Sexual Positioning among Men Who Have Sex with Men: A Narrative Review

Sexual positioning practices among men who have sex with men (MSM) have not received a thorough discussion in the MSM and HIV literature, given that risks for acquiring or transmitting HIV and STIs via condomless anal sex vary according to sexual positioning. MSM bear a disproportionate burden of HIV compared to the general population in the United States; surveillance efforts suggest that HIV and STIs are increasing among domestic and international populations of MSM. 

We conducted a narrative review, using a targeted literature search strategy, as an initial effort to explore processes through which sexual positioning practices may contribute to HIV/STI transmission. Peer-reviewed articles were eligible for inclusion if they contained a measure of sexual positioning identity and/or behavior (i.e., "top", "bottom," etc.) or sexual positioning behavior (receptive anal intercourse or insertive anal intercourse), or assessed the relationship between sexual positioning identity withHIV risk, anal sex practice, masculinity, power, partner type, or HIV status. 

A total of 23 articles met our inclusion criteria. This review highlights dynamic psychosocial processes likely underlying sexual decision making related to sexual positioning identity and practices among MSM and MSM who have sex with women (MSMW), and ways these contexts may influence HIV/STI risk. 

Despite limited focus in the extant literature, this review notes the important role the contextual factors (masculinity stereotypes, power, partner type, and HIV status) likely to play in influencing sexual positioning identity and practices. Through this review we offer an initial synthesis of the literature describing sexual positioning identities and practices and conceptual model to provide insight into important areas of study through future research.

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By:  Dangerfield DT 2nd1, Smith LR2, Williams J3, Unger J3, Bluthenthal R3.

• 1Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, 90032, USA. ddangerf@usc.edu.
• 2Division of Global Public Health, University of California, San Diego, La Jolla, CA, USA.
• 3Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, 90032, USA.
• Arch Sex Behav. 2016 May 13. 

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Anxious Attachment, Social Isolation, and Indicators of Sex Drive and Compulsivity: Predictors of Child Sexual Abuse Perpetration in Adolescent Males?

It has been suggested that child sexual abuse is related to poor attachment to parents, which is associated with an inability to form intimate relationships. Seto and Lalumière indicated that there were too few studies of adolescent males to determine whether poor attachment was associated with perpetration. 

This study was designed to follow up on a previous study and further explored the association between insecure attachment to parents, social isolation, and interpersonal adequacy to child sexual abuse perpetration in adolescents. We compared two samples of adolescent males who had committed sexual offenses, those who committed offenses against children (n = 140) and those who committed offenses against peer or adults (n = 92), with a sample of similarly aged males in treatment for mental health or substance use issues (n = 93). Data were collected using a semi-structured interview and computer-administered questionnaire. 

We found an indirect association between anxious attachment and sexual offenses against child victims, which was accounted for by measures of social involvement and social isolation. These involvement and isolation measures also did not have a direct association with sexual offenses against child victims, in that their contribution was accounted for by a measure of Masculine Adequacy. This Masculine Adequacy, combined with decreased levels of Sexual Preoccupation and Hypersexuality and increased Sexual Compulsivity, was associated with commission of child sexual abuse. 

The interpersonal variables did not enter a model predicting sexual offending against peers/adults, which seemed solely associated with the interaction between Sexual Compulsivity and Hypersexuality.

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By:  Miner MH1, Swinburne Romine R2, Robinson BB2, Berg D2, Knight RA3

• 1University of Minnesota, Minneapolis, USA miner001@umn.edu.
• 2University of Minnesota, Minneapolis, USA.
• 3Brandeis University, Waltham, MA, USA. 
• Sex Abuse. 2016 Mar;28(2):132-53. doi: 10.1177/1079063214547585. Epub 2014 Aug 20.

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Romancing the Boundary: Client Masculinities in the Chinese Sex Industry

This paper draws on 24 in-depth interviews and 2 focus-group discussions conducted since 2012 with Hong Kong heterosexual men who buy sex in order to examine men's level of physical and emotional engagement with sex workers under two dominant sexual scripts in contemporary Hong Kong. 

Torn between companionate sexuality, with its companionate model of relationships, and recreational sexuality, with its promiscuous model of sexual pleasure, Hong Kong male clients seek to satisfy their sexual and affective needs through commercial sexual relationships. The term (meaning 'chicken worm', connoting a 'McSex' form of masculinity) refers to those men who seek impersonal sexual release with as many women as they wish, while the term (meaning 'sunken boat' and connoting a 'Titanic' form of masculinity) refers to those men who seek an intense level of emotional intimacy with sex workers. Between these two contrasting types, the majority of respondents fall into a form of 'bounded' masculinity characteristic of men who emphasise control and balance by seeking emotionally responsive women in a time-bound romance. 

