPAREUNIA
*PROSTATE CANCER
*PEYRONIE’S DISEASE
*PENILE FRACTURE
CONCLUSION
There is a high prevalence of sexual health disorders among MSM. Minority stress can lead to an increase in high-risk sexual behavior, sexual dysfunction, and mental health disorders. High-risk sexual behavior, such as CAI, can lead to an increase in the transmission of HIV and other STIs. Though MSM may have higher numbers of sexual partners than MSW, being in a stable relationship has a positive effect on sexual dysfunction for MSM. Compared to MSW, there are higher rates of ED among MSM, even in young adults. There is no clear relationship between sexual partner preference and PE. Depending on their sexual practices, MSM may experience different forms of sexual dysfunction besides erectile and ejaculatory dysfunction, such as anodyspareunia. They also have different activators of Peyronie’s disease and penile fracture, which are both associated with insertive anal intercourse. Prostate cancer treatment in MSM can have a debilitating effect on sexual function, disease-specific quality of life, and psychological well-being. ED and anodyspareunia from treatment can cause MSM to change sexual roles and practices or abstain from sexual activity altogether. Anejaculation can be particularly distressing for MSM given the eroticization of semen by some men.
Prostate cancer is an example of how disparities in research negatively impact the health of MSM. Sexual medicine studies have historically neglected MSM and few validated questionnaires are able to adequately assess sexual function in MSM, such as insertive and receptive anal intercourse. There is an abundance of research on HIV transmission among MSM, but otherwise, there are very few studies that evaluate other aspects of sexual health in this underserved population. Many of the studies described in this review are small qualitative studies, and the quantitative studies that have compared MSM with MSW or GBM with heterosexual men often consist of small numbers of MSM or GBM. In the studies that do have comparison groups, it is important to highlight that there is significant heterogeneity among these studies; some studies focus on self-identified sexual orientation while others focus on sexual practices; some studies include bisexual men while others exclude them. There is a necessity for further research on sexual dysfunction among MSM as a whole and specifically on MSM who self-identify as different sexual orientations in order to evaluate differences among these groups. For instance, MSM who identify as gay may have differences in sexual and mental health parameters compared to MSM who identify as heterosexual and MSM who identify as bisexual. In order to better evaluate this specific population in research studies and in clinical practice, new validated instruments are warranted.
Healthcare practitioners need better education and training in treating MSM patients, as culturally competent care for sexual minority patients is part of medical professionalism. Providers are often unprepared to address the unique needs of MSM, a problem compounded by the fact that they often do not ask patients about their sexual preferences and practices. Providers should ask about the diversity of sexual practices that their patients engage in instead of focusing solely on penetrative intercourse. When counseling patients, it is important to avoid assumptions and be self-aware of biases. Tailored resources and tools for MSM are also necessary for patient education, which can hopefully lead to improvement in health care outcomes and quality of life.
Introduction: Historically, sexual health research has focused on men who have sex with women (MSW), and most research examining the sexual health of men who have sex with men (MSM) has focused on HIV transmission. Despite a high prevalence of sexual health disorders among MSM, there is limited research that has evaluated the diversity of sexual issues in these patients.
Objectives: The purpose of this review is to describe the unique sexual behaviors, concerns, and dysfunctions of MSM by evaluating the literature on sexual health in this specific patient population. Methods: A PubMed literature search was conducted through December 2020 to identify all relevant publications related to the sexual health, sexual practices, and sexual dysfunction of MSM. Original research, review articles, and meta-analyses were reviewed, including comparisons of sexual behavior and dysfunction between MSM and non-MSM populations and between gay/bisexual men and heterosexual men. Approximately 150 relevant articles were reviewed and 100 were included in the manuscript.
Results: Minority stress can lead to an increase in high-risk sexual behavior, sexual dysfunction, and mental health disorders in MSM. MSM engage in a variety of sexual behaviors, which can lead to differences in sexual dysfunction, such as anodyspareunia during receptive anal intercourse. MSM have higher rates of erectile dysfunction than non-MSM counterparts. MSM has unique activators of sexual pathologies, such as insertive anal intercourse for Peyronie’s disease. Prostate cancer treatment may cause MSM to change sexual roles and practices following treatment due to ED, anodyspareunia, or decrease in pleasure from receptive anal intercourse after prostatectomy.
Conclusion: MSM has been neglected from sexual medicine research, which translates to disparities in health care. Further research that focuses on the MSM population is necessary to better educate healthcare practitioners so that MSM patients can receive adequate care that is tailored to their specific needs.
