Men who have sex with men (MSM) are men who engage in sexual activity with other men, regardless of their sexual orientation or sexual identity. The term was created by epidemiologists in the 1990s, to better study and communicate the spread of sexually transmitted infections such as HIV/AIDS between all sexually active males, not strictly those identifying as gay, bisexual, pansexual or various other sexualities, but also for example male prostitutes. The term is often used in medical literature and social research to describe such men as a group. It does not describe any specific kind of sexual activity, and which activities are covered by the term depends on context. The alternative term "males who have sex with males" is sometimes considered more accurate in cases where those described may not be legal adults.
As a constructed category The term men who have sex with men had been in use in public health discussions, especially in the context of HIV/AIDS, since 1990 or earlier, but the coining of the initialism by Glick et al. in 1994 "signaled the crystallization of a new concept." This behavioral concept comes from two distinct academic perspectives. First, it was pursued by epidemiologists seeking behavioral categories that would offer better analytical concepts for the study of disease-risk than identity-based categories (such as "gay", "bisexual", or "straight"), because a man who self-identifies as straight may nonetheless be sexually active with other men; similarly, a man who self-identifies as gay or bisexual is not necessarily sexually active with other men. Second, the concept's usage is tied to criticism of sexual identity terms prevalent in social construction literature, which typically rejected the use of identity-based concepts across cultural and historical contexts. The Huffington Post postulates that the term MSM was created by Cleo Manago, who is also credited for coining the term "same gender loving" (SGL). MSM are not limited to small, self-identified, and visible sub-populations. MSM and gay refer to different things: behaviors and social identities. MSM refers to sexual activities between men, regardless of how they identify, whereas gay can include those activities but is more broadly seen as a cultural identity. Homosexuality refers to sexual/romantic attraction between members of the same sex and may or may not include romantic relationships. Gay is a social identity and is generally the preferred social term, whereas homosexual is used in formal contexts, though the terms are not entirely interchangeable. Men who are non-heterosexual or questioning may identify with all, none, a combination of these, or one of the newer terms indicating a similar sexual, romantic, and cultural identity like bi-curious. In their assessment of the knowledge about the sexual networks and behaviors of MSM in Asia, Dowsett, Grierson and McNally concluded that the category of MSM does not correspond to a single social identity in any of the countries they studied. There were no similar traits in all of the MSM population studied, other than them being males and engaging in sex with other men. In some countries, homosexual relationships may be illegal or taboo, making MSM difficult to reach. The term's precise use and definition has varied with regard to transgender and intersex people, who do not fall neatly into binary sex categories.
Sexual practices Historically, anal sex has been popularly associated with male homosexuality and MSM. However, many MSM do not engage in anal sex, and may engage in oral sex, frotting or mutual masturbation instead. 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 engage in either role may be referred to as versatile—with those who do not prefer/practice anal sex being referred to as side.
Number of sexual partners 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." According to the 2013 NATSAL (a representative population study in the UK), MSM typically had 17 lifetime sexual partners (median), which included all forms of sexual contact including oral and anal sex. An epidemiological article in The BMJ reported that national probability surveys like the NATSAL have been found to better reflect the population of MSM but are limited by their smaller samples of MSM. Convenience sample surveys recruit larger samples of MSM but tend to over-represent MSM identifying as gay and reporting more sexual risk behaviors.
Health issues
Sexually transmitted infections
Among men who have anal sex with other men, anal sex without use of a condom is considered to be high-risk for STI transmission. A person who inserts their penis into an infected partner is at risk because sexually transmitted infections (STIs) can enter through the urethra or through small cuts, abrasions, or open sores on the penis. Also, condoms are more likely to break during anal sex than during vaginal sex. Thus, even with a condom, anal sex can be risky.
HIV/AIDS
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