The Global Online Sexuality Survey (GOSS): Male Homosexuality among Arabic-Speaking Internet Users in the Middle East—2010 Osama Shaeer, MD, PhD and Kamal Shaeer, MD Department of Andrology, Kasr El Aini Faculty of Medicine, Cairo University, Cairo, Egypt DOI: 10.1111/jsm.12634 ABSTRACT Introduction. The prevalence of male homosexuality is difficult to elicit considering the sensitivity of one’s sexual orientation. The Global Online Sexuality Survey (GOSS) is an online epidemiologic study of male and female sexuality. The online nature of GOSS allows more confidentiality and wider geographic reach, particularly important in investigating sexual issues within the more conservative societies. Aim. This study aims to determine the prevalence of male homosexuality among Internet users in the Arabic- speaking Middle East and the unique characteristics of this subset of the population. Main Outcome Measures. Prevalence of male homosexuality. Methods. In the year 2010, GOSS was offered to Arabic-speaking web surfers above 18 years of age in the Middle East. Potential participants were invited via advertising on Facebook®. Invitations were dispatched randomly with the exception of geographic region and age, regardless web surfing preferences. GOSS relied in part on validated questionnaires such as the International Index of Erectile Function, as well on other nonvalidated questions. Results. 17.1% reported desire toward the same sex, of whom 5.6% had homosexual encounters, mostly in the form of external stimulation rather than intercourse, and exclusively undercover. An overwhelming majority was ego- dystonic (78.2%). Conclusion. This is—to our knowledge—the first online survey to address the prevalence of homosexual orientation and practice in the Middle East, discriminating desire from practice, ego-syntonic from ego-dystonic, and investi- gating the pattern of practice. Homosexual desire is present in the Middle East as it is around the world, and homosexual encounters are as prevalent. Yet, the undercover and ego-dystonic states prevail. Shaeer O and Shaeer K. The Global Online Sexuality Survey (GOSS): Male homosexuality among Arabic-speaking Internet users in the Middle East—2010. J Sex Med 2014;11:2414–2420. Key Words. Homosexuality; Survey; Internet; Middle East; Arab Introduction T he prevalence of male homosexuality is diffi- cult to elicit considering the sensitivity of one’s sexual orientation, particularly in cultures with homophobic attitudes, where admitting same-sex preferences may lead to stigmatization and possibly legal consequences. There are at least 83 countries where homosexuality is condemned by penal code; 26 of these are Muslim countries, and in seven countries, the death penalty threatens persons presumed guilty of homosexual acts. Nev- ertheless, same-sex relationships do take place, even in the most repressive countries [1]. Most available studies of the homosexual population in Muslim countries are case accounts and opinion studies [2,3] rather than prevalence studies. The Global Online Sexuality Survey (GOSS) is an online epidemiologic study of male and female sexuality. The online nature of GOSS allows for a wide geographic reach and nonconfrontational reporting that confers confidentiality, encourages participation, and decreases the stress of one-on- one interviewing and the possibly biased replies, 2414 J Sex Med 2014;11:2414–2420 © 2014 International Society for Sexual Medicine