If one associates high level of sexual desire and frequency of sexual activity with a problem, they might fail to recognize sexual diversity. Interestingly, another body of work has highlighted HSDD as the most frequent sexual dysfunction among gay men together with anodyspareunia [ 63 ]. Studies suggested HSDD prevalence rates between 8. Using the dual control model of the sexual response [ 69 ], in which sexual excitation and inhibition regulate the expression of desire and arousal, Kowalczyk et al. However, MSM were more inhibited to the threat of negative sexual response consequences and complained more often of diminished levels of sexual desire compared to other men.
Overall, same-sex partners have shown to be more concordant in their views of intimacy and levels of sexual desire than opposite sex partners [ 39 ]. Men in same-sex couples seem to be more likely to agree on having sexual relationships outside the committed relationship consensual non-monogamous relationships or open couples.
This choice does not seem to impact the well-being of the relationship as the partners are able to separate sexuality from emotional intimacy [ 71 ]. Gay couples often establish rules to prevent possible emotional bonds with sexual partners outside the relationship [ 38 ]. These agreements do not seem to influence the emotional work devoted to maintaining intimacy in their long-term relationship [ 39 ].
In some cases, the ability to share their sexual repertoire with other people e. That said, generalizing gay relationship with open, non-monogamous couples is reductive. Many men opt for meaningful and satisfying monogamous long-term relationships based on fidelity, trust, and security. Yet, the non-monogamy stereotype of gay relationships persists, and the desire for monogamy is described as old-fashioned, utopist, or insecure.
Such arguments fail to consider the importance for some men to adhere to social norms and cultural values e. Research on gay relationships and sexual desire indicates that men may find different strategies and compromises to deal with sexual diversity, intimacy, and fidelity [ 74 ].
Clinicians should be aware that men could experience tension balancing their desires for stable and secure relationships with sexual opportunities available in the gay community and be mindful of their own prejudices and beliefs [ 75 ]. Although gay and heterosexual men might be more similar than they are different in their experience of sexual drive [ 30 ], factors such as negative stereotypes and stigmatization may impact how gay men express and interpret their desire [ 76 , 77 ].
Bancroft et al. Hiding homosexual fantasies and desire is strongly associated with a perceived negative social climate regarding same-sex sexual behavior and may be functional for some men in dangerous contexts, such as some Arabic countries [ 79 ]. However, it is usually related to worse sexual satisfaction [ 20 ].
Coming out and self-disclosure should be better investigated in relation to their possible effects on sexual desire, both at individual and couple level. Creating sexual values inside romantic relationships predicted higher sexual satisfaction and dyadic sexual desire [ 80 ]. Among male sexual minority adolescents and adults, psychosocial concerns, stigma, and perceived vulnerability to HIV are widely common [ 81 ].
MSM frequently report more distractive thoughts related to fear of STIs compared to heterosexual men [ 82 ]. Conversely, some men may cope with a new diagnosis of HIV infection increasing their sexual activity and desire [ 78 , 84 ]. This relates to coping strategies to manage high anxiety and depression rates and defense mechanisms such as denial.
This reaction to trauma is often associated with higher risk-taking such as substance consumption, unprotected sex, and therapy drop-out. Older age, being single, and less satisfied with general health and sexual desire were factors associated with sexual withdrawal in HIV gay men [ 85 ]. Nevertheless, HIV fear and stigma may still play an important role in explaining higher rates of sexual desire problems among gay men [ 63 ] and should be investigated during sexual health assessments.
These results may also suggest the need to deepen the relationship between sexual desire, sexual activity, and reactions to HIV infection in order to improve care. Sexual beliefs seem to be important vulnerability factors for sexual desire problems in MSM. Even if a discussion of the chemsex phenomenon is out of the aims of the current review, Weatherburn et al. For some men suffering from lack of sexual desire, the use of drugs enhancing and prolonging the sexual activity represents a momentary relief. Being more disinhibited allowed them to engage in sexual experiences that they desire.
In this sense, it should be recognized how the use of drugs, although very risky and harmful, may allow a different kind of liberation and a pleasurable sexual experience for some gay men [ 87 ]. Early studies [ 89 , 90 ] highlighted that gay men seem to engage more frequently in erotic fantasies than heterosexuals, both during masturbation and partnered sexual activity. Gay men seem to be principally triggered by visual stimuli and oriented to body parts rather than real partners.
An Italian study partially confirmed these premises, recognizing a central role to physical, emotional, and relational elements in the imagery [ 91 ]. Gay men reported more fantasies concerning exploratory e. No difference was found in paraphilic-related fantasies [ 92 ].
Schmitt [ 93 ] showed that gay men fantasize about having more than one sexual partner more often than heterosexual men, but less than bisexual men. Some MSM engage in online chat fantasizing about barebacking activities e.
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Cuckolding fantasies sexual arousal obtained by having a romantic partner engaging in sexual activity with someone else were addressed in gay men, sharing many common elements with heterosexual-oriented studies on this topic. Frequent cuckolding fantasies were linked to several overlapping sexual interests such as group sex and voyeurism [ 95 ]. Gay men in the BDSM community showed a high frequency of fantasies including leather outfits, wrestling, special equipment and uniform scenes, rimming, anal intercourse, and dildos [ 96 ].
BDSMers seem to be more satisfied and less concerned about sexuality than the general population [ 97 ]. Overall, it should be recognized how giving space to personal erotic fantasies, sharing and exploring them in a safe environment might have a positive outcome on sexual satisfaction and quality of life [ 96 , 97 ]. Lesbian and gay people showed a variety of sexual expressions that are hard to categorize referring to heteronormative sexual standards that are predominant in literature and clinical practice.
Although sexual desire levels and related dysfunctions may not significantly differ from heterosexual cisgender people, evidence showed that lesbian and gay people may have specific sexual expressions and biopsychosocial factors influencing their sexual health. Negative sexual beliefs and attitudes may represent barriers to access to sexual health care. Accepting sexual fantasies and supporting disclosure with partners are important tools in sexual therapy and might foster personal growth and couple intimacy [ 98 ]. In this sense, professionals who attended educational programs in sexology seem to be the best references, for their formation and their personal attitudes, for clinical work with gay and lesbian patients complaining about sexual problems [ 99 ].
This review has some limitations that should be considered. Some studies did not differentiate between sexual orientation e. Considering the whole range of sexual possibilities, the scenery may sensibly change [ ]. Due to these limitations, comparing and discussing evidences was quite challenging and the findings should be interpreted with caution.
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