Health

Sexual health, body and mind: the 5 areas of gay men’s health

Sexual health begins with the pathogens, and the sexually transmitted infections (STIs) run from syphilis to shigella. Prevention & Protection bundles condoms, PrEP, PEP, treatment as prevention and vaccinations. Mental Health deals with addiction, counselling, men’s groups and the warning signs of suicide. Sexual Hygiene handles washing, shaving, rimming preparation, sex toy cleaning, sounding and the fresh intimate piercing. The Guide has the broadest range, from haemorrhoids to tantra to lip care.

Penis size and intimate piercings belong to the gay magazine, anal sex mishaps and anal toys to Fucking & Anal, poppers and their side effects to Poppers.

Sexually transmitted infections: 5 questions for every pathogen

Infections come first in gay men’s health, and for 12 pathogens the same 5 answers appear in the same order: cause, symptom, test, treatment, prevention. The 12 are syphilis, gonorrhoea, chlamydia, genital herpes and hepatitis A to E. The same holds for the human immunodeficiency virus (HIV), for genital warts, pubic lice, scabies, shigellosis, trichomonas and non-specific urethritis.

Step 3 is always the same: get tested, and get tested regularly. How often you should get tested depends on the risk. Men on PrEP need quarterly screenings, HIV therapy comes with a check every 3 months, and HIV-negative partners should test once a year at least. The STI overview starts with transmission and works as a solid starting point before the individual pathogens.

Penis problems: what turns urgent and what belongs with a urologist

When it comes to the penis, gay men’s health gets concrete, and 1 mechanism underlies all of it. Blood fills the erectile tissue, as grower and shower explains. The difference between blood penis and flesh penis is how much the flaccid state already shows, with examples of both. Meat penis and meat dick are other names for the flesh penis, while grower dick and shower dick name the same 2 types. A 2018 study in the International Journal of Impotence Research drew the line at 4 centimetres of gain. It counted 26 % growers against 74 % showers.

5 penis complaints rank by urgency, and the most pressing is the penis fracture. The name misleads, since it is a tear in the sheath around the erectile tissue. Typical signs are a cracking sound, immediate loss of the erection, bruising and blue discolouration. Cool it and head for the emergency room. Stay away from painkillers containing acetylsalicylic acid (ASA) until a doctor has checked you, because they thin the blood. With priapism the clock decides. A painful erection lasting more than 2 hours is an emergency, and by definition any erection beyond 4 hours needs treatment.

More time comes with a curved penis. Peyronie’s disease affects 1 to 9 % of men worldwide, with a peak between 50 and 60, and the bend shows only during an erection. Lumps in the shaft still need a urologist. A tight foreskin is normal in around 96 out of 100 newborns and persists in about 1 in 100 adolescents. A foreskin can also become tight later in life: the secondary form develops through inflammation and scarring, and partial phimosis falls under the same heading. How to fix a tight foreskin is covered there, and paraphimosis is the case where the foreskin gets trapped behind the glans. With blood in urine the range runs from a marathon to a tumour, and which doctor to see about it is covered there as well. When tablets and training hit their limit, the penile injection covers the procedure and its side effects.

A sunbath, dark skin and a hickey: 3 times not an illness

At first glance 3 topics look like health issues, and on a closer look they turn into something else. Perineum sunning has a clear verdict: unnecessary. The trend arrived through Instagram and TikTok and leans on the Daoist point Hui Yin and a book from 1986. Its claim: 30 seconds of sun on the anus replace a whole day outdoors. Scientific evidence for any benefit is missing. Anal sunbathing, butt sunning, butthole tanning, sunning the taint and pointing your asshole at the sun all mean the same thing.

Anal bleaching is settled quickly: the procedure is purely aesthetic, and darker skin around the anus is a matter of pigmentation. The idea that frequent anal sex darkens it is a myth, and male anal bleaching only changes the colour. Laser depigmentation and chemical peeling are the 2 methods. The peeling needs at least 2 sessions 10 weeks apart, and hydroquinone is best avoided because of a suspected cancer risk. That leaves the hickey, a bruise under the skin, with cooling in the first 12 hours and warmth from 48 hours onwards.

