Ask the Doc :: The Sadly Lacking Research on Same Sex Intimacy

Sexual medicine has a problem. There's a serious lack of sexual health research that includes gay men in any way other than as a way to study diseases. The same studies that address the problems of heterosexual couples don't often include gay couples, and the ones that do rarely address the unique issues that arise in same sex relationships.

In this edition of Ask a Doc, sexual health expert and physician in residence at Roman Health Dr. Michael Reitano shines the spotlight on how sexual health studies handle erectile dysfunction in same sex relationships-emphasis on relationships.

Same Sex Health Representation and ED

Q: Are gay men accurately represented in sexual health studies for erectile dysfunction?

A: Recently, I searched Google Scholar for "Men Sildenafil, Viagra" and the top articles had titles like:

"Efficacy and safety of oral sildenafil (Viagra) in men with erectile dysfunction caused by spinal cord injury"

"Use of sildenafil (Viagra) in patients with cardiovascular disease."
Only one article included data specifically related to gay men, and it was in the last line of the abstract (the summary at the top). The abstract stated:

"Viagra use appears to have become a stable fixture of the sexual culture of MSM, crossing age, race, and socioeconomic subgroups. Its use is associated with a general behavioral risk pattern for HIV/STD transmission."

It's disconcerting that the gay population is approached as a monolithic group that's promiscuous, prone to unsafe sex, and vulnerable to disease. Yes, it's vital that attention be given to the health concerns that can affect the gay population. However, the only thing worse than paying too much attention is paying too little.

The fact is, the lifestyle issues that are important to heterosexual couples are equally important to same sex couples. And they've been relatively ignored by sexual health studies.

The Gay Bias in Health Studies

Q: How do these studies even address sexuality in their research?

A:. In my experience, I've found questions related to recent sexual activity a much more reliable indicator of sexual habits than asking whether someone has ever engaged in some sort of sex. For instance, there's a big difference between-"Have you had receptive anal sex recently?" vs. "Have you ever had receptive anal sex?"

Contrary to what many people-and unfortunately what many doctors believe-the sexual intimacy gay and bisexual men share is not significantly different from what is sought by men in heterosexual relationships.

One 2011 study in the Journal of Sexual Medicine, conducted a survey of nearly 25,000 gay and bisexual men. They asked detailed questions about their most recent sexual encounter, and the findings were fascinating precisely because they weren't very fascinating. The survey found the most commonly reported behaviors in gay and bisexual men were:

Kissing a partner on the mouth (74.5%)
Oral sex (72.7%)
Partnered masturbation (68.4%)

Anal intercourse occurred in only about a third of the interactions. That's higher than the percentage of anal intercourse in heterosexual contexts, but not by much.

Anal intercourse was most common among gay and bisexual men ages 18-24 (42.7%) while anal sex was at least a part of the sexual repertoire in nearly 25% of heterosexual couples in their 20s.

The very conservative conclusion of the study was simply that "Gay and bisexually identified men have a diverse sexual repertoire and that partnered sexual behaviors are not limited solely to acts of penile insertion." Not exactly groundbreaking research, but it does expose a bias in the health community towards studying same sex partners as some kind of medical anomaly with different behaviors ands risk factors, when all the evidence points to the contrary.

So, What Does This Mean for Erectile Dysfunction?

In terms of erectile dysfunction, gay couples can't be approached as the equivalent of a male in a relationship with another male who plays the role of a female substituting anal sex for vaginal penetration. There's no substitute for an individualized and detailed sexual history-one that includes the sexual practices most often experienced and how erectile dysfunction limits the
couple's (not just an individual's) enjoyment of sex.

There shouldn't be any assumptions about what constitutes a satisfactory erection based on the ability to penetrate a partner, and healthcare providers should be open to helping the couple achieve their individual, and perhaps unique, goals.

Both men in a couple deserve to have a frank discussion about their lifestyle and sexual intimacy choices, and how their healthcare provider can help them achieve their goals.

***

Dr. Michael Reitano is currently the Physician in Residence for Roman Health, a men's health company based in New York. He is a nationally recognized physician who specializes in sexual health and wellness.

His clinical research has been published in prestigious medical journals, he is an author of several books on STD'S, and was the founding editor of Sexual Health Magazine.