There is renewed interest in the relationship between homosexual identities and mental health (Cochran, Sullivan, & Mays, 2003; de Graaf, Sandfort & ten Have, 2006; Meyer, 2003; Omoto & Kurtzman, 2006; Sandfort, de Graaf, & Bijl, 2003; Sandfort, de Graaf, Bijl, & Schnabel, 2001) and continuing controversy regarding the use of reparative therapies with lesbian, gay, and bisexual populations (Jenkins & Johnston, 2004; Gonsiorek, 2004; Spitzer, 2003; Zucker, 2003). Heterosexually married men who have sex with men (MMSM) are a key research population in these ongoing debates. Same-sex sexual behaviors may result from a variety of motivations and may or may not be associated with primary, or exclusive, homosexual interests and behaviors (Dickemann, 1995; Malcolm, 2000). Married men who have sex with men (MMSM) are difficult to study as their same-sex interests and behavior often are clandestine, inhibiting research participation; and, within this population, the often confusing and contradictory relationship between sexual behaviors and identity labels is magnified. While some MMSM conceptualize themselves as gay, others prefer to self-identify as bisexual or heterosexual but their marital status, sexual behaviors, and sexual identity labels may not necessarily be concordant. (Matteson, 1985; Ross, 1983).
