The Ins and Outs of Gay Sex: A Medical Handbook for Men
288
The Ins and Outs of Gay Sex: A Medical Handbook for Men
288eBook
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Overview
At last! Answers to the questions you're too embarrassed to ask--but always wanted to know!
Why does it hurt down there? Is it really safe to do that? What does it mean when something looks like this--and how do I make it go away?
Chances are you never learned anything about gay intimacy from your parents, your school, or your family physician. Here, at last, is reliable, comprehensive information on a wide spectrum of gay medical concerns, written by an eminent surgeon and recognized authority on gay health issues.
With up-to-date facts, interviews, and case studies from the author's practice, The Ins and Outs of Gay Sex goes far beyond HIV concerns, combining a complete education about the safe and pleasurable practices of male-male sexuality with a comprehensive medical volume.
Here are the facts about what you need to know to keep your sex life hot and healthy, including:
The rules of safe anorectal stimulation.
Symptoms to send you running to the doctor.
Foreplay, sex toys, and other accessories.
Viral and nonviral STDs-don't wake up with an unpleasant surprise!
Treatments for impotence and other sexual dysfunctions.
Diseases that can be spread without penetration.
Drugs...relationships...doctors (how to find the right one for you), and much more.
Product Details
| ISBN-13: | 9780307788771 |
|---|---|
| Publisher: | Random House Publishing Group |
| Publication date: | 05/11/2011 |
| Sold by: | Random House |
| Format: | eBook |
| Pages: | 288 |
| File size: | 3 MB |
About the Author
Read an Excerpt
CHAPTER 1
Anal Sex—
OR SO WHAT IF IT’S NOT A VAGINA?
I shook my head. I still could not find anything wrong. Alex rolled over on the table. Even with the new mustache he still looked like the surfer boy he’d been.
“What’s wrong with me?” he asked.
I rested my hand on his shoulder. “Nothing as far as I can see. You’re not too tight.”
“I must be. Richard’s not that big. I did everything you said and I still can’t take him.”
“You’re tensing up,” I said. He tried to argue, but I stopped him. “Not willfully. It’s beyond your control. Maybe anal sex isn’t for you. There are plenty of other ways to satisfy Richard.”
He looked away. “You don’t understand. This is important. If I don’t do this …” His voice trailed off. “Can’t you put me to sleep or something? Make it wider?”
“It’s wide enough.” I gently directed him to look at me. “There is nothing wrong down there. What else is bothering you?”
He didn’t answer for several minutes, but I waited. Some things can’t be rushed.
Whether we call it anal sex, anal intercourse, or just plain fucking, this type of sex is an integral part of sexual relations for many men who have sex with men. But the practice is in no way limited to gay men; many women enjoy it too. In a recent survey of 100,000 women, Redbook Magazine found that 42 percent of women had tried it once, and, for 2 percent, anal sex was an important part of their sexual relationships. We are not alone! Many men enjoy anal sex; the experience is pleasurable and vital to their sex life.
I remember standing in horror as a physician I worked with berated a gay man he treated with a terse “Your asshole is for shitting, not fucking!” Well, this is not the case. Anal sex can be both pleasurable and safe if practiced properly. Unfortunately, homophobia has clouded the issue. Ignorance and rumor often magnify our fears about possible injury. Many gay men refuse to discuss anal sex with their physicians, and most physicians know little if anything about it—other than that it transmits HIV.
Many women view vaginal intercourse as the major step in their sexual evolution, giving considerable thought to who will be their first. Men joke about losing their virginity after their first anal sex experience and minimize its significance. True, we don’t have a hymen to rupture, but anal sex is not an insignificant step, emotionally or physically. Many men view anal sex as the final step on their path to gayness. (Once you’ve done it you must be gay.) For some it’s a sign of their first true love. Others view anal sex as an assault on their masculinity. Unfortunately, some men recall their first episode of anal sex as the horror of sexual abuse, and they may never recover. In any case, you shouldn’t bend over for anyone until you’re ready.
