Topping and Bottoming: What’s in a label?

One banana entering a pink sprinkles donut and another banana entering a chocolate sprinkles donut. There is a milky substance on the donuts.

Within the gay and bisexual communities, men are commonly labeled based on their preferred penetrative role during intercourse. Three major self-labels exist.

  1. “Top” refers to a man who prefers the insertive position during intercourse.
  2. “Bottom” refers to a man who prefers the receptive position during intercourse.
  3. “Versatile” refers to a man who is willing to perform either position.1

In Latin American countries, the terms “top,” “bottom,” and “versatile” are replaced by “active,” “passive,” and “versatilo.”

Recently, new labels “vers bottom” and “vers tops” have been added to describe men with less concrete preferences. “Vers bottom” means one who prefers being bottom but who takes the insertive role occasionally, and “vers tops” means one who prefers being top but who takes the receptive role occasionally.2 The addition of such labels suggests that sex-role preferences are fluid and may be influenced by individual, interpersonal, and/or sociocultural factors. In 2008, researchers studying proportions of self-labels amongst a sample of American gay men found 19% self-labeled as tops, 34% self-labeled as bottoms, and 47% self-labeled as versatiles.1 However, in 2011 a survey reporting on gay men in San Francisco found 37% self-labeled as tops, 21% self-labeled as bottoms, and 42% self-labeled as versatiles.2

Researchers have found a strong correlation between sexual self-labels and actual sexual behaviors. There is substantial evidence indicating that self-identified tops engage in more insertive anal intercourse and that self-identified bottoms engage is more receptive intercourse. As one would expect, men identifying as tops reported experiencing greater pleasure from insertive intercourse, and men identifying as bottoms reported experiencing greater pleasure from receptive intercourse. Recent studies have replicated these results, finding that tops were more likely to engage in insertive anal intercourse, bottoms were more likely to engage in receptive anal intercourse, and that versatiles reported intermediate rates of both behaviors.2

Psychosocial Implications

In heterosexual relationships, male female penetrative roles are believed to have developed evolutionarily in order to promote human reproduction. Typically, penetrative roles in heterosexual relationships are inflexible, and highly correlated with physiological and psychological expressions of gender.3 Much less is known about the penetrative roles men adopt during same-sex intercourse. What orients men to identify as a top, bottom, or versatile is poorly understood because there is scarce research on the topic; and, what little evidence does exist relies heavily on anecdotal evidence. However, a couple potential correlates of sex-roles have been proposed.

Dominance and Submissiveness

Dominance and submissiveness (i.e. power) have been suggested as potential correlates of penetrative roles. It is often assumed that self-identified tops are naturally more dominant than self-identified bottoms, and vice versa. Though this belief is pervasive in both the academic and cultural landscapes, research on the topic has wielded inconsistent results. Some researchers have found that tops report being more dominant and that bottoms report being more submissive1, while others argue that these findings are inconsistent and are heavily dependent on the dynamics between sexual partners.4

Gender Roles

Two bare-chested men. One individual is hugging the individual in front of him.

In recent years, researchers have explored how gender roles may influence sexual positioning during anal sex. In a 2004 study of adult gay Latino men in the United States, researchers found masculinity to be central in determining anal sex positions. Within the sample, men who perceived their partners to have more masculine physical characteristics (e.g., older, taller, larger penis, etc.) were more likely to bottom and vice versa.5 These findings show sexual positioning to be a dynamic and shifting process in which sex roles are negotiated in relation to traits expressed by sexual partners. A 2011 study found discrepancies between adult gay men’s professed gender roles and sexual behavior. They found men who acted only as a top or only as a bottom typically adhered to those behaviors regardless of their partners’ characteristics. Amongst men without a strong preference, however, masculine physical characteristics were again found to be highly predictive of sexual positioning. Researchers identified a particularly strong correlation between penis size and sexual positioning.3 Evidence indicated that the partner with the larger penis typically adopted the insertive role, and that the partner with the smaller penis typically adopted the receptive role. For many men, comparative penis size seemed to ultimately guide the enactment of penetrative roles. Taken together, these results show that while some rely heavily on normative understandings of gender roles to guide their sexual behaviors, others prefer to top or bottom purely because they find it to be more pleasurable physically.

Researchers have also found that sexual positioning is decided differently in casual encounters versus long-term relationships. In one study, a sample of young gay men were asked how they determined whether or not to top. Researchers noticed that respondents described casual encounters and long-term relationships differently. When describing casual encounters, participants seemed to rely on stereotypical gender-based attributes associated with tops and bottoms to guide their sexual decision-making. As seen in prior studies, they assessed partners’ physical characteristics to ascertain who was more masculine. Again, penis size proved to be the highest predictor of sexual positioning. Gender roles were less influential in determining sexual positioning amongst romantic partners or members of long-term relationships. Rather, they value pleasure, both their own and their long-term partner’s, as a key contribution to the process of negotiating sexual positions. Many cited partners’ preferences as the main determining factor of whether they would act as a top or a bottom. These findings suggest that within romantic or long-term relationships, gender scripts play a much smaller role in the negotiation of sexual positions and behaviors.6

Health Implications

Lubricant dripping on a banana.