By comparing clients' variations in the level of physical and emotional engagement with sex workers, this paper seeks to understand individual differences in client types and offers a new understanding of Chinese male sexuality and relationship formation, and the corresponding health risks (e.g., sexual, emotional) associated with each type.

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By:  Kong TS1.

• 1 Department of Sociology , University of Hong Kong , Hong Kong. 
• Cult Health Sex. 2015;17(7):810-24. doi: 10.1080/13691058.2015.1004197. Epub 2015 Feb 17.

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'Men at Risk': Sex Work, Tourism & STI/HIV Risk in Jamaica

Female sex tourism has become an accepted income generator for many underemployed men in Jamaica who seek to reap economic benefits from relationships with visiting tourist women. 

This issue provides contexts to explore the numerous ways in which health intersects with issues of masculinity, sexuality and marginality. Based on ethnographic fieldwork in a popular Jamaican resort town, this paper examines the health implications of female sex tourism for the local population and tourist visitors. 

Data from this project indicate the need for improved sexually transmitted infection education and HIV outreach work towards men who are involved in transactional sex with tourist women. Due to prevalent perceptions of masculinity and gendered notions of sexuality, men who engage in sex tourism constitute a population that rarely receives the attention of local and national health authorities. 

Data from this qualitative study suggest that engaging this particular vulnerable population could potentially decrease the risk of STI and HIV infection in the country's most popular resort areas. 

Research of this kind is urgently needed to better understand the risk factors and challenges for Caribbean populations, as well as to inform future prevention efforts in the region.

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By:  Johnson LC^1,2.

¹ Department of Anthropology , University of South Florida , Tampa , USA.

² College of Education , University of North Georgia , Dahlonega , USA.

Cult Health Sex. 2016 Mar 22:1-14

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A Lover or a Fighter? Opposing Sexual Selection Pressures on Men's Vocal Pitch & Facial Hair

The traditional assumption within the research literature on human sexually dimorphic traits has been that many sex differences have arisen from intersexual selection. More recently, however, there has been a shift toward the idea that many male features, including male lower-pitched voices and male beard growth, might have arisen predominantly through intrasexual selection: that is, to serve the purpose of male-male competition instead of mate attraction. 

In this study, using a unique set of video stimuli, we measured people's perceptions of the dominance and attractiveness of men who differ both in terms of voice pitch (4 levels from lower to higher pitched) and beard growth (4 levels from clean shaven to a month's hair growth). 

We found a nonlinear relationship between lower pitch and increased attractiveness; men's vocal attractiveness peaked at around 96 Hz. Beard growth had equivocal effects on attractiveness judgments. In contrast, perceptions of men's dominance simply increased with increasing masculinity (i.e., with lower-pitched voices and greater beard growth). 

Together, these results suggest that the optimal level of physical masculinity might differ depending on whether the outcome is social dominance or mate attraction. These dual selection pressures might maintain some of the documented variability in male physical and behavioral masculinity that we see today.

Below:  Estimated marginal means of attractiveness ratings of each of the voice pitch and facial hair combinations

Full article at:   http://goo.gl/XH5809

By:  Saxton TK1, Mackey LL1, McCarty K1, Neave N1.

• 1Department of Psychology, Northumbria University , Northumberland Building, Ellison Place, Newcastle NE1 8ST , UK. 
• Behav Ecol. 2016 Mar-Apr;27(2):512-519. Epub 2015 Nov 1.

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'When You Visit a Man You Should Prepare Yourself': Male Community Care Worker Approaches to Working with Men Living with HIV in Cape Town, South Africa

Caring is typically constructed as a feminised practice, resulting in women shouldering the burden of care-related work. Health-seeking behaviours are also constructed as feminine and men have poorer health outcomes globally. Employing men as carers may not only improve the health of the men they assist but also be transformative with regards to gendered constructions of caring. 

Using semi-structured interviews and observational home visits, this study explored the techniques that community care workers employ when working with male clients. The empirical analysis draws on the perspectives of eight care workers and three of their male clients from the Cape Town area. 

