Objectives. To explore the theoretical utility of current health psychology in understanding the occurrence of unprotected anal sex amongst gay men in relationships.Design. Interpretative Phenomenological Analysis was employed to highlight the utility of incorporating the perspective of gay men in addressing a theoretical understanding of sexual decision making.Methods. Twenty in‐depth interviews were conducted with working‐class gay men from a small South Yorkshire town. These were transcribed and analysed for recurrent themes which reflect the way gay men thought about sex and relationships.Results. There were many differences between the way gay men thought about sexual activity and the way health psychology assumes men think about it. Within the context of romantic relationships men often privileged the expression of commitment, trust and love as more important than their own health.Conclusions. Psychological theory relating to sexual health would benefit from a consideration of the way gay men report thinking about sexual behaviour in the context of romantic relationships. Such an informed theory would direct sexual health promotion beyond the simple provision of cond