Topics in Sex Therapy for Gay Men:  Overcoming Fear of Topping


Topics in Sex Therapy for Gay Men:  Overcoming Fear of Topping
The eggplant emoticon is often used online, such as in Instagram or gay apps like Grindr and Scruff, to connote a penis.

In part one of this two-part article on gay men’s fears in sex, I discussed the fear of bottoming.  In this part, we look at gay men who have a fear of topping instead.

I’ve been a specialist in therapy and coaching for gay men for over 27 years, as individuals and couples.  I work with guys on lots of issues and disorders, such as depression, bipolar disorder, OCD, ADD, substance abuse recovery, dating skills, career planning, and couples in conflict.  Lately, I’ve had more and more gay men come to me with issues more specifically about sex therapy, and currently as of this writing (June, 2019), I’m undergoing the education and supervision process to become a Certified Sex Therapist.  I’ve been helping guys with sexual issues for almost my whole career, though, because most of my clients are gay men who feel more comfortable discussing very personal sexual issues with another gay man, especially one with a lot of experience and one who doesn’t shy away from frank discussions of intimate details.  My clients seem relieved that they have someplace to go to discuss these things with a professional.

These sexual fears hinder gay men from a more robust quality of life, because they hinder having a more robust sex life; they go together.  Lots of material written by therapists exists for straight men, and gay men can sometimes “translate” these for a partial benefit, but there is little material written by a licensed psychotherapist that addresses sexual issues in more candid detail.

In this part, we look at gay men who have a fear of topping.  It’s not because they just don’t like it (which is fine, by the way!), but it’s that they want to be the active, penetrating partner in anal intercourse, and perhaps even crave it as a sexual need and desire, but they have a neurotic anxiety that prevents them from accessing this part of their sexual selves.  These fears, in my observation over many years in practice, are these:  1) hurting a partner physically; 2) not being “butch” or “dominant” enough to meet some kind of expectation from their partner; 3) fear of erectile dysfunction (ED) to get and sustain an erection long enough to reach orgasm (for himself, and perhaps his bottom, too); 4) not satisfying his bottom partner; and 5) not knowing “how” to control and manipulate his bottom in various positions or variety.  Let’s look at each of these in turn:

Topics in Sex Therapy for Gay Men:  Overcoming Fear of Topping1) Fear of Hurting a Partner – I’ve heard from guys in my practice, particularly younger gay men who are still a bit new to sex, or at least new to certain kinds of sex, that they have a fear of topping because they might be well-endowed and fear hurting their partner when they want to make them feel good.  Makes sense.  How do guys cope with this fear?

To start, we have to separate “real” fears from neurotic, anxious ones that aren’t realistic.  If you are, indeed, well-endowed (meaning that you have a large (long or thick or both) penis, then a fear of hurting your partner might be justified, particularly if it’s from experience.  While many bottoms don’t mind (or even crave!) larger guys, if you’ve gotten feedback even from bottom guys who want you to penetrate them but your anatomy makes them uncomfortable, it’s important to respond to that.  Don’t cajole, manipulate, or force (although that can be a kink).  Variables can factor in, such as are you using enough or the right lube product?  Are you going slowly, to “entice” the sphincter muscle to relax?  While it’s controversial (and these things aren’t exactly health food), could using “poppers” help?  (Just be careful in the use of these; combining them with erectile dysfunction medications like Viagra or Cialis could be dangerous, and cause a reaction, such as fainting, or worse; get educated on the proper use of poppers as a sexual health topic).  Could you have more communication with your partner?  Sometimes a bottom who is more turned on can actually accommodate a larger guy, so maybe more foreplay to get “hot” is in order.

If it turns out that you’re so big that the number of bottoms who can or want to be with you is small, you may have to seek out partners that are especially “accommodating” as a strategy in your sexual expression.  They are out there!

But if your fears are not really practical in terms of anatomy, and you fear hurting your partner when you’re not even, let’s say, at “high risk” of that, then the problem is more psychological.  Maybe you’ve been hurt before by a top yourself, and you’re projecting your memory/vulnerability on your bottom now.  Maybe you’re an abuse survivor, and you associate bottoming with pain.  Maybe you lack a certain “assertiveness” to be a top and not only penetrate, but also add some dominant dynamics that is often a part of sex.  Just like any other assertive communication skill (which I teach clients in my office often; there is a six-step model in CBT for training someone in Assertive Communication), being a top in sex involves a certain “playing a role” which can feel like an actor playing a part (think of porn models and how they talk/act, and, uh, grunt).  My CBT work (since I’m in Los Angeles) often involves working with actors, and there is a lot where therapy (of the CBT/coaching/behavioral style, that is) that can overlap with acting coaching.  Over time, if gaining the self-confidence to top more often and more effectively is what you want, this can be cultivated within yourself, just like learning any other interpersonal communication skill in non-sexual situations.