Anal sex is considered to be a high-risk sexual activity. Because the anus does not produce a natural lubricant, inserting a penis (as well as a finger or sex toy) into the anal cavity without using generous amounts of lubricant can easily cause small tears or fissures in the anal tissue. These small tears can serve as open pathways for the transmission of STIs and viruses, including HIV (Human Immunodeficiency Virus).  HIV is the virus that causes the life-threatening disease AIDS (Acquired Immunodeficiency Syndrome). Even if lubrication is used, these small tears in the anal tissue can still occur, which is why it is very important to always wear a condom when engaging in anal intercourse. The risks associated with anal sex can be very serious, so it is important to exercise safe sexual practices.

Risk for HIV transmission

Both partners should be educated on the risk of HIV transmission during anal intercourse regardless of self-label or typical sexual position. With that being said, there are different health issues and responsibilities associated with topping and bottoming.

Risks and responsibilities associated with topping

It is a common misconception that little to no health risks are associated with topping. Although the individual topping is generally at a lower risk for HIV than the individual bottoming, both topping and bottoming during unprotected anal intercourse are considered unsafe. Without the barrier of a condom, HIV can enter through small cuts, abrasions or open sores at the opening of the penis. For this reason, the presence of another STI increases risk for transmission. Researchers have also found that uncircumcised tops are at a greater risk for HIV infection than those who are circumcised. Regardless, it is important to realize that topping does not protect you from HIV.7

It is incredibly important for tops to know their HIV status. If a top is HIV-positive but not on treatment, they could have a high viral load and put their partner at a high risk for transmission. Viral load describes the amount of HIV in one’s blood, so if someone has a high viral load it means they have a large amount of HIV in their blood. Tops with HIV positive partners are still at risk but that risk is reduced, especially if they are on treatment and undetectable. A condom or PrEP could both be used for protection in this scenario. PrEP (pre-exposure prophylaxis) is when people at very high risk for HIV take HIV medicines daily to lower their chances of getting infected.8 When a top is HIV-positive, sustaining an undetectable viral load through consistent use of medication is the best way to protect himself from transmitting the virus.

Risks and responsibilities associated with bottoming

Unfair as it is, men who bottom are at greater risk for HIV. As discussed above, the delicate tissue of the anus is susceptible to cuts and abrasions during intercourse. If HIV is present in the top’s ejaculate or pre-cum, these cuts and abrasions allow it to enter the bottom’s bloodstream.7 Therefore, a bottom should always ask about their partner’s HIV status and encourage them to use a condom. However, Truvada as PrEP is the best method of protection for a bottom because it puts them in control of their own health regardless of their partner’s status or condom use.  Truvada is a combination of two HIV medicines (tenofovir and emtricitabine) and is approved for daily use as PrEP to help prevent an HIV-negative person from getting HIV from a sexual partner who’s positive.8 As mentioned above, an HIV-positive man who bottoms can protect himself from transmitting by consistently taking HIV medication and staying in control of his condition.

Gay and bisexual men commonly use penetrative role labels, yet there is no common explanation about what’s in a label. Though scarce research has been done in the field, sex-role correlates have been proposed to explain how men orient themselves. Men are said to either prescribe to a dominant-submissive, normative gender role, or pleasure-seeking schema. Regardless, when it comes down to it, safe sexual practices should come first when engaging in anal sex, because of its high-risk nature. To be safe, please ask about a partner’s HIV status and encourage condom use. Moreover, consider use of HIV medication such as Truvada as PrEP, which allows for utmost control over personal health, regardless of a partner’s status or condom use.


1. Moskowitz, David A., Gerulf Rieger, and Michael E. Roloff. “Tops, bottoms and

versatiles.” Sexual and Relationship Therapy 23.3 (2008): 191-202.

2. Wei, C., & Raymond, H. F. (2011). Preference for and maintenance of anal sex roles among

men who have sex with men: Sociodemographic and behavioral correlates. Archives of sexual behavior40(4), 829-834.

3. Moskowitz, D. A., & Hart, T. A. (2011). The influence of physical body traits and masculinity

on anal sex roles in gay and bisexual men. Archives of Sexual Behavior40(4), 835-841.

4. Kippax, S., & Smith, G. (2001). Anal intercourse and power in sex between

men. Sexualities4(4), 413-434.

5. Carballo‐Diéguez, A., Dolezal, C., Nieves, L., Díaz, F., Decena, C., & Balan, I. (2004).

Looking for a tall, dark, macho man… sexual‐role behaviour variations in Latino gay and bisexual men. Culture, Health & Sexuality6(2), 159-171.

6. Johns, M. M., Pingel, E., Eisenberg, A., Santana, M. L., & Bauermeister, J. (2012). Butch tops

and femme bottoms? Sexual positioning, sexual decision making, and gender roles among young gay men. American journal of men’s health6(6), 505-518.

7. Curry, Tyler. “Gay Sex Ed: Topping and Bottoming 101 :: HIV Equal.” Gay Sex Ed: Topping

and Bottoming 101 :: HIV Equal. N.p., 9 Nov. 2015. Web. 15 Nov. 2016

8. PrEP. (2016, November 10). Retrieved November 29, 2016, from

Last Updated: 29 November 2016