M4m

For other uses, see Measure for Measure.


Men, such as these celebrants at Tel Aviv's gay nightclub Barzilay Venue (2009), may never identify as men who have sex with men but researchers do so for a variety of reasons.

Men who have sex with men or males who have sex with males (MSM) refers to men who engage in sexual activity with other men, regardless of how they identify themselves; many choose not to accept social identities of gay or bisexual. The term was created in the 1990s by epidemiologists in order to study the spread of disease among men who have sex with men, regardless of identity. Down-low, in same-sex sexual contexts, is slang for MSMs who may also be closeted about being non-heterosexual.
MSM is often used in medical literature and social research to describe such men as a group for clinical study without considering issues of sexual self-identity.


MSM as behavioral category
Young and Meyer (2005) note that the term has been in use within the public health discourse since 1990 or earlier, but that the coining of the initialism by Glick et al. (1994) "signaled the crystallization of a new concept." They trace the emergence of this behavioural concept to 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 gay or bisexual is not necessarily sexually active with men and someone who identifies as straight might be. Second, its 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.
MSM as a construct
As a risk category, MSM are not limited to small, self-identified, and visible sub-populations.

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 men, and may or may not extend to romantic relationships with the same sex.

Gay is a social identity and is the preferred social term, whereas homosexual is used in scientific contexts.
In their assessment of the knowledge about the sexual networks and behaviors of MSMs 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.
Applying MSM to trangender individuals
The term's precise use and definition has varied with regard to transwomen, people born either biologically male or with ambiguous genitalia who now identify as female. Some sources consider transwomen to be MSM, others considering transwomen "along side" MSM, and others are internally inconsistent (defining transgender women to be MSM in one place but referring to "MSM and transgender" in another).
Health issues
When two males have sexual intercourse, there is not a possibility of reproduction. All human sexual behavior that involves contact with the bodily fluids of another person should be considered to have some risk of transmission of sexually transmitted infections (STIs).Although the likelihood of transmitting infection varies a great deal by activity, in general all sexual activities between two (or more) people should be considered a two-way route for the transmission of STIs; "giving" or "receiving" are both risky, although receiving carries a higher risk.
Physical
Sex has many health benefits, including relieving stress, boosting the immune system with higher levels of immunoglobulin A, improving cardiovascular health, increasing self-esteem, improving intimacy, reducing pain by production of the hormone oxytocin, reducing the risk of prostate cancer, strengthens pelvic muscles, and promoting good sleep. Sexual behavior can be a disease vector. Among those who do have anal sex, the insertive partner is referred to as the top or active partner.

The man being penetrated is referred to as the bottom or passive partner. Preference for either is referred to as versatile.
Anal sex most often refers to the sex act involving insertion of the penis into the anus. The term anal sex can also sometimes include other sexual acts involving the anus, including but not limited to anilingus and fingering.

From the temple of Chhapri, Central India, 12th century CE.

Oral sex refers to sexual activities involving the stimulation of the genitalia by the use of the mouth, tongue, teeth or throat. Oral stimulation of other parts of the body (as in kissing and licking) is usually not considered oral sex.

People may engage in oral sex as part of foreplay before sexual intercourse, or during or following intercourse. STI has come to be preferred, as it has a broader range of meaning; a person may be infected, and may potentially infect others, without showing signs of disease.Many STDs are (more easily) transmitted through the mucous membranes of the penis, rectum, urinary tract, and (less often, depending on type of infection) the mouth, throat, respiratory tract and eyes. Mucous membranes differ from skin in that they allow certain pathogens into the body. Pathogens are also able to pass through breaks or abrasions of the skin, even minute ones.

The shaft of the penis is particularly susceptible due to the friction caused during penetrative sex. The primary sources of infection in ascending order are venereal fluids, saliva, mucosal or skin (particularly the penis); infections may also be transmitted from feces, urine and sweat. The amount required to cause infection varies with each pathogen, but is always less than can be seen with the naked eye.
Although mucous membranes exist in the mouth as in the genitals, many STIs seem to be easier to transmit through oral sex than through deep kissing.

