For the majority of the twentieth century research on lesbians and gay men focused on a circumscribed number of topics based on an understanding of homosexuality as a mental illness, most particularly “curing” or treating same-sex arousal.  Upon its removal from the Diagnostic and Statistical Manual of Mental Disorders (DSM) in 1973, research that would have been unthinkable a few years earlier began to occur, including efforts to promote the mental health of gays and lesbians.[i]    It was soon determined that one of the major challenges was simply defining “lesbian” and “gay.” Is a woman a lesbian if she has a strong attraction to other females but is married to a male and never engaged in same-sex sexual activity?  Is a male who has sex with other males but considers himself “straight” really gay or bisexual?  Does simply labeling oneself a lesbian or gay man make one so?  It is questions like these that researchers must consider in their study designs.

Almost all studies define sexual orientation based on at least one of the three following indicators:

  1. Attraction
  2. Sexual behavior
  3. Self-identification

It is strongly urged that researchers use at least two of these identity markers when formulating a study design. Those that do not risk misidentifying study subjects.  For example, a 2013 article examining sexual orientation research concluded that many studies ask subjects to merely describe their sexual behaviors during the past year.  As such, if a bisexual male is in a monogamous relationship during that time with a same-sex partner, he is identified as a gay man.  If he is with an opposite sex partner he is identified as heterosexual.[ii]  Regardless, he calls himself a bisexual, an identity that will not be captured in studies relying strictly on sexual behavior to identify orientation.  The uncontested exemplar however of the complex interactions amongst attraction, behavior, and identity remains “straight men who have sex with other men.” (SMSM) (And now given the unwieldy moniker “non-gay identified men who have sex with other men”).

Studies repeatedly find a number of men who classify themselves as straight or heterosexual in spite of engagement in sexual contact with other males.  A 2006 study published in the Annals of Internal Medicine, the largest of its kind to that date, found discordance between self-reported sexual behavior and self-reported sexual identity and that many men who had sex with other men did not necessarily identify as gay.  In addition, approximately 10% of straight men in the survey said they only had sex with other men.[iii]​  A 2005 report found SMSM interviewees strongly disagreed with labeling themselves as gay: “Many of the respondents indicated that, for both themselves and society, the term gay suggest that a man is effeminate, weak, and somehow less of a man, and that a gay man is “different” from other men.”[iv]  

For some men, sexual activity with another male “does not require a definition or identity” and is simply an act that “provides sexual pleasure, and it is not seen as anything more profound.”[v]  For others though same-sex sexual activity leads to ambivalence, guilt or shame, and is a source of discomfort.  A 2013 study found that almost 80% of SMSM did not reveal their same-sex sexual activities to others in their lives, particularly female romantic partners and spouses. Over 50% of participants reported that having sex with other males was too embarrassing to share with others in their lives, and 63% would lie if asked if they had engaged in same-sex sexual activity.[vi]  Similar findings are replicated throughout the database on this population.

In sum, research has identified a population of males who consider themselves heterosexual, do not label themselves gay or bisexual, who eschew involvement with the LGBT community, who are often married or romantically involved with an opposite-sex partner, and who engage in sex with males or express the desire to do so.  This classification of SMSM is a source of lively debate in the fields of public health, psychology, and sexology. It is also a source of consternation for the general public since it challenges the traditional and for many the unyielding belief that sexual behavior is indicative of identity. 

The next posting in this series will examine how SMSM elucidate their own sexual behavior, which we will see encompasses a multitude of explanations, including recreation, sport, novelty, high sex drive, alcohol and other substance use, and accident.

References

[i] Jeremy Grey, Beatrice ‘‘Bean’’ E. Robinson, Eli Coleman, and Walter O. Bockting, “A Systematic Review of Instruments that Measure Attitudes Toward Homosexual Men,” Journal of Sex Research 50, no. 3-4 (2013).

[ii] Greta Bauer and David Brennan, “The Problem with ‘Behavioral Bisexuality’:  Assessing Sexual Orientation in Survey Research,” Journal of Bisexuality 13, no.2  (2013)

[iii] Preeti Pathela, Anjum Hajat, Julia Schillinger, Susan Blank, Randall Sell, and Farzad Mostashari, “Discordance between Sexual Behavior and Self-Reported Sexual Identity: A Population-Based Survey of New York City Men,” Annals of Internal Medicine 145, no. 6 (2006).

[iv]STD Communications Database: Interviews with Non-Gay Identified Men who have Sex with Men (NGI MSM),” (Atlanta, Georgia: Orc Macro, 2005): vi.

[v] Jeffrey H. Hudson, “Comprehensive Literature Review Pertaining to Married Men Who Have Sex with Men (MMSM),” Journal of Bisexuality 13, no. 4 (2013): 497.

[vi] Eric W. Schrimshaw, Karolynn Siegel, Martin J. Downing, Jr., and Jeffrey T. Parsons, “Disclosure and Concealment of Sexual Orientation and the Mental Health of Non-Gay-Identified, Behaviorally-Bisexual Men,” Journal of Consulting Clinical Psychology 81, no. 1 (2013).

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