Body Image and Anonymous Sex Among Men Who Have Sex with Men (MSM)

Background: Men who have sex with men (MSM) have a higher prevalence of body image disorders than heterosexual men. While reports in women link body image and sexual behavior, few studies in MSM have investigated this association. We evaluated the association between body image and self-reported anonymous sex in the past 3 months in a convenience sample of MSM at an urban, public STD clinic.

Methods: MSM (n=112) self-administered a behavioral survey on tablet computers. Body image was assessed using the Male Body Attitudes Scale (MBAS), a validated scale that produces a total score and muscularity, body fat, and height subscores. Scores have a potential range of 1 to 6; higher scores indicate poorer body image.  Anonymous sex was defined as sex with a partner without knowing his/her name. We used logistic regression to compute unadjusted and adjusted associations of the effect of poorer body image on anonymous sex in the last 3 months.

Results: Median total MBAS score was 2.83, while median body fat, muscularity and height subscores were 2.63, 2.95, and 2.00, respectively. Thirty men (29%) reported anonymous sex in the past three months. In unadjusted analyses, we observed a significant association between body fat subscore and anonymous sex (OR:1.38, 95% CI: 1.01,1.90), but no significant associations between total MBAS score, muscularity subscore or height subscore and anonymous sex. After adjustment for age, race, muscularity and height subscores, a 1-unit increase in body fat subscore (indicating worsening body image) was significantly associated with increased odds of anonymous sex in the last 3 months (OR:1.44, 95% CI: 1.02,2.03).

Conclusions: Men with poorer body fat body image had higher odds of reporting anonymous sex in the past three months. Further studies are warranted to understand the temporality of this relationship and whether other sexual risk behaviors are affected by body image.