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Do not assume that all MSM have anal-receptive sex. Or you may prefer to preface this portion of the history by informing the patient that you need to ask personal questions-questions that you ask all your patients. The question may be presented as “Have you ever had sex with men, women, or both?” Some men might initially balk, but adding “I ask all my patients this question” may put them at ease. It is also important to understand how hard it is for a patient to divulge his sexual orientation to a physician. MSM have health-care risks related to sexual practices (most notably HIV infection), making sexual orientation an integral component of the medical history. In fact, the physical examination often confirms the diagnosis we made with the history. A basic understanding of sexual practices and behavioral patterns will also help practitioners administer optimal patient care.Īs health-care providers, we all understand how important a patient history is to understanding illness. When treating MSM it is also important to modify, where appropriate, the history and physical examination to fully access their special health-care issues, especially when focusing on the area of anorectal health. 1 For this reason it is best to categorize “homosexual men” as “men who have sex with men” (MSM). They may not self-identify as homosexual but the fact that they have had sex with other men admits them to this group of individuals with select health-care needs. The first and most basic nuance when evaluating men is to move beyond the terms “gay,” “bisexual,” or “straight.” While most men are heterosexual, a significant number will have had sex with other men. If we as physicians are to offer effective care to these patients, especially with respect to sexually transmitted infections (STIs), it is important to understand various ways in which this patient population requires modifications to our standard approach. As a sign of political correctness we no longer classify patients as homosexual, but as lesbian, gay, or bisexual. Medicine is also coming to understand that just as ethnicity and race play important roles in health-care requirements and our effectiveness to provide care, so too does sexual orientation. In medicine, however, we have long realized that all people are not the same and that different racial and ethnic groups have their own needs. In the “politically correct” world we all aspire to live in, we would try to blur distinctions between different peoples and treat all as one.