2) Fear of Not Being Dominant “Enough” – See above in terms of assertive communication, but this is another fear that is rooted in the interpersonal/psychological.  Gay men often have a history of their overall masculinity or virility challenged, questioned, or undermined.  Some homophobic people, especially some women (I’ve had employees like this when I was a Clinical Director in the non-profit world) manifest their anti-gay antipathy by not really respecting gay men as men, and don’t “take orders” from them in a work setting (misogynistic men or racial bigots can be the same way about reporting to a boss who is a woman or person of color).  Gay men get subtle “digs” at their masculinity throughout life.  So when it comes to sex, being a top, and showing a certain “dominant attitude”, some guys fear they don’t measure up in this area, particularly if they are more femme in presentation, yet still physically and emotionally prefer to be a top in sex.  Exactly how butch is “masc” enough to top?  This is a question that can’t be answered, because it’s different for every guy.  Part of what undermines sexual performance (and enjoyment) is a fear that someone or something is “judging” your performance from afar, and unless you’re an OnlyFans star, this isn’t the case.  There are no supervisors, evaluators, or judges, just you and your partner.  Ask your bottom early in foreplay what he likes.  If he likes you to play a dominant role, use your favorite porn stars as examples and try to emulate their “style”, but realize that developing your own style is the most authentic and probably the most effective.  This also takes reassuring yourself that you are “good enough” already as you are, and you don’t need to change how “masc” you are for anyone.  If your partner doesn’t like that, it might be time for another partner.  But validate yourself first, and trust that your particular style of top – whatever that is – is what’s right for you in your sexual repertoire.

Gay Men and Erectile Dysfunction: Cognitive Causes and Cures
In another article, I discussed gay men and erectile dysfunction.

3)  Fear of Erectile Dysfunction – Unfortunately, this fear is very common.  I treat the psychological side of ED often, while I collaborate with MD’s (usually a urologist, or an endocrinologist) on these cases.  What makes ED often difficult to treat is that it can have a medical etiology, a psychological etiology, or a combination of both.  I wrote about ED in another blog article, here, that discussed how Cognitive Behavioral Therapy can be applied for erectile dysfunction issues, and I’ve received some nice feedback on that from guys who said it really helped both validate what they were experiencing, and also given them something to do about it.

Maybe your anxieties in topping aren’t just ED, but other fears about “performing” to some kind of objective expectation or evaluation.  It’s important to try to ignore this, and realize that no one is “watching” (usually…) but you’re creating the sexual experience merely between the two of you.  You might ask what your bottom likes, but be careful of trying to elicit too much “reassurance” from him, because that can get annoying by making you look insecure.  Confidence is sexy in so many situations, but perhaps nowhere more than in the bedroom!  The key, or the antidote to this kind of anxiety, is trust.  Trust yourself that the performance you give with your own body, penis, and overall spirit/energy you already have is just for right for this bottom, in this moment.  This will help you relax, which will help him relax, too, and make for a better experience overall.

If you want to “improve” your performance in some way, this can sometimes (not always) be a nice conversation with your bottom after you’re done.  Saying, “what did you like best just now?” might give you feedback, especially if you hear it over and over, that a certain position or “thing you do” is appreciated.  Maybe you vary positions.  Maybe you talk dirty.  Maybe you vary your speed or depth of thrusts.  Maybe you stimulate your bottom’s other senses.  It might be difficult to get an overall consensus, because one bottom might especially like something you do that another guy doesn’t at all, but you can’t please everyone equally.  But you can perhaps look for patterns, and if many guys say they like or don’t like something you try, maybe that can shape your personal sexual style.

Some tops get anxious if they can’t “make” their bottom reach orgasm by thrusting in them alone.  Some tops “achieve” this frequently (again, the pitfall of “performance” language), while others don’t.  This depends a lot on your anatomy (such as the curve of your penis) and also your bottom’s sensitivity to his prostate to be stimulated, and its physical location in his anatomy.  While this “simultaneous orgasm” can be fun, it can’t really be expected or used as an arbiter of your sexual performance.  I would take a philosophical approach on this; it is what it is.  If that happens, fun, if not, don’t judge yourself as inferior for it.  In the words of the show tune by Jerry Herman, from the gay-themed “La Cage Aux Folles”, “I am what I am, and what I am, needs no excuses” (hear the full song if you want to be more inspired by these lyrics and various inspirational performances).