Physiologically, anal sex must not be taken lightly. Sure, you can’t get pregnant, but there are a million other things you can get instead. Anal sex is probably the highest-risk sexual act performed by men who have sex with men—and not just because of HIV. Most sexually transmitted diseases (STDs) pass between partners during anal sex—even without ejaculation. And a condom may not be protection enough. In this era of sexual freedom, it is almost impossible to have a healthy sex life and avoid an STD. Before you let that guy inside you, make sure he’s clean and you’re protected.
If you have anal sex regularly, use these pages as a guide; they may protect you from injury and STDs. And for those of you who aren’t ready for anal sex, read on. Someday a relationship might arise when it becomes something that you both desire.
Anatomy
Anal intercourse differs from vaginal intercourse in several significant ways. First and foremost, a hole is not just a hole, and a woman’s vagina is anatomically very different from your anus. The colon’s purpose, as we all know, is to transport digestive waste from your small intestine to your anal opening where it’s excreted. As part of this task, the colon’s lining, or mucosa, is specially equipped to absorb water from the liquid waste of your small intestines and turn it into solid feces. When your colonic mucosa doesn’t work properly, diarrhea results. Your colon’s heightened absorption capability makes it a particularly susceptible entryway for many infections; HIV, of course, is one of the most deadly.
Your colon is approximately six feet long, and unless your partner is something of a “giant” among men, anal intercourse affects only the last few inches. This area includes your anus and rectum; although they both are regions of your colon, they are, in actuality, two very distinct anatomic sites. Your anus is lined by squamous cells, which are closely related to skin. Your rectum resembles the rest of your colon. Importantly, your anus has nerve endings capable of experiencing pain while your rectum does not.
The muscles that control bowel movements, or sphincters, as they are commonly called, are concentrated in your anus and lower rectum. These muscles can be divided into an external sphincter and internal sphincter. (See Figure 1.1.) Your external sphincter, the outermost band of muscle, is under your direct control. You can willfully tighten it to keep gas or feces from leaking out, and you can relax it for defecation. Your internal sphincter muscle abuts your colon wall. It is an involuntary muscle, and as such you cannot willfully cause it to relax or contract. When feces enter your lower rectum, the internal sphincter involuntarily relaxes for defecation. If you’re miles from a bathroom or in the middle of some speech, you depend on your external sphincter to contract and prevent an embarrassing situation from occurring. The rectal wall also contains nerve fibers that tell you the difference between feces and gas.
Just as your internal sphincter muscle involuntarily relaxes when feces enter your rectum, it involuntarily contracts when a penis or other object attempts to enter from the outside. As the word “involuntarily” implies, this sphincter contraction is beyond your ability to control, no matter how relaxed or sexually aroused you are. The relaxation and contraction of the internal sphincter allows you to pass large bowel movements painlessly, yet a penis of equal or smaller size can hurt during insertion. An anal tear can occur during the initial phase of anal sex precisely because your partner pushes his penis through your closed sphincter. Think of his penis as a battering ram, one for which your internal sphincter is no match.
Interviews
On Monday, June 21st, barnesandnoble.com welcomed Stephen E. Goldstone to discuss THE INS AND OUTS OF GAY SEX.
Moderator: Welcome, Dr. Goldstone. We're excited to host you during Gay Pride Month and can't wait to get to our many questions regarding THE INS AND OUTS OF GAY SEX. How are you this evening?
Stephen E. Goldstone: I'm fine. I'm relaxing at home, anxious to answer the questions.
Greene from Boston: What made you decide to write this book?
Stephen E. Goldstone: I treat a lot of gay men in my practice, and over the years I've realized that so many men have been carrying around questions relating to sex and its impact on their health with nowhere to turn for answers. Even most physicians aren't able to answer these questions. Every day I see how this dangerous lack of knowledge impacts negatively on gay men's health.
Michael Wallis from San Francisco: Dr. Goldstone, I have always been sex positive, and I read your book and was happy to see it doesn't say dark shadowy things about sex but is a real, honest look at what sex means to the body and how we can enhance it. I have a question you probably don't run across every day: Is anal sex bad for you? I have had it for many years, and I don't seem to suffer from any problems as far as I can tell. Are all men built the same for it? Is there a way to maybe improve the pleasure of it?