Drugs around sex: the emergency comes before the high

Across all 4 drug topics the worst case comes before the effect. The most drastic case is ethyl chloride. Sold as a spray, the substance comes from medicine and was used in surgery. In the scene it circulates as Red Czech, Blackjack or U4EA. Why switching off pain is a bad idea and what sudden sniffing death syndrome means is explained there.

With GHB and GBL the conversion comes first. Gamma-hydroxybutyrate (GHB) forms in the body out of gamma-butyrolactone (GBL). The key points are overdose, assault risk and practical rules for a night out. Both act as narcotics and circulate as liquid ecstasy, G or Gina. Poly-drug use walks through the main combinations one by one, and chemsex traces the consequences for erectile function. The term goes back to HIV activist David Stuart.

Haemorrhoids, anal fissures and IBS: when the gut has a say

3 gut conditions matter for gay men’s health, and the first needs a correction up front. Everybody has haemorrhoids. They are cushions filled with blood that seal the rectum together with the sphincter, and they turn into a complaint once blood congestion enlarges them. The causes are lack of movement, chronic constipation and lasting pressure on the pelvic floor. Anal sex is ruled out as a cause, and generous lube is part of prevention. Over 50, around 1 in 2 people is affected, as haemorrhoids and sex adds.

A lengthwise tear in the anal canal is the anal fissure, with 75 to 90 % of them on the side facing the tailbone. Sufferers describe the pain as a shard of glass when passing stool. Irritable bowel syndrome (IBS) is understood as a communication problem between gut and brain. You can still bottom with IBS, and douching needs its own rules for men who have it.

PEP works better the sooner it starts

Post-exposure prophylaxis can stop an HIV infection after a risk contact, and speed is what decides. It works best within 2 hours, and it should preferably start within 24. The window closes 48 to 72 hours after contact at the latest. How the virus is transmitted in the first place is covered by the HIV entry. Whether cum in the mouth is a risk is answered by swallow or spit.

Counting hours only wastes time. The PEP guide describes the route: treatment goes through a specialised clinic or an HIV specialist practice, and outside consultation hours through A&E. That route stays open around the clock, and you go to whichever you reach fastest. 4 weeks is how long the course then lasts.

Condoms, PrEP and treatment as prevention stand side by side

Safer Sex 3.0 covers 3 routes to HIV protection, and the PrEP piece puts them expressly on equal footing. Pre-exposure prophylaxis (PrEP) has been covered by German health insurers since 2019. You can take it continuously or just around sex. Condoms also lower the risk of further sexually transmitted infections. How to dispose of a condom afterwards is settled separately, club and forest included.

Treatment as prevention is the third route and the one with the strongest evidence base. Undetectable equals untransmittable (U = U) is the formula behind it. The formula rests on the PARTNER and Opposites Attract studies, the latter following 358 gay couples. In each couple one partner was HIV-positive and on effective therapy, and there were zero transmissions. Protection begins after 6 months at the earliest, and it lasts as long as a blood test every 3 months confirms an undetectable viral load. 12 widespread safer sex misconceptions get a fact check of their own, and 5 more sit with unprotected sex.

4 vaccinations for men who have sex with men

4 vaccinations matter beyond the childhood standard, as the vaccination guide lists: hepatitis A, hepatitis B, MPOX (monkeypox) and the human papillomavirus (HPV). Hepatitis A requires 2 doses 6 months apart, and the combination with hepatitis B needs 3 doses in adults over 16. The German standing committee on vaccination recommends the hepatitis A vaccine for men who have sex with men. That recommendation is what unlocks the insurance cover. The anal cancer piece picks up from the HPV shot and moves into early detection and screening.

