This study is the first of its kind to report an association between men who have sex with men (MSM) and lower urinary tract symptoms (LUTS). Nine hundred and forty-nine consecutive individuals who presented to a uro-andrology clinic for complaints apart from LUTS were reviewed. The International Prostate Symptom Score (IPSS) was used to assess severity of LUTS in 213 MSM and 736 heterosexual individuals. MSM reported consistently higher rates of mild and moderate-severe storage and voiding symptoms (p<0.01). Being a MSM independently predicted mild voiding symptoms, moderate-severe storage symptoms and severe total IPSS. The authors proposed that these findings are the result of local subclinical inflammation in the lower urinary tract. This is likely to be a consequence of exposing highly receptive tissue to pathogens. This was further supported by data that MSM who engaged in both receptive and penetrative sex experienced higher rates of moderate-severe storage symptoms and severe total IPSS scores. While this study raises the possibility of an association, no concrete conclusion can be reached on a causal relationship highlighting the need for further work.