Stephen E. Goldstone: Thank you for your positive comments about my book. It's nice to hear. Your question is not unusual, and I'm asked about anal sex often. Anal sex is the highest-risk sexual activity gay men can perform, and not just for HIV transmission. Many other STDs are transmitted through anal sex, and a condom when worn only for penetration may not be protective enough. As far as damaging your rectum, as long as it doesn't hurt, you should be fine. Men who are into fisting and large toys may have permanent damage to their anal sphincters, which can in later years lead to difficulty controlling their bowels.
Roger Burroughs from Chatham, MA: I've heard so many conflicting things about this, and I'm not sure who to trust: Can you get infected by the HIV virus from oral sex? Has that been documented?
Stephen E. Goldstone: This is a very difficult question to answer. I wish I could tell you that it's either absolutely safe or not safe. Studies in the medical literature document HIV transmission through oral sex in a very small number of cases. The best answer I can give you is that oral sex is relatively safe with only a small chance of transmitting HIV. Interestingly enough, medical studies have not shown that having a partner ejaculate into your mouth statistically increases HIV transmission. However, most physicians feel that ejaculation does increase risk.
Barney from San Francisco: If you are fairly promiscuous yet always practice safe sex, how often should you have an HIV test?
Stephen E. Goldstone: Anal sex is the greatest risk factor for HIV transmission. The second greatest risk factor is the number of different sexual partners you have. If you are "fairly promiscuous" and practice anal sex, you should probably be HIV tested every six months.
Michel from Brooklyn: What's your take on Viagra? Is it for everyone?
Stephen E. Goldstone: No, it's not for everyone. Viagra is a drug designed to help men who are truly impotent and not for guys who just want to keep it up all night. There are dangerous interactions between Viagra and poppers, which have resulted in deaths. There are also reported cases of men unable to lose their erection after taking Viagra. While this may sound like a dream come true, it is actually a medical emergency. Most men who suffer from this complication will be left impotent.
K. C. from Nowhere Special: I'm still a virgin and 23. I guess there is something wrong with me because I'm afraid of what I think will be painful about sex with another man. I like to be sexual with guys, but they seem to want to penetrate me, and I'm not sure that's possible. Do all gay men have anal sex?
Stephen E. Goldstone: Absolutely not! You should never do anything that you don't want to do. If a man forces himself upon you, it's called rape. If, however, you do want to try anal sex, it might be best to first buy a small dildo (a little bigger than your finger) and gently insert it into your anus. You will quickly find out whether or not this is a pleasurable experience for you. If it is, you just may find a man that you want to have anal sex with. But always remember, it's your choice, and you don't have to do it.
Alain Robert from Canada: Hello, Dr. Goldstone. I enjoyed your book on gay sex and laughed at some of the introductions you had and chapter titles, too. Thank you. My lover and I always wonder about some of these things with our bodies and how they fit together and the medical side of things. Sometimes sex is painful for us, and I tried doing what you mention in the book (sitting astride him), which seemed to help. How long have you been treating gay men?
Stephen E. Goldstone: Thank you, Alain, for your comments. I'm so glad I could help you. I have always treated gay men, but in the last five years they have become the largest part of my practice -- and happily so.
Oaks from Darien, CT: If I have a problem or a question, should I talk to my GP or should I go to a urologist? I really don't feel comfortable talking about my sex life to my GP, and I'm not sure if changing doctors would help. Any suggestions?
Stephen E. Goldstone: Find a new doctor. You should never go to a doctor with whom you don't feel comfortable discussing sexually related issues. A urologist can be just as homophobic as your GP. Talk to other gay men for recommendations, call a gay and lesbian switchboard, or look in gay-specific publications. Doctors who reach out to the gay community through these sources will most likely not be homophobic.
Chas from Hotlanta: Is it possible to have a latent STD? I've been with the same person for almost a year and have just been told that he has genital warts from a previous relationship. Can it really remain hidden for that long?
Stephen E. Goldstone: Absolutely. More than half of all gay men carry the virus that causes genital warts, and many have no idea. You can carry the virus and not have warts, and then suddenly, for reasons we don't yet understand, warts grow. Many other STDs can also be present without your knowing it. Syphilis is a classic example of an STD men can carry for years without realizing they have it.