Interviews reveal how care workers and clients perform and negotiate masculinities as they navigate hegemonic masculine norms that require men to act tough, suppress emotions and deny weakness and sickness. Both parties bump up against ideals of what it means to be a man as they strive to provide care and receive support. Community care workers avoid rupturing client performances of hegemonic masculinities which inhibit confession and support. To do this, they use techniques of indirectly broaching sensitive subjects, acting in a friendly way and being clear about the intention of their work.

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By:  Gittings L1.

• 1 AIDS and Society Research Unit (ASRU), Centre for Social Science Research , The University of Cape Town , Cape Town , South Africa. 

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"I Feel Like More of a Man": A Mixed Methods Study of Masculinity, Sexual Performance, and Circumcision for HIV Prevention

Ethnographic studies from numerous societies have documented the central role of male circumcision in conferring masculinity and preparing boys for adult male sexuality. Despite this link between masculinity, sexuality, and circumcision, there has been little research on these dynamics among men who have been circumcised for HIV prevention. 

We employed a mixed methods approach with data collected from recently circumcised men in the Dominican Republic (DR) to explore this link. We analyzed survey data collected six to 12 months post-circumcision (N = 293) as well as in-depth interviews conducted with a subsample of those men (n = 30).

We found that 42% of men felt more masculine post-circumcision. In multivariate analysis, feeling more masculine was associated with greater concern about being perceived as masculine, feeling more potent erections post-circumcision, and reporting increased ability to satisfy their partners post-circumcision. 

In qualitative interviews, these factors were all related to masculine norms of sexually satisfying one's partner, and men's experiences of circumcision were shaped by social norms of masculinity. 

This study highlights that circumcision is not simply a biomedical intervention and that circumcision programs need to incorporate considerations of masculine norms and male sexuality into their programming.

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By:  Fleming PJ1,2, Barrington C2,3, Pearce LD4, Lerebours L5, Donastorg Y6, Brito MO7.

• 1 Division of Global Public Health , University of California , San Diego.
• 2 Department of Health Behavior , Gillings School of Global Public Health, University of North Carolina at , Chapel Hill.
• 3 Carolina Population Center , University of North Carolina at , Chapel Hill.
• 4 Carolina Population Center and the Department of Sociology , University of North Carolina at , Chapel Hill.
• 5 Clinica de Familia , La Romana , Dominican Republic.
• 6 HIV Vaccine Trials Unit , Instituto Dermatológico y Cirugía de Piel , Santo Domingo , Dominican Republic.
• 7 Division of Infectious Diseases , University of Illinois at Chicago. 

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"Come on Baby. You Know I Love You": African American Women's Experiences of Communication with Male Partners and Disclosure in the Context of Unwanted Sex

We examined African American women's experiences of communication with their male intimate partners a couple of hours before and after an incident of unwanted sex. 

We also examined women's experiences of disclosure following an incident of unwanted sex. Semi-structured qualitative interviews were conducted with a community-based sample of sexually active African American women (n = 19) reporting at least one incident of sexual coercion (i.e., being pressured into unwanted sex without consent) by an intimate male partner since the age of 18. Our analysis was guided by "the sexual division of power" from Connell's (1987) theory of gender and power. Data were analyzed inductively by examining the interviews for common themes in the following domains: communication before the unwanted sex, communication after the unwanted sex, and disclosure to others. 

Men pressured partners for unwanted sex through verbal and non-verbal tactics, ranging from pestering and blunt requests for sex to verbal bullying and violence. Many women responded by clearly saying no. However, many women also described eventually ceasing to resist their partners and engaging in unwanted sex. After the unwanted sex, men actively and passively avoided discussing the incident. Although many women discussed the unwanted sex with family and friends, less women disclosed to trained professionals. In some cases, women did not discuss the incident with anyone at all. 

These findings indicate that, when addressing sexual violence against women, there is a need to target men as well as the norms of masculinity that underpin physical and sexual violence against women.

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By:  Gutzmer K1,2, Ludwig-Barron NT3, Wyatt GE4, Hamilton AB4,5, Stockman JK6.

• 1Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, CA, USA.
• 2Graduate School of Public Health, San Diego State University, San Diego, CA, USA.
• 3Division of Global Public Health, Department of Medicine, University of California, San Diego, 9500 Gilman Drive, MC 0507, La Jolla, CA, 92093-0507, USA.
• 4Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, USA.
• 5VA Greater Los Angeles Healthcare System, Los Angeles, Los Angeles, CA, USA.
• 6Division of Global Public Health, Department of Medicine, University of California, San Diego, 9500 Gilman Drive, MC 0507, La Jolla, CA, 92093-0507, USA. jstockman@ucsd.edu. 
• Arch Sex Behav. 2016 Feb 18.