Hepatitis B is transmitted through blood and body fluids. Toothbrushes, razors and sex toys can carry it too, because the virus stays infectious outside the body. Up to 120 days pass before the first symptoms, and you are infectious before that. Anyone weighing up a self-test finds the 3 test types and the diagnostic window there, including a comparison with a doctor’s diagnostics. Where HIV research at the Charité stands is mapped in a separate report.

Pelvic floor training: one muscle, 3 goals

One and the same training serves 3 goals. The basics aim at continence, staying power and delaying ejaculation. The 6 exercises promise stamina and a firmer erection. Potency training continues both and sets a condition first: clarify the cause with a specialist, then train. First changes show after 2 to 3 months.

Among men under 30 around 2.3 % have erection problems, among the over-70s roughly 53 %. How an erection comes about at all is covered by a separate primer. For higher testosterone, raising it naturally covers sleep, weight, alcohol and vitamin D. That route shifts testosterone slowly, and a quick boost stays out of reach.

Sex addiction, porn addiction and the question of a normal amount

The World Health Organization has listed compulsive sexual behaviour in the international classification of diseases (ICD) since 2022, under 6C72 of the ICD-11. The older ICD-10 filed sex addiction as satyriasis under F52.7, and whether it counts as a mental disorder remains disputed. Porn addiction is already filed under the ICD-11.

Both catalogues describe the same features: loss of control and rising consumption. Rising porn use counts among the 3 main markers. A yardstick for how much sex is normal is missing, so too little or too much sex works with averages instead. A sex journal gives you a way to spot your own pattern, from a sober log to an erotic diary. Tantra for beginners takes the opposite route: slowing down instead of tracking.

When gay men’s health leads to doctors or counselling

Some topics in gay men’s health end with a contact point instead of a verdict: doctors and counselling services. That is clearest for the topics beyond the body. Warning signs of suicide lists suicide as the second leading cause of death among 10- to 24-year-olds. It puts attempt rates among LGBTQIA+ youth at 4 times those of their peers, with family rejection and harassment as amplifying factors.

For adults, men’s groups gives the core figure: in Germany around 10,300 people died by suicide in 2023, 3 quarters of them men. Men’s groups are a low-barrier offer and often a gateway to professional counselling. 4 reasons come up again and again when gay men seek counselling: fear of one’s own sexuality, discrimination after coming out, emotional trouble with mixed triggers, and symptoms with something deeper behind them. Alongside them stand shame and addiction with its list of counselling centres and self-help groups. Winter depression adds minority stress as a factor of its own.

Common questions about gay men’s health

Which 5 questions count for every STI?

Cause, symptom, test, treatment and prevention, in that order. That holds for all 12 pathogens, from syphilis to hepatitis to scabies. Step 3 is always the same: get tested, and get tested regularly, because many of these infections stay silent in the throat, the urethra or the rectum. The STI overview opens with transmission and works as the first stop.

How fast does PEP have to start after a risk contact?

As soon as possible. PEP works best within 2 hours of the risk contact, and the window closes 48 to 72 hours afterwards at the latest. An HIV clinic makes that call during consultation hours, and A&E covers the rest of the day. Treatment then runs for 4 weeks, and the sooner it starts the better it works.

Does anal sex cause haemorrhoids?

Anal sex is ruled out as a cause. Everybody has haemorrhoids, and they turn pathological through blood congestion. The causes are lack of movement, chronic constipation and pressure on the pelvic floor. Generous lube is part of prevention, and over 50 around 1 in 2 people is affected.

When does a tight foreskin need treatment?

In around 96 out of 100 newborns it is normal. If it persists into puberty, treatment is usually necessary. That affects about 1 in 100 adolescents. In adulthood the secondary form develops through inflammation and scarring, and paraphimosis is the case where the foreskin gets trapped behind the glans.

Does perineum sunning deliver more vitamin D?

Evidence for that is missing, and the verdict is that perineum sunning is unnecessary. The alternative is 30 minutes of daily sun on arms and face plus vitamin D through food. The claim that 30 seconds on the anus match a whole day outdoors stays unsupported as well.