MSM and physical activity Most MSM in our study indicated that gym training was important in building their self-confidence and reported that their main reason for performing IAT was to selleck chem increase their muscle mass thereby making them feel more desirable. In contrast, heterosexual men rated improvements in health and fitness as the most important reasons for training in the gym, in agreement with other publications.8

23 In our study, MSM who train in gyms expressed a high level of concern over their body image and believed that the results of their training enhanced their physical and sexual prowess.9 Pornography, which is more commonly used by MSM than heterosexual men, is full of mesomorphic, muscular, and highly athletic ‘porn stars’ with smooth bodies.1 Viewers may internalise the messages and embrace the belief that they need to possess a similar physique in order to obtain sexual gratification. In addition, MSM-oriented internet sites,

which are used as the major platform for searching out other MSM, encourage web participants to upload their own body images. This is an additional external motivation to attain ‘ideal’ muscular aesthetics, while enhancing their attractiveness and securing their MSM identity. It has previously been suggested that MSM who are satisfied with their body express higher well-being scores and self-esteem, while those who fail to achieve this physical model may be more depressed and isolated.24 It has been well documented that physical activity reduces morbidity and preserves health.11 Although both aerobic and anaerobic training are important components of achieving physical fitness, some men in our study performed IAT disproportionally. Gym coaches can be trained to identify men who perform excessive anaerobic exercise, and can then recommend that such men balance their different sporting activities to achieve better health results or emphasise a more self-directed approach of accepting their bodies. Gym premises can also be used to deliver safe-sex messages targeting

MSM. Risk taking and physical activity The association found in our study between high-risk sexual behaviour and IAT is in agreement with other publications.25 26 This effect was multiplicative among MSM. MSM who are more muscular, as a result of Dacomitinib IAT or the use of anabolic steroids, are considered more attractive and may be more self-confident.27 They are therefore able to increase their repertoire of partners and their involvement in sexual adventurism, thereby increasing their risk of acquiring HIV/STI (figure 1). Health promotion professionals and homosexual community leaders should consider initiating debate regarding the preoccupation of MSM with their body image and related sexual adventurism, which places them at increased sexual risk and at the same time exposes them to possible sport injuries.