How Do Gay Men Have Sex? Practices, Positions, and Safety

Gay men have sex in a wide variety of ways, and anal intercourse is only one part of the picture. Survey data consistently show that kissing, oral sex, mutual masturbation, body contact, and rimming are all common practices, sometimes more common than penetration itself. A large cross-sectional study of gay and bisexual men in Melbourne found that kissing was the single most frequent activity with casual partners, reported by over 92% of participants, with oral sex close behind.¹ Understanding the full range of what happens between men sexually, and the health and relationship dynamics that go with it, gives a far more accurate picture than the stereotypes suggest.

More Than Penetration

One of the most persistent misconceptions is that sex between men is defined by anal intercourse. In reality, many encounters involve no penetration at all. A U.S. national sample comparing sexual practices found that gay men in relationships were more likely than heterosexual men to both give and receive oral sex regularly: roughly 61% of gay men usually or always received oral sex during intimacy in the prior month, compared with 27% of heterosexual men.² The same study found that deep kissing, gentle kissing, and saying “I love you” during sex were common in both groups, with gay couples slightly more likely to engage in deep kissing. Viewing pornography together was also more common among gay couples.

A cross-sectional study of over 1,500 sex episodes between men and casual male partners mapped out how activities cluster together in a single encounter. The most common single combination was all nine tracked activities happening in one session, including kissing, penises touching, mutual masturbation with saliva, rimming (both giving and receiving), fellatio (both giving and receiving), and both insertive and receptive anal sex.³ That full combination accounted for about 11% of episodes, meaning the other 89% involved some smaller subset. The point is that sexual encounters between men are typically a mix-and-match of activities, not a single act.

Oral Sex and Rimming

Oral sex is central to most sexual encounters between men. In a study of over 2,300 men who have sex with men, about 89% had performed fellatio on at least one male partner in the prior three months, with a median of two partners.⁴ Fellatio is often treated as lower-stakes than anal sex, and in terms of HIV transmission it carries substantially less risk, but it is not risk-free for other infections. That same study found that the number of fellatio partners was not significantly associated with oropharyngeal gonorrhea, while the number of kissing and rimming partners was.

Rimming, oral-anal contact, has become more common over recent decades. An Australian longitudinal dataset tracking gay men’s behavior from 1986 to 2003 found that rimming a casual partner increased from under 18% among HIV-negative men in the late 1980s to over 52% by the early 2000s.⁵ Among HIV-positive men, the increase was even steeper. More recent data from the Melbourne cross-sectional study put giving rimming at about 38% and receiving it at about 46% among casual partners, making it the least common of the major tracked activities but still practiced by a substantial minority.⁶ Rimming tends to pair with anal intercourse in the same session: statistical agreement between receiving rimming and receptive anal sex was the strongest of any two-activity pair measured in one study.⁷

Anal Intercourse and Positional Preferences

When anal sex does happen, the question of who penetrates whom matters to many gay men, both practically and as part of sexual identity. The terms “top” (insertive), “bottom” (receptive), and “versatile” (both) are widely used. Research suggests these labels develop over time. A survey of 282 gay and bisexual men found that men’s sexual position self-label was learned across roughly a 15-year span, influenced by factors including pleasure, sense of control, anxieties, and how masculine or feminine a man perceived himself to be.⁸

In practice, versatility is the norm rather than the exception. An Australian study of men who had anal intercourse in the prior year found that 83% had engaged in both insertive and receptive anal sex, and 57% of those were highly versatile, meaning they had roughly equal numbers of partners for each role. As many as one in five men who had anal sex in their most recent encounter had both insertive and receptive anal sex with the same partner during that single session.⁹ The popular idea that most gay men slot neatly into one fixed role does not hold up in the data.