According to a safe sex chart, many infections that are easily transmitted from the mouth to the genitals (or from the genitals to the mouth) are much harder to transmit from one mouth to another. With HIV, genital fluids happen to contain much more of the pathogen than saliva. Some infections labeled as STIs can be transmitted by direct skin contact.

KSHV, on the other hand, may be transmitted by deep-kissing, but also when saliva is used as a sexual lubricant.
As may be noted from the name, sexually transmitted diseases are transmitted from one person to another by certain sexual activities rather than being actually caused by those sexual activities. It is not possible to catch any sexually transmitted disease from a sexual activity with a person who is not carrying a disease; conversely, a person who has an STD got it from contact (sexual or otherwise) with someone who had it or with their bodily fluids.Epidemiological studies have investigated the networks that are defined by sexual relationships between individuals, and discovered that the properties of sexual networks are crucial to the spread of sexually transmitted diseases. Regardless of the gender of the receptive partner, anal sex carries a higher risk of infection than most sex acts, but most penetrative sex acts carry some risk.

The main route of transmission is through unprotected sex. Properly used condoms can reduce this risk.
The adult prevalence rate in the United States is 0.7%, with over 1 million people currently living with HIV. In the United States from 2001–2005, the highest transmission risk behaviors were sex between men (40–49% of new cases) and high risk heterosexual sex (32–35% of new cases). Experts attribute this to "AIDS fatigue" among younger people who have no memory of the worst phase of the epidemic in the 1980s and early 1990s, as well as "condom fatigue" among those who have grown tired of and disillusioned with the unrelenting safer sex message.

This trend is of major concern to public health workers.
MSM have an increased incidence and prevalence of Kaposi's sarcoma-associated herpesvirus, which causes a cancer called Kaposi's sarcoma (KS) in immunocompromised individuals. With the onset of the AIDS epidemic in the early 1980s, there was a sudden epidemic resurgence of KS affecting primarily gay and bisexual AIDS patients, with up to 50% of reported AIDS patients having this tumor – an extraordinary rate of cancer predisposition. The disease has caused epidemics in parts of Asia and Africa, and it is endemic in China. About a third of the world's population, more than 2 billion people, have been infected with the hepatitis B virus. Transmission of hepatitis B virus results from exposure to infectious blood or body fluids containing blood.

Possible forms of transmission include (but are not limited to) unprotected sexual contact, blood transfusions, re-use of contaminated needles and syringes, and vertical transmission from mother to child during childbirth. HBV can also be transmitted between family members within households, possibly by contact of nonintact skin or mucous membrane with secretions or saliva containing HBV. However, at least 30% of reported hepatitis B among adults cannot be associated with an identifiable risk factor.
Infection with the Hepatitis B virus is about 5-6 times more common in men who have sex with men than in the general population.
Other STIs
Syphilis is passed from person to person through direct contact with a syphilis sore which occur mainly on the external genitals, vagina, anus, or in the rectum. Sores also can occur on the lips and in the mouth. Transmission of the organism occurs during vaginal, anal, or oral sex. In 2006, 64% of the reported cases in the United States were among men who have sex with men.
Genital human papillomavirus (HPV) is a common virus that most sexually active people in the U.S.will have at some time in their lives. It is passed on through genital contact and is also found on areas that condoms do not cover. Most men who get HPV of any type never develop any symptoms or health problems. Some types of HPV can cause genital warts, penile cancer, or anal cancer. MSM and men with weak immune systems are more likely than other men to develop anal cancer. Men with HIV are also more likely to get severe cases of genital warts that are hard to treat.
Mental
Since medical literature began to describe homosexuality, it has often been approached from a view that sought to find an inherent psychopathology as the root cause. Much literature on mental health and homosexuals centered on their depression, substance abuse, and suicide.

Although these issues exist among non-heterosexual men, discussion about their causes shifted after homosexuality was removed from the Diagnostic and Statistical Manual of Mental Disorders in 1973.