Gay sexual practices

Gay sexual practices are sexual activities involving men who have sex with men (MSM), regardless of their sexual orientation or sexual identity. The authors of the 1948 Kinsey Reports state that 37% of their male subjects had had at least one homosexual experience. Evidence shows that sex between men is significantly underreported in surveys due to social desirability bias.

Activities
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. MSM may also 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." 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.

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. 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. 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. A study sampling single people in the U.S. indicated that orgasm rates are similar among men across sexual orientations. With regard to pain or being uncomfortable during anal sex, 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. In a large sample (n = ~25,000) of U.S. gay and bisexual men, about 86% of those who bottomed in their last sexual encounter described the penetration in that event as being a little or not at all painful; around 5% described it as extremely or quite a bit painful.

Reports pertaining to the prevalence of anal sex among MSM have varied over time, with some percentages higher than others. A large percentage of gay and bisexual men self-report lifetime participation in anal sex. 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. Some men who have sex with men, however, believe that being a receptive partner during anal sex questions their masculinity.

With regard to non-penetrative sex, there is also variety. Frot is a form of male-male sexual activity that usually involves direct penis-to-penis contact. 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.

Various sex positions may be performed. In one study of U.K. and U.S. respondents, those respondents who identified as gay reported that doggy style, missionary, 69, oral, and anal (in that order) were their favorite sex positions. MSM may also engage in BDSM or use sex toys. A nationally representative survey carried out in Australia from 2001 to 2002 found that, in the 12 months prior to the survey, 4.4% of gay men and 14.2% of bisexual men participated in BDSM-related sexual activities, and 19.2% of gay men and 36.4% of bisexual men used sex toys. A non-representative, questionnaires-based survey on the sexual behavior of American students published in 1997 found 24% of gay and bisexual men had experience with spanking as a sexual practice. Among medicine students in North America, 6% of gay men and 17% of bisexual men reported ever receiving pain for sexual pleasure, and 5% of gay men and 9% of bisexual men reported inflicting pain for this purpose. According to an online survey of over 25,000 men who self-report a homosexual or bisexual orientation, 49.8% have ever 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%).

A study sampling single people in the U.S. indicated that rates of orgasm achieved with a familiar partner are similar among men across sexual orientations. Research indicates that MSM are much more apt to both achieve orgasm and find sex very or extremely pleasurable when it is with a stable partner, or someone they are in love with. The same has been observed in a sample representative of the general U.S. male population (91% heterosexual).

For trans men who still have a vagina and partake in sex with cisgender men, sex may involve penile penetration of the vagina.

Health risks
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."

Acquired immune deficiency syndrome (AIDS) is a disease of the human immune system caused by the human immunodeficiency virus (HIV). Worldwide, an estimated 5–10% of HIV infections are the result of men having sex with men. However, in most of the Western world, more HIV infections are transmitted by men having sex with men than by any other transmission route. In the United States, gay and bisexual men accounted for 54% of HIV/AIDS cases and 67% of new diagnoses in 2014. Of the 5,164 people diagnosed with HIV in the UK in 2016, 54% were gay or bisexual men. This statistic is decreasing in London as reported by Public Health England in 2017.

Syphilis is passed from person to person through direct contact with a syphilis sore; mainly on the external genitals, the vagina, or anus. In 2006, 64% of the reported cases in the United States were among men who have sex with men. 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. Some studies utilizing convenience samples have concluded that such rise can be attributed to increased rates of sex without a condom among MSM, 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.

According to a US survey, HIV, syphilis, and anal warts are both 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.