INTRODUCTION
Data from the 2009 National Survey of Sexual Health and Behavior showed that 4.2% of adult men in the United States (U.S.) identified as gay, 2.6% as bisexual, and 1.0% as other.1 The National Health and Nutrition Examination Surveys in 2001−2006 revealed that 5.2% of male respondents had sex with men, while only 44.5% of those men identified as homosexual or gay.2 Since sexual identity does not necessarily correlate with the gender of recent or lifetime sexual partners, this article will use the term men who have sex with men (MSM) and men who have sex with women (MSW) rather than homosexual, gay, bisexual, and heterosexual unless that terminology was used in the original cited studies. Historically, sexual health research on men have focused on MSW and most research examining the sexual health of MSM has focused on the HIV-positive population and HIV transmission risk. Recently, more studies have evaluated the diversity of sexual health issues among MSM, as the prevalence of sexual disorders among HIV-negative MSM ranges from 42.5% to 79%.3,4 Commonly reported sexual symptoms include low sexual desire, erectile dysfunction (ED), premature ejaculation (PE), performance anxiety, and anorgasmia.3 This article will review the different types of sexual behavior of MSM and summarize the different forms of sexual dysfunction in MSM, including sexual desire disorders, mental health disorders, ED, ejaculatory dysfunction, anodyspareunia, the effects of prostate cancer and its treatment, Peyronie’s disease (PD), and penile fracture.
*HEALTHCARE DISPARITIES AND EVALUATION OF MSM
*SEXUAL BEHAVIOR
*SEXUAL DESIRE
*HIV AND SEXUALLY TRANSMITTED INFECTIONS
*MENTAL HEALTH
*ERECTILE DYSFUNCTION
*EJACULATORY DYSFUNCTION
*ANODYSPAREUNIA
*PROSTATE CANCER
*PEYRONIE’S DISEASE
*PENILE FRACTURE
CONCLUSION
There is a high prevalence of sexual health disorders among MSM. Minority stress can lead to an increase in high-risk sexual behavior, sexual dysfunction, and mental health disorders. High-risk sexual behavior, such as CAI, can lead to an increase in the transmission of HIV and other STIs. Though MSM may have higher numbers of sexual partners than MSW, being in a stable relationship has a positive effect on sexual dysfunction for MSM. Compared to MSW, there are higher rates of ED among MSM, even in young adults. There is no clear relationship between sexual partner preference and PE. Depending on their sexual practices, MSM may experience different forms of sexual dysfunction besides erectile and ejaculatory dysfunction, such as anodyspareunia. They also have different activators of Peyronie’s disease and penile fracture, which are both associated with insertive anal intercourse. Prostate cancer treatment in MSM can have a debilitating effect on sexual function, disease-specific quality of life, and psychological well-being. ED and anodyspareunia from treatment can cause MSM to change sexual roles and practices or abstain from sexual activity altogether. Anejaculation can be particularly distressing for MSM given the eroticization of semen by some men.
Prostate cancer is an example of how disparities in research negatively impact the health of MSM. Sexual medicine studies have historically neglected MSM and few validated questionnaires are able to adequately assess sexual function in MSM, such as insertive and receptive anal intercourse. There is an abundance of research on HIV transmission among MSM, but otherwise, there are very few studies that evaluate other aspects of sexual health in this underserved population. Many of the studies described in this review are small qualitative studies, and the quantitative studies that have compared MSM with MSW or GBM with heterosexual men often consist of small numbers of MSM or GBM. In the studies that do have comparison groups, it is important to highlight that there is significant heterogeneity among these studies; some studies focus on self-identified sexual orientation while others focus on sexual practices; some studies include bisexual men while others exclude them. There is a necessity for further research on sexual dysfunction among MSM as a whole and specifically on MSM who self-identify as different sexual orientations in order to evaluate differences among these groups. For instance, MSM who identify as gay may have differences in sexual and mental health parameters compared to MSM who identify as heterosexual and MSM who identify as bisexual. In order to better evaluate this specific population in research studies and in clinical practice, new validated instruments are warranted.
Healthcare practitioners need better education and training in treating MSM patients, as culturally competent care for sexual minority patients is part of medical professionalism. Providers are often unprepared to address the unique needs of MSM, a problem compounded by the fact that they often do not ask patients about their sexual preferences and practices. Providers should ask about the diversity of sexual practices that their patients engage in instead of focusing solely on penetrative intercourse. When counseling patients, it is important to avoid assumptions and be self-aware of biases. Tailored resources and tools for MSM are also necessary for patient education, which can hopefully lead to improvement in health care outcomes and quality of life.
