What is "Healthy" Sex? 4 Guidelines From A Gay Therapist in Los Angeles

Michael Pezzullo
1 day ago
4 min read

Updated: 5 hours ago

What is "Healthy" Sex? 4 Guidelines From A Gay Therapist in Los Angeles

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Sex in gay culture can sometimes feel like a free-for-all—endless options, endless possibilities, and endless opinions about what’s “normal.” We’re surrounded by hookup apps, porn, party culture, and social messaging that can make sex feel simultaneously exciting and overwhelming. But beneath all of that noise, a question many of my clients ask is deceptively simple:

What actually makes sex healthy?

As a gay therapist Los Angeles based and working with hundreds of gay men over the years, I’ve seen firsthand how confusing this question can be. Some men worry they’re “too sexual.” Others fear they’re not sexual enough. Many feel pressure to fit into a narrow definition of what gay sex is supposed to look like—wild, casual, adventurous, spontaneous, boundary-pushing.

But healthy sex isn’t about conforming to a stereotype or following someone else’s template. It’s about creating a meaningful relationship with your own sexuality—one that supports your mental health, emotional well-being, and sense of self.

If you read Part 1 of this series, you already know some of the foundational ideas. (If you haven't yet, check out that Guide to Healthy Sex for Gay Men). Here in Part 2, I want to expand the framework and offer four more parameters to help you better understand what healthy sex can look like in your life.

1. Healthy Sex Is Safe

Let’s start with one of the most misunderstood concepts: safety.

Safety is not a one-size-fits-all idea. It’s personal, and it evolves with your experiences, preferences, and relationships.

For some gay men, safety means:

Using condoms
Staying consistent with STI testing
Taking PrEP
Setting boundaries before the clothes come off

For others, safety has a more emotional or psychological dimension:

Choosing partners who are respectful
Avoiding environments that feel chaotic or triggering
Knowing that you can pause, stop, or renegotiate anything at any time

At its core, sex is safe when:You feel physically protected, emotionally grounded, and psychologically respected.

There’s no universal rulebook. There’s only what’s healthy for you. As a gay therapist in Los Angeles, I remind clients that safety is not simply abstaining from risk—it’s about creating conditions where you can be present with your pleasure rather than anxious about the aftermath.

2. Healthy Sex Is Authentic

Healthy sex isn’t a performance. It isn’t about living up to a sexual script or proving something. It’s about truth.

Authenticity means:

You’re tuned into your real desires
You’re not pretending to want something
You’re not doing anything out of pressure, expectation, or fear of rejection
Your sexual choices line up with who you actually are—not who you think you’re supposed to be

Gay men often feel pressure to “play a role”: the top who’s always dominant, the bottom who’s endlessly submissive, the versatile who’s always game for anything, the sexual adventurer who never says no.

But healthy sex is grounded in your inner reality, not in gay culture’s fantasies.

Even if you’re trying something new—a kink, a dynamic, a fantasy—your curiosity should come from within you, not from someone else’s agenda.

Authentic sex is sex where you can breathe. Sex where your body and mind feel like they’re on the same page. Sex that reflects you—not the persona you’re trying to impress others with.

3. Healthy Sex Is Sober

Call me a purist, but I stand by this one: healthy sex is sober sex.

This doesn’t mean pleasure and substances can never overlap. But when it comes to defining “healthy,” here’s why sobriety matters:

You deserve to be fully present for your own pleasure.
You deserve to remember the experience—not just the aftermath.
You deserve boundaries that are clear and intact.

Alcohol and drugs blur awareness. They weaken instincts. They make your “no” softer and your “yes” less grounded. They can lead to consent that doesn’t feel like consent the next morning.

Sober sex is sex where your mind, body, and instincts are actually online. You’re connected to your sensations, your limits, and your desires. There’s integrity in it.

As a gay therapist Los Angeles clients often turn to for navigating sex, dating, and intimacy, I can tell you this: sobriety doesn’t limit pleasure. It enriches it. It creates sex you can trust—not just in the moment, but afterward too.

4. Healthy Sex Is Expressive

Healthy sex isn’t just about bodies—it’s about expression.

Sex can express:

Desire
Curiosity
Vulnerability
Connection
Playfulness
Power
Release
Even joy

You don’t need a romantic partner for sex to be meaningful. But the experience should allow you to feel more alive, not less. More connected, not empty. More attuned, not numb.

Healthy sex is an emotional language. It’s a way of saying something real—even if the words never leave your mouth.

When sex leaves you feeling more grounded in yourself, more aware of your emotions, and more connected to your body, that’s healthy. That’s expressive.

A Gay Therapist in Los Angeles' Take

Healthy sex isn’t about rules—it’s about resonance.It’s about aligning your sexual life with your emotional life.It’s about truth, safety, clarity, and expression.

If you’re struggling to define your own sexual boundaries or you’re trying to heal your relationship with sex, working with a gay therapist Los Angeles based professional can help you untangle the pressures, expectations, and internal conflicts that shape your experience.

Healthy sex begins with self-knowledge.And it grows with self-respect.

If you want Part 3, just let me know—I can expand the framework even more.

If you’d like to learn more about my practice, you can book a complementary consultation. You can also read more about my psychotherapy work with gay men.