When a man’s preferred role does not match what he does in practice, it can affect satisfaction in interesting ways. A study of same-sex male couples found that tops who bottomed in their relationships reported lower sexual satisfaction due to the mismatch, but paradoxically reported higher relationship satisfaction. The researchers suggested this might reflect sexual altruism: doing something for a partner’s pleasure even when it is not your preference can strengthen the bond overall.¹⁰

Pleasure, Pain, and the Prostate

The prostate gland, located a few inches inside the rectum along the front wall, is often described in popular sources as a reliable pleasure center during receptive anal sex. The reality is more individual than that. A study mapping the subjective experience of receptive anal intercourse among people with prostates found that pleasure was experienced in multiple areas, not just the prostate region, and that for some individuals the prostate was not the primary source of pleasure at all.¹¹ Sensations from the anal sphincter, the rectal walls, and deeper internal pressure all contribute. The takeaway is that bottoming feels different for different people, and the “male G-spot” framing oversimplifies a more varied experience.

Pain during receptive anal sex, sometimes called anodyspareunia, is a real and underreported concern. A narrative review found that the risk of discomfort increases with an overactive pelvic floor, emotional tension, insufficient lubrication, frequency of anal penetration, and rough practices.¹² Relaxation is a major factor, both physical and psychological. Men who feel anxious, rushed, or pressured are more likely to experience pain because the pelvic floor muscles tighten involuntarily. Using adequate lubrication, proceeding gradually, and communicating openly with a partner all reduce the risk considerably.

Why Lubrication Matters

Unlike the vagina, the rectum does not produce its own lubrication, so external lubricant is essential for comfortable and safer anal sex. But not all lubricants are equally suitable. An in-vitro study testing commercial personal lubricants found that most were hyperosmolar, meaning their chemical concentration was much higher than the body’s own fluids. Exposure to these lubricants reduced the integrity of rectal epithelial cell barriers by roughly 60% within two hours, and four of the tested products significantly increased HIV replication in cell cultures.¹³

That sounds alarming, but laboratory results do not always translate directly to real-world infection risk. A follow-up study using a macaque model found that applying a highly osmolar lubricant before viral exposure did cause visible rectal tissue damage, but did not increase susceptibility to infection compared with controls. The estimated infectious dose was actually higher, not lower, in the lubricant-treated group, though the difference was not statistically significant.¹⁴ The practical advice from this research is that water-based or silicone-based lubricants with lower osmolality are the safer bet for rectal use. Oil-based products degrade latex condoms, making them a poor match for condom use.

Rectal Douching Before Sex

Many gay men douche or use enemas before receptive anal sex to clean the rectum. In one study of HIV-negative men on PrEP, about 66% reported rectal douching.¹⁵ The practice is widespread and rarely discussed in clinical settings, but it carries some health trade-offs.

That same study found that men who douched weekly or more had roughly 3.6 times the odds of prevalent rectal gonorrhea or chlamydia, and about 3.9 times the odds of acquiring a new rectal infection, compared with men who did not douche. The association held even after controlling for the number of sex partners and other risk factors. A separate study found that rectal douching was associated with signs of gut dysbiosis and elevated markers of intestinal permeability, suggesting the practice can compromise the mucosal barrier that normally helps protect against pathogens.¹⁶ If you do douche, using plain lukewarm water in moderate volumes and avoiding doing it immediately before sex may reduce these risks, though the evidence on optimal practices is still limited.

STI Prevention and Safer Sex

Unprotected receptive anal intercourse carries the highest per-act risk of HIV transmission of any common sexual activity. A systematic review and meta-analysis estimated the per-act risk of unprotected receptive anal intercourse at about 1.4%, compared with roughly 0.17% for unprotected insertive anal sex.¹⁷ These numbers reflect sex without condoms, without PrEP, and without viral suppression in the HIV-positive partner. All three of those tools dramatically change the math.