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Johnny Depp, Reconsidered: How Category-Relative Processing Fluency Determines the Appeal of Gender Ambiguity

Individuals that combine features of both genders–gender blends–are sometimes appealing and sometimes not. Heretofore, this difference was explained entirely in terms of sexual selection. 

In contrast, we propose that part of individuals’ preference for gender blends is due to the cognitive effort required to classify them, and that such effort depends on the context in which a blend is judged. In two studies, participants judged the attractiveness of male-female morphs. Participants did so after classifying each face in terms of its gender, which was selectively more effortful for gender blends, or classifying faces on a gender-irrelevant dimension, which was equally effortful for gender blends. In both studies, gender blends were disliked when, and only when, the faces were first classified by gender, despite an overall preference for feminine features in all conditions. Critically, the preferences were mediated by the effort of stimulus classification. 

The results suggest that the variation in attractiveness of gender-ambiguous faces may derive from context-dependent requirements to determine gender membership. More generally, the results show that the difficulty of resolving social category membership–not just attitudes toward a social category–feed into perceivers’ overall evaluations toward category members.

Below:  Examples of stimuli used in Study 1 as a percentage of the female parent

Below:  Examples of face blends used in Study 2

Full article at:   http://goo.gl/RE2YqJ

By:  Helen E. Owen,1 Jamin Halberstadt,1,* Evan W. Carr,2 and Piotr Winkielman2,3,4,*

¹Department of Psychology, University of Otago, Dunedin, New Zealand

²Department of Psychology, University of California San Diego, La Jolla, California, United States of America

³Behavioural Science Group, Warwick Business School, University of Warwick, Coventry, United Kingdom

⁴Department of Psychology, University of Social Sciences and Humanities, Warsaw, Poland

Brock University, CANADA

Competing Interests: The authors have declared that no competing interests exist.

Conceived and designed the experiments: HO JH PW. Performed the experiments: HO JH PW. Analyzed the data: HO JH PW EC. Contributed reagents/materials/analysis tools: HO JH PW EC. Wrote the paper: HO JH PW EC.

* E-mail: zn.ca.ogato.ysp@sreblahj; Email: ude.dscu@namleikniwp

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A Discourse Analysis of Male Sexuality in the Magazine Intimacy

Background

The World Health Organization's publication, Developing sexual health programmes, states that the media is an important source of information about sexuality. Although the media can promote awareness of sexual health issues, it also acts as a vehicle for defining and regulating sex norms. In other words, the standards of ‘normal’ sex are in part defined by the media. Accordingly, it has become imperative to analyse the media's construction of sexual norms in order to reveal how they are related to specific ideological views. For the purposes of this study, the focus will be limited to analysing the South African publication Intimacy.

Aim

The study aims to reveal how the sex advice articles written in Intimacy for women in regard to their male partner's sexuality reflect patriarchal and phallocentric ideologies.

Method

A discourse analysis of the sex advice articles in the magazine Intimacy was conducted. It was informed by feminist theories of sexuality that seek to examine the ways in which texts are associated with male-centred versions of sexual pleasure.

Results

The discourse analysis identified a number of key themes regarding male sexuality. These include: (1) biological accounts of male sexuality; (2) phallocentric scripting of the sex act; and (3) the melodramatic penis.

Conclusion

Constructions of male sexuality require the inclusion of alternative modes of male erotic pleasure. This requires texts that encourage men to explore and also to experiment with pleasurable feelings associated with non-genital erogenous zones of the body.

…Intimacy's aim to ‘empower you as its reader and give you permission to take control of your sex life’,³⁴ is, at best, only a pseudo-empowerment for women in heterosexual relations.⁸ It can only ever promote an illusory sense of female control and pleasure as it persists in defining male sexuality according to patriarchal standards. The patriarchal underpinning of male sexuality in Intimacy has been revealed to delimit the sexual act, female sexuality and men to predefined potentials and gender relations: restriction of male sexual expression to the erect penis; notions of ‘real’ sex as penile-vaginal penetration (at the expense of diverse erotic experiences derived from non-genital erogenous zones); biological accounts of the male sex drive (that negate acts of communication and negotiation); the relegation of any sexual act that departs from coitus to foreplay (and thus of secondary importance); and the continual description of the penis as a revered icon of sexual pleasure for both men and women…

  

Full article at: http://goo.gl/tclUtA

By:  Rory du Plessis1

¹Department of Visual Arts, University of Pretoria, South Africa

Corresponding author.

