Last reviewed
Healthy Gay Sex: Pleasure, Safety and Connection
A practical, shame-free guide to healthy sex for gay and bi men, covering prevention, communication, substances and how mental health fits in.
Earl Johns, MSN, PMHNP-BC
Board-certified psychiatric nurse practitioner and founder of Wellthy Psychiatry & Wellness
✓ Medically reviewed by Earl Johns, MSN, PMHNP-BC
Photos are illustrative and don’t show actual patients.
Healthy sex isn’t just about avoiding risk. It’s about feeling safe, respected, present and good about yourself before, during and after. Here’s a practical, shame-free look at what that can include for gay and bisexual men.
Prevention that fits your life
PrEP, taken as a daily pill or as a long-acting injection, is highly effective at preventing HIV. Doxy-PEP, an antibiotic taken after sex, can lower the risk of syphilis and chlamydia. Condoms help prevent HIV and many other STIs. Vaccines for hepatitis A, hepatitis B, HPV and mpox are recommended for many gay and bi men. Testing every three to six months, including throat and rectal swabs when relevant, catches infections early.
Undetectable equals untransmittable: people living with HIV who maintain an undetectable viral load do not transmit HIV through sex.
Communication
Talking about what you like, what you don’t, your status and your prevention methods before things heat up makes sex safer and often better. It’s also okay to change your mind at any point.
Being present
Anxiety, body image worries and past trauma can make it hard to stay in the moment. Slowing down, breathing, and focusing on sensation rather than performance can help. Sex doesn’t have to follow a script.
Substances and sex
Alcohol, poppers, GHB, meth and other drugs sometimes become part of sex, especially in chemsex settings. Mixing can be dangerous, particularly GHB with alcohol, or poppers with erectile dysfunction medications. If you find you can’t enjoy sex sober, that’s worth exploring with someone you trust.
Aftercare for your mind
Notice how you feel after sex. Feeling connected, relaxed or happy is a good sign. Regular feelings of shame, emptiness or anxiety afterward are worth paying attention to. They often point to old messages or unmet needs rather than something wrong with you.
Your mental health and your sex life
Depression, anxiety and some medications can affect desire and performance. These are common and treatable. Please bring them up with your prescriber rather than stopping a medication on your own.
A gentle next step
Wellthy Psychiatry offers judgment-free, LGBTQ+ affirming care by telehealth across California. A free 15-minute phone consult is an easy way to see if we’re a good fit.
This article is for general education and isn’t medical advice. If you’re in crisis, call or text 988, the Suicide & Crisis Lifeline, or call 911.
About the author
Earl Johns, MSN, PMHNP-BC
Board-certified psychiatric nurse practitioner · UCSF-trained · Founder of Wellthy Psychiatry & Wellness
Earl provides LGBTQ+ and neurodivergent-affirming psychiatric care, blending medication management, therapy and whole-person approaches. His background includes inpatient psychiatry and community mental health at Glenn County Behavioral Health and Equity Health, a federally qualified health center. He sees clients in San Francisco and by telehealth across California.
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