Condoms remain a straightforward and effective barrier. An event-level analysis of gay and bisexual men found that condoms were used in about 56% of anal sex events, though that proportion declined monthly over the study period as other prevention tools became more available.¹⁸ Pre-exposure prophylaxis, the daily or on-demand pill regimen known as PrEP, has become a major prevention strategy. A French nationwide study found PrEP effectiveness reached 93% among those with high adherence, though effectiveness dropped sharply among younger users and those facing socioeconomic disadvantage, largely because those groups were more likely to take the medication inconsistently or stop altogether.¹⁹

For bacterial STIs like syphilis, chlamydia, and gonorrhea, a newer tool has emerged: doxycycline post-exposure prophylaxis, or doxy-PEP, which involves taking a dose of the antibiotic doxycycline within 72 hours after sex. The CDC’s 2024 clinical guidelines note that across three large randomized trials, this approach reduced syphilis and chlamydia infections by more than 70% and gonorrhea by about 50%.²⁰ Doxy-PEP is most efficient for men who have already had a bacterial STI: a Canadian analysis found that preventing a second infection among men who had already had one required treating only about 8 men, while preventing a first infection in the general population of gay and bisexual men required treating about 60.²¹ Concerns about antibiotic resistance are active and unresolved, so this strategy is being rolled out cautiously.

Relationship Agreements and Communication

Gay male couples often negotiate explicit agreements about what sexual activity outside the relationship is or is not acceptable. A qualitative study of couples found that among those with open agreements, most set specific conditions around when, where, how often, and with whom outside sex could happen. The agreements served multiple purposes: defining the relationship’s boundaries, supporting a non-heteronormative identity, and addressing each partner’s sexual needs.²²

Getting on the same page is harder than it sounds. A study of 207 couples who agreed they had a sexual agreement found that only 58% concurred about having explicitly discussed it, and only 54% had both partners adhering to its terms. The variety of sexual behaviors endorsed within agreements also varied by agreement type, monogamous versus open.²³ The research underscores that having a conversation once is not the same as having a shared understanding. Couples who revisit their agreement regularly and spell out specifics, rather than relying on assumptions, tend to have better concordance.

Sex Toys

Sex toys are widely used and generally treated as a normal part of the repertoire. A large U.S. survey of gay and bisexually identified men found that about 79% had used at least one type of sex toy. Dildos were the most common at 62%, followed by non-vibrating cock rings at 52%, vibrators at 50%, butt plugs at 34%, masturbation sleeves at 28%, and anal beads at 19%.²⁴ Among men who used insertable toys like dildos or butt plugs, the vast majority used them during solo masturbation, and about 72% also used them during partnered sex. Participants in that study generally reported that toys enhanced the quality of their sexual experiences.

Chemsex

The term “chemsex” refers to the intentional use of specific drugs, most commonly methamphetamine, GHB/GBL, and mephedrone, before or during sex. It is distinct from simply drinking alcohol before a hookup. An Australian survey of gay and bisexual men found that about a third reported engaging in chemsex in the past year.²⁵ Those who engaged in chemsex reported higher levels of psychological distress alongside higher sexual self-esteem and satisfaction with their sex lives, a combination that points to the complexity of the phenomenon. They were also more likely to engage in group sex and to report lower connectedness to the broader LGBT community. Chemsex is a public health concern because the substances involved can impair judgment around safer sex practices and carry their own risks of overdose and dependency, but it is also an area where stigma and shame can prevent men from seeking help.²⁶

How Affection Fits In

Discussions of gay male sex sometimes focus so narrowly on mechanics and risk that they leave out the emotional dimension entirely. The U.S. national comparison study found that a majority of gay men in relationships reported expressing affection during their last sexual encounter, including saying “I love you” (57%), deep kissing (75%), and gentle kissing (72%).²⁷ Gay men were actually more likely than heterosexual men to engage in deep kissing during sex. The rates of verbal and physical affection were broadly similar across orientations, a reminder that intimacy between men in romantic relationships looks much like intimacy in any other relationship, with the same mix of physical pleasure and emotional connection.