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Gay Sex Ed: Topping and Bottoming 101

The age-old binary relationship between the top and the bottom is as simple as it is complex. In any sexual encounter, gay, straight, or otherwise, one person typically assumes the dominant role while the other takes on a submissive role in the bedroom. And while the “give and receive” of actions and pleasures may ebb and flow during intercourse, most people generally prefer one role or another. But while tops and bottoms are equal, their differing roles do come with different health issues and responsibilities that every gay and bisexual man should be well informed about, regardless of sexual position.

Preface: All sexually transmitted infections are bad for your health. However, they are not all created equally. In general, condoms do protect against STIs that are spread through bodily fluids (semen, blood, and anal or vaginal fluids). STIs that spread through skin-to-skin contact (herpes, HPV) can still spread with condom use, especially if either partner has any open sores or lesions. In terms of focus and clarity, this discussion will singularly focus on HIV.

The Bottom

Definition: The receptive partner in same-sex anal sex for cisgender gay men or transgender gay men, or frontal, vaginal sex with transgender gay men.

Synonyms: The Hole; Jane; Power Bottom; The Brains

Overview: Tops may get the glory, but bottoms make the world go round. To be a good bottom, a guy has to know what works for his body, how to maintain a healthy and hygienic rear end, and how to navigate his sexual health without compromising his pleasure. Quite simply, tops have it easy when it comes to sex, because being a good bottom is no easy job.

Popular myth: If an HIV-positive guy is always the bottom, he will never transmit the virus.

Risk: Simply put, a gay man who bottoms is more at risk for HIV. The sensitive lining of the anus is more susceptible to cuts and abrasions during sex. These cuts and abrasions allow for HIV that is present in the top’s cum or pre-cum to come into contact with the bottom’s bloodstream.

Responsibility: When bottoming, you should always inquire about your partner’s HIV status, since your position places you more at-risk for transmission. Regardless of his answer, your best option for protection is the use of Truvada as PrEP, because it places you in control of your own health regardless of his status or condom use. Proper anal care is also of the utmost important. Remember to take your fiber and use a lube that is right for you. Maintaining the integrity of your anal wall is key to staying healthy and reducing your risk of STIs.

The Top

Definition: The insertive partner in anal sex between cisgender gay men (biological men who identify as men), or transgender gay men, or frontal, vaginal sex with transgender gay men.

Synonyms: The Knob; Handy Man; The Unit; Tarzan; The Muscle

Overview: There is nothing like a good top. There is a general misconception that there are few to no health risks associated with topping, but a good top knows that he has to think about his sexual health and safety just like any bottom out there. In fact, the top’s sexual health is probably the most important, as his status is what could place the bottom at risk for HIV transmission.

Popular Myth: A guy who exclusively tops will never get HIV.

Risk: A guy who is topping is generally at a lesser risk for HIV than the guy who is bottoming, but both topping and bottoming during unprotected anal sex is considered high-risk behavior. When a condom isn’t used, HIV can enter through the opening of the penis through small cuts, abrasions, or open sores. Having another STI can further increase your risk for transmission. Research also suggests that uncircumcised tops are at a higher risk for HIV infection than those who are circumcised. Either way, topping doesn’t protect you from HIV.

Responsibility: When topping, it is arguably more important to know your HIV status. If you are HIV-positive and not on treatment, you may have a high viral load that places your sexual partner at higher risk for transmission. If your partner is HIV-positive, you are still at risk but that risk is reduced, especially if he is on treatment and his viral load is undetectable. A condom or PrEP are your best options for protection, because they place you in control of protecting your partner and protecting yourself.  For a top who is HIV-positive, maintaining an undetectable viral load through consistent use of medication and care is the best method of protecting himself from transmitting the virus.

The Perfect Top-Bottom Dynamic

If you are a gay man, you may have a position preference, but chances are you will change it up every now and then. Whether you are a guy who prefers to top or just a big ol’ bottom, make sure you know the ins and outs of both roles so that you can be pleasing to your partner while protecting yourself. If you do so, then it won’t matter if the top is on bottom, the bottom is on top, or if both of you are tangled sideways because you both will be equal, and equally protected. 

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