Clinical Review ABC of sexual health

Homosexual men and women

BMJ 1999; 318 doi: http://dx.doi.org/10.1136/bmj.318.7181.452 (Published 13 February 1999) Cite this as: BMJ 1999;318:452
  1. Robin Bell

    The range of sexual dysfunctions encountered in gay men and lesbians is the same as that found in men and women in general, and the skills needed to help them are the same. That said, there are areas of concern, both for patients and doctors, that merit particular consideration.



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    People may encounter problems when they become aware of their homosexual orientation and try to match it to their view of an ideal self. If this occurs in adolescence it may be useful to offer counselling to help with the readjustment in life that may be required. However tolerant our society may become, being openly gay still has major implications for future career and family life. Help at this time can include (for men especially) information about safer sex, since sexual exploration may present a greater risk of exposure to HIV.

    Although many gay men and lesbians are aware of their orientation from their earliest sexual thoughts, a sizeable minority do not discover their orientation until later in life, perhaps in a failing marriage and with the responsibilities of parenthood. These people require careful and compassionate counselling. Some choose to remain married, and the couple may need help to reorganise the basis of their heterosexual relationship. The counsellor must be seen to be completely impartial and not encourage any particular outcome.

    Avoiding prejudice

    Presumptions—When counselling gay people about sex, it is important not to have preconceived ideas about their sexual repertoire. Perhaps as many as a third of gay men choose not to practise penetrative anal sex on a regular basis,1 and the traditional division of gay men into “active” and “passive” is not born out by experience—most gay men who do have anal sex will play either role. The assumption that the passive partner is somehow less “male” or less …

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