Correspondence to: Rory du Plessis Email:Email: az.ca.pu@sisselpud.yror, Postal address: Private Bag X20, Hatfield 0028, South Africa

How to cite this article: Du Plessis R. A discourse analysis of male sexuality in the magazine Intimacy. Afr J Prm Health Care Fam Med. 2015;7(1), Art. #691, 7 pages. http://dx.doi.org/10.4102/phcfm.v7i1.691

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Individual Differences in Men's Misperception of Women's Sexual Intent: Application and Extension of the Confluence Model

Men are more likely than women to misperceive a cross-sex companion's degree of sexual interest. The current study extends previous research by using the confluence model (Malamuth et al., 1991) to examine how narcissism and impulsive sensation-seeking are directly and indirectly associated with men's misperception of women's sexual interest. 

A community sample of young, single men (N = 470) completed audio computer-assisted self-interviews. Using path analyses, hostile masculinity and impersonal sexual orientation were proximal predictors of men's misperception of women's sexual intent. 

Additionally, narcissism was indirectly related to men's misperception through hostile masculinity. Impulsive sensation-seeking was directly and indirectly related to men's misperceptions through impersonal sexual orientation. Although there was a bivariate relationship between alcohol consumption and misperception, this relationship was not significant in the path model. 

Overall, these findings demonstrate the importance of considering how personality traits increase the risk for misperception.

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By:  Wegner R1, Abbey A1.

• 1Wayne State University. 
• Pers Individ Dif. 2016 May 1;94:16-20.

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The Decline of Inpatient Penile Prosthesis over the 10-Year Period, 2000–2010

AIMS:

Our aims were to analyze national trends of penile prosthesis (PP) surgery and to examine patient and hospital characteristics, and perioperative complications in the inpatient setting.

METHODS:

We analyzed data from National Inpatient Sample. Patients in NIS who underwent PP insertion between 2000 and 2010 were included.

MAIN OUTCOME MEASURES:

Our main outcomes were the number of inpatient PP procedures, type of prosthesis, patient demographics, comorbidities, hospital characteristics, and immediate perioperative complications.

RESULTS:

There was a progressive and dramatic decline by nearly half in the number of both inflatable (IPP) and noninflatable (NIPP) inpatientinsertions performed from 2000 to 2010 (P = 0.0001). The overall rate of inpatient complications for PP insertion was 13.5%. Patients with three or more comorbidities were found to have a higher risk of complications than patients with no comorbidities (OR = 1.45, 95% CI = 1.18-1.78) (P = 0.0001). Surgeries performed in high-volume hospitals (10 or more PP cases per year) were associated with reduced risk of complications (OR = 0.6) (P < 0.0001). There was a dramatic decrease in inpatient setting for PP placement in high-volume hospitals (32% in 2000 compared with 6% in 2010; P < 0.0001), and when compared with lower volume hospitals. NIPP was more likely performed in younger patients and in community hospitals, and less likely in white patients. Medicaid health insurance was associated with much higher rate of NIPP insertion than other types of insurance.

CONCLUSIONS:

The number of PP procedures performed in the inpatient setting declined between 2000 and 2010, likely reflecting a shift toward increasing outpatient procedures. Our data also suggest a better outcome for patients having the procedure done at a high-volume center in terms ofinpatient complications

Below:  Volume of inpatient PP in the United States from 2000 to 2010. IPP, inflatable penile prosthesis; NIPP, noninflatable penile prosthesis

Below:   Patient comorbidities of inpatient PP from 2000 to 2010. 0, no comorbidity; 1, one comorbidity; 2, two comorbidities; 3+, three or more comorbidities

Below:  Hospital volume of inpatient penile prosthesis from 2000 to 2010. 1, one case/year; 2–9, two to nine cases/year; 10+, 10 or more cases/year

Full article at:   http://goo.gl/VmGOEU

By:  Alwaal A1, Harris CR2, Hussein AA2, Sanford TH2, McCulloch CE3, Shindel AW4, Breyer BN2.

• 1 Department of Urology, University of California San Francisco, San Francisco, CA; Department of Urology King Abdul Aziz University Jeddah Saudi Arabia.
• 2 Department of Urology University of California San Francisco San Francisco CA USA.
• 3 Department of Epidemiology and Biostatistics University of California San Francisco San Francisco CA USA.
• 4 Department of Urology University of California at Davis Sacramento CA USA.

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