Understand important health issues for gay men and men who have sex with men — from sexually transmitted infections to depression — and get tips for taking charge of your health.By Mayo Clinic Staff
All men face certain health risks. However, gay men and men who have sex with men have some specific health concerns.
Although your individual risks are shaped by many factors beyond your sexual orientation and practices — including family history and age — it's important to understand common health issues for gay men and steps you can take to stay healthy.
Men who have sex with men are at increased risk of contracting HIV, the virus that causes AIDS, as well as other sexually transmitted infections, including hepatitis, human papillomavirus (HPV), herpes simplex, gonorrhea, chlamydia and syphilis.
To protect yourself from sexually transmitted infections:
Use a condom or other protection. Use a new latex or polyurethane condom every time you have sex, especially during anal sex but ideally during oral sex as well.
Use only water-based lubricants, not petroleum jelly, hand lotion, cold cream or oils. Oil-based lubricants can weaken latex condoms and cause them to break. Don't share sex toys, and keep them safe by protecting them with a condom and cleaning them before and after every use.
- Be monogamous. Another reliable way to avoid sexually transmitted infections is to stay in a long-term mutually monogamous relationship with a partner who isn't infected.
- Limit the amount of alcohol you drink, and don't use drugs. If you're under the influence, you're more likely to take sexual risks. If you choose to use injectable drugs, don't share needles.
- Know the risks associated with sexual venues. Sexual venues such as bathhouses, sex parties and the Internet can facilitate multiple sexual partnerships and anonymous sexual encounters, as well as higher risk sexual behaviors.
Get vaccinated. Vaccinations can protect you from hepatitis A and hepatitis B, serious liver infections that can spread through sexual contact.
Not all sexually transmitted infections are prevented by vaccines, however. Hepatitis C is not covered by any vaccine and can lead to liver failure, liver cancer and death. The HPV vaccine is available to men up to age 26. HPV is associated with anal cancer in men who have sex with men.
Get tested and have your partner tested. Don't have unprotected sex unless you're certain you and your partner aren't infected with HIV or other sexually transmitted infections.
Testing is important because many people don't know they're infected, and others might not be honest about their health.
Different types of tests have a different "window period," the period of time between HIV infection and when signs of the infection show up on a test. Being tested during this time might result in a false negative. It is possible to transmit the HIV infection to someone during this period.
Consider the drug Truvada. In July 2012, the Food and Drug Administration (FDA) approved the use of the drug emtricitabine-tenofovir (Truvada) to reduce the risk of sexually transmitted HIV infection in those who are at high risk. Truvada is also used as an HIV treatment along with other medications.
When used to help prevent HIV infection, Truvada is only appropriate if your doctor is certain you don't already have an HIV or hepatitis B infection. The drug must also be taken daily exactly as prescribed. And it should only be used along with other prevention strategies such as condom use every time you have sex.
Gay men and men who have sex with men might be at higher risk of depression and anxiety. In addition, youth who identify themselves as lesbian, gay, bisexual or transgender might have a higher risk of depression and attempted suicide.
Contributing factors could include social alienation, discrimination, rejection by loved ones, abuse and violence. The problem might be more severe for men who try to hide their sexual orientation and those who lack social support.
Left untreated, depression can lead to risky sexual behavior and a downward spiral of emotional, behavioral, health, and even legal and financial problems. If you think you might be depressed, talk to your doctor or seek help from a mental health provider.
If you're reluctant to seek treatment, confide in a trusted friend or loved one. Sharing your feelings might be the first step toward getting treatment.
Gay men are more likely to experience body image problems and eating disorders, such as anorexia and bulimia nervosa, than are their straight counterparts.
One potential explanation is that gay men identify with the cultural value placed on an ideal — yet often unattainable — body image. Gay men might also be more likely to view their bodies as sexual objects, which can lead to dissatisfaction and poor body image.
If you're struggling with body image concerns or an eating disorder, get help. Talk to your doctor or a mental health provider about treatment options.