4) Fear of Not Satisfying Your Partner – See above, regarding the “simultaneous orgasm” phenomenon.  Maybe the best way to ascertain if your bottom is having a good time with you is to ask him, but again, not too often.  Another approach is to try to be especially “attuned” to him; try to notice if he makes a certain moan or sound when you do something (thrusting in a certain position), or if you do something else stimulating like pinching his nipple or biting his neck. (By the way, be very careful with the whole “choking” thing as a dominant act; actual restriction of the windpipe can induce heart attacks later, according to one article I read long ago, and doctors will have plenty of caution to say about this.  It’s probably better to “make like” you’re choking than to actually do it).  The finer points of breath control are a BDSM/kink play technique that need another whole discussion.  But various techniques you can try during sex will either elicit some kind of word or signal from your bottom that he likes what you’re doing, or not.  His words like “oooh, easy” or “eh!” when you try something might be a signal to slow down or try something else, or prompt you to say to him, “You OK?”, as a form of “checking in” with your bottom and demonstrating attention, care, and concern, even if you’re otherwise playing a dominant role.  Being kind of “tantrically attuned” to your bottom’s breathing rate, sounds, body language, heart beat (if you can feel it), and eye contact can all be non-verbal ways that you’re interacting and creating a hot moment.

Topics in Sex Therapy for Gay Men:  Overcoming Fear of Topping

5)  Fear of Not Knowing How to Control/Manipulate for Variety – Some bottoms have said that a particularly good top – one that stands out as being particularly fun – have a confident sense of controlling their bottom partner and getting him into varied positions during sex, sometimes without even withdrawing from him.  The finer points of developing your personal sexual style as a top can get fancy, but it doesn’t have to.  Maybe viewing porn and making a note of what your favorite tops are doing can be a behavioral modeling for developing your own style.  Certain positions might stimulate you in ways that are better than others, just as varying your own speed/depth can make you feel differently.  Even using different lube products can give you different sensations, and of course the variables of your bottom partner.  Again, trying to stay “out of your head” is important in avoiding self-judgment.  Try instead to go with where your own instincts take you, even in the moment, saying “Oh, let’s try this…” or “This would feel really good right now..” and gently ask verbally or maneuver your partner into a different position.  Often, a bottom will appreciate a top taking that control, and having him experience taking you in deliberately varied positions will give different experiences.  See books like “The Gay Kama Sutra” for ideas on the countless positions you could try.  But remember that it’s not a contest, and there are no points, prizes, or demerits.  While porn or books might help, your own instincts are probably the best guides for learning the “how” to your top skills.


Just as some gay men are very invested in enjoying their bottom role, perhaps an equal number (some would question that LOL) are investing in being tops.  And maybe the largest cohort would be guys who identify as versatile, which is why I hope this two-part article gives you support for developing whichever “side” of you, top or bottom, needs the most “coaching” to make you have a better time of it.

With all the crap that gay men take from society with discrimination, rhetoric, hate crimes, harassment, disrespect, devaluation, and even murder (such as in many Muslim-government countries, but it can be right here in the United States, too, just not government-sanctioned – exactly – yet), we have to remember that culture, interpersonal relationships, love, and, yes, sex, are the “up sides” to being gay.  It’s supposed to be fun – even exquisite – and overcoming your fears and embracing a sexually self-empowered self is one way to improve your overall quality of life, and certainly mental health and well-being.  It’s worth “troubleshooting” and pursing, and you don’t have to do it alone.  All of these fears are things that can be managed or eliminated with some support, particularly doing the cognitive/behavioral therapy work to move past them.

The opposite of these fears and anxieties are relaxation, comfort, confidence, and even abandon.  Ask any gay top how he likes his “job”, and you’ll likely get a satisfied grin in response.  That kind of delight can be yours to enjoy, as well, if we remove the barriers that stand between your current state of mind and another state you could achieve with some work on yourself.

If having some support for this is something you’re interested in, call/text 310-339-5778 for more information on having a session in my office (near San Vicente and Sixth in LA), or we can discuss my telehealth coaching services available anywhere in the world via webcam.

[Ken Howard, LCSW, is a licensed psychotherapist in California, CA LCS18290, and is a Licensed Clinical Social Worker, with additional certification in psychiatric illness and currently undergoing the process to be Certified Sex Therapist under the supervision of David Ley, Ph.D.  He is also an Adjunct Associate Professor at the Suzanne Dworak-Peck School of Social Work at USC, and is the founder/director of GayTherapyLA, where he supervises three associate clinicians.  He is also an organizational consultant, conference speaker, and expert witness on LGBT, HIV/AIDS, and Diversity issues, and hosts the podcast, “Gay Therapy LA with Ken Howard, LCSW”.]



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