Mental health practitioners might be surprised to learn that many gay men establish and maintain relationships that allow outside sexual activity. However, for both monogamous and non-monogamous gay male couples, difficulties can arise which indicate that a couple needs to revisit, revise, or reaffirm their original agreements regarding extrarelational sex. This article reviews the existing literature on monogamous and open gay male unions and offers clinical case examples that suggest how to assess and assist coupled gay men, incorporating an understanding of this aspect of gay male relationships.
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