Gay and bisexual men might face unique risk factors for substance abuse, such as:
- Relying on bars and clubs for socializing and peer support
- Stress related to passing as a heterosexual or coming out
- Trauma due to bullying, violence, abuse or self-abuse
- Impact of discrimination
If you have a substance abuse concern, remember that help is available. Local lesbian, gay, bisexual and transgender health, mental health or community centers often provide substance abuse treatment. Organizations such as the Gay and Lesbian Medical Association also may provide referrals.
Domestic violence can affect anyone in an intimate relationship. Warning signs specific to gay men might include a partner who:
- Threatens to tell friends, loved ones, colleagues or community members your sexual orientation
- Tells you that authorities won't help a sexual minority person
- Tells you that leaving the relationship means you're admitting that same-sex relationships are deviant
- Tells you that domestic violence is a normal part of same-sex relationships or that men are naturally violent
Staying in an abusive relationship might leave you depressed, anxious or hopeless. If you don't want to disclose your sexual orientation, you might be less likely to seek help after an assault. Still, the only way to break the cycle of domestic violence is to take action — the sooner the better.
If you're a target of domestic violence, tell someone about the abuse, whether it's a friend, loved one, health care provider or other close contact. Consider calling a domestic violence hotline and creating a plan to leave your abuser.
Don't let fear of homophobia or the stigma associated with homosexuality prevent you from seeking routine health care. Instead, take charge of your health.
Look for a doctor who puts you at ease. Identify yourself as gay or bisexual, and ask about routine screenings recommended for men in your age group — such as blood pressure and cholesterol measurements and screenings for prostate, testicular and colon cancer.
If you're not in a long-term, mutually monogamous relationship, schedule regular screenings for sexually transmitted infections. Share any other health concerns you might have with your doctor as well. Early diagnosis and treatment help promote long-term health.
Aug. 15, 2014
- Makadon HJ. Primary care of gay men. http://www.uptodate.com/home. Accessed June 24, 2014.
- The health of lesbian, gay, bisexual, and transgender people: Building a foundation for better understanding. Institute of Medicine. http://www.iom.edu/. Accessed June 24, 2014.
- What gay, bisexual and other men who have sex with men need to know about sexually transmitted diseases. National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention. http://www.cdc.gov/std/life-stages-populations/STDFact-MSM.htm. Accessed June 24, 2014.
- Sexually transmitted diseases: Treatment guidelines, 2010: Clinical prevention guidance. Centers for Disease Control and Prevention. http://www.cdc.gov/std/treatment/2010/clinical.htm#pm. Accessed June 24, 2014.
- FDA approves first medication to reduce HIV risk. U.S. Food and Drug Administration. http://www.fda.gov/ForConsumers/ConsumerUpdates/ucm311821.htm. Accessed June 24, 2014.
- Stigma and discrimination. Centers for Disease Control and Prevention. http://www.cdc.gov/msmhealth/stigma-and-discrimination.htm. Accessed June 24, 2014.
- Lesbian, gay, bisexual, and transgender health. HealthyPeople.gov. http://www.healthypeople.gov/2020/topicsobjectives2020/overview.aspx?topicid=25. Accessed June 24, 2014.
- Intimate partner abuse and relationship violence. American Psychological Association. http://www.apa.org/about/division/activities/abuse.aspx. Accessed June 24, 2014.
- Top 10 things gay men should discuss with their healthcare provider. Gay and Lesbian Medical Association. http://www.glma.org/. Accessed June 24, 2014.
- Makadon HJ, et al. The Fenway Guide to Lesbian, Gay, Bisexual and Transgender Healthcare. Philadelphia, Pa.: American College of Physicians; 2008:253.
- Feldman MB, et al. A group intervention to improve body image satisfaction and dietary habits in gay and bisexual men living with HIV/AIDS. Eating Disorders: The Journal of Treatment and Prevention. 2011;19:377.
- Nippoldt T (expert opinion). Mayo Clinic, Rochester, Minn. July 11, 2014.
- How can people prevent HPV? Centers for Disease Control and Prevention. http://www.cdc.gov/hpv/prevention.html. Accessed July 13, 2014.