Dismantling Stereotypes About Being Top, Versatile, or Bottom: Sexual Minority Men’s Anal Sex Position Identity as It Relates to Attraction, Sexual Behavior, and Anthropomorphic Characteristics

Many sexual minority men (SMM) use sex position self-labels, including "top," "bottom," "versatile," as well as combinations like "vers/top" and "vers/bottom" to describe engagement in anal intercourse. Despite the use of these labels, there is limited literature identifying various aspects that may impact SMM's chosen sex position label. The purpose of this study was to examine factors (i.e. sexual behavior, participants' anthropomorphic characteristics, and attraction to partners' attributes) associated with self-reported sex position label use. Participants (<i>n =</i> 4,802) were cisgender SMM from a U.S. nationwide cohort exploring missed opportunities for HIV prevention. The main analyses used iterative logistic regression models to predict self-reported sex position labels based on sexual behavior, participants' anthropomorphic characteristics, and attraction to partners' attributes. A higher proportion of participants identified as bottom/versatile (24%) followed by top/versatile (22.5%), versatile (20.3%), top (17.2%), and bottom (15.8%). Sexual attraction, behavior, and anthropomorphic characteristics poor-to-moderately predicted single sex position label categories. However, when considering near-adjacent sex positions (e.g. top/versatile as adjacent to top), model prediction improved substantially, indicating variability in self-labels and factors associated with each label. Sex positionality is complex and requires multidimensional measurement to fully understand this aspect of an individual's sexuality.