Sexual Dysfunctions And Sexotherapeutic Approaches For Gay Men

Objective. - Therapeutic approaches for sexual dysfunctions seldom address the specific characteristics of sexual orientation. Yet, sexual practices, relational modes, psychosocial and medical variables associated with HIV and its treatments are as many factors that should be considered during clinical evaluation and that can modulate sexual function of men who have sex with men (MSM). This paper presents a review of the literature on sexuality in MSM before and after the HIV-AIDS epidemy and highlight guideline and intervention strategies.Method. - A systematic review of the literature based on the key-words: "sexual dysfunction*'', "gay men'', "homosexuality'', "treatment'' and "HIW'', was performed with no date limits and aiming any article in French or English, excluding clinical cases.Results. - Of the 38 articles found, the results summarize in a table show that across time, MNM report more sexual dysfunctions than heterosexual men (hypoactive sexual desire, erectile dysfunctions, orgasm dysfunction, anodyspareunia), but ejaculatory dysfunctions show a reverse tendency with retarded ejaculation being more frequent in MSM and premature ejaculation in heterosexual men. The reasons for the greater incidence of sexual dysfunctions in general and retarded ejaculation in particular includes psychological and intrapsychic components (e.g., internalized homophobia), risky behaviors (e.g., chemsex), serologic status and associated treatments.Conclusion and clinical implications. - Interventions for sexual dysfunctions for MSM should avoid strictly heteronormative approaches (e.g., questionnaire selection, heterosexual aims of treatment) and consider variables specific to MSM including serologic status, associated medications, use of specific drugs (chemsex, steroids), concerns with body image and internalized homophobia. (C) 2021 Sexologies. Published by Elsevier Masson SAS. All rights reserved.