Greta from NYC: Will you be writing a book like this for women as well? I'm assuming this doesn't cover lesbian sex....
Stephen E. Goldstone: Thank you for asking. I haven't thought about it, but I'll give it careful consideration.
Peter Fasteau from Middleton CT: Good evening, Doctor! I really love your book, especially how erotic it is in parts and then balanced with good medical advice. You've got a ton of information in your book about truly gay men's sexuality and all kinds of problems and solutions. What's the most unusual case you've ever dealt with?
Stephen E. Goldstone: Thank you so much, Peter, for your kind words. It's really nice to know people enjoy my book. I think the most unusual story is the one about the zucchini. Not because someone put a vegetable up his rectum (I've certainly seen that before), but because he did it while driving on a very busy highway! I can't believe that I was stuck in the same traffic on the same highway while all this was going on. (I was not in the same car!)
Bret from Kansas: Hi, Dr. Goldstone. I have a strange question. Is anal sex bad for the body? Can you have too much sex, basically?
Stephen E. Goldstone: It's not a strange question. As long as it doesn't hurt, you should be okay. If you notice bleeding or pain, you might be having a problem and should stop the sex. If the pain or bleeding doesn't go away, then see a doctor before trying anal sex again. Fisting and large toys can cause serious problems. For more information, please read my response to the earlier question.
James from Michigan: Dr. Goldstone, what kinds of fears do gay men seem to have most about sex?
Stephen E. Goldstone: Clearly gay men are most afraid of catching HIV and other STDs from a new partner. Once they have a problem, they are often too afraid to mention it to a doctor for fear that it will lead to instant outing. Although I advise complete honesty with your doctor, I assure you that there is no STD you can get which will identify you as a gay man.
DV from Madison, WI: Hello, Dr. Goldstone. Is syphilis still a disease we should be concerned about?
Stephen E. Goldstone: I'm so glad you asked this question, because syphilis, unfortunately, is still very common in this day and age. There were over 100,000 new cases reported in this country last year. The United States has the highest incidence of syphilis as compared to all other industrialized nations. Most people with syphilis don't even know they have it.
Jimmy from New York: Thanks for coming here. I read your book, and it has some really good advice in it. I really love having sex and being sexual, but sometimes I feel like I'm being unsafe. How safe is safe? Are condoms really good enough?
Stephen E. Goldstone: I think it's wonderful that you can enjoy sex. Condoms are our best protection against HIV. Unfortunately, many STDs are spread just by skin to skin contact, so rubbing during foreplay when most men don't wear condoms can pass STDs between partners. I also advise in my book that you examine your partner for signs of STDs before sex. Now, I don't expect you to put on a white coat and gloves like a doctor, but please keep the lights on. If you see sores on his penis or a discharge, it might be best to limit your activity to just masturbation. That can be hot and relatively safe.
Hun from Birmingham: What are your thoughts on the at-home tests for HIV? Are they reliable?
Stephen E. Goldstone: I think that the at-home tests are very accurate and an excellent way to be tested if you don't feel you can go to a clinic or doctor in your area. I still feel that the more personal testing and counseling a doctor's office or clinic can provide is the best way to be tested. Unfortunately because of privacy issues, this option may not be acceptable to some men. In that case, go for the home test kit. Just remember that a home HIV test is not like a home pregnancy test where you get immediate results. With home HIV testing, you prick your finger for a sample of blood in the privacy of your own home. The blood is then mailed to a laboratory and identified only by a confidential number. You call up a week later and obtain your results by telephone.
Bugle from Seattle: Does your book cover having sex with a partner who is HIV positive?
Stephen E. Goldstone: Yes, it does. I think that in these cases, condom usage is a must, even if an HIV-negative receptive partner doesn't want it.
Oreo from Toledo: I've been with my boyfriend exclusively for three years, and I'm totally comfortable using condoms. However, my partner isn't and is begging to go bareback. Although I trust that he is monogamous, I'm not willing to gamble with my life. What should I do? I know this isn't a counseling session, but do you recommend always using condoms?
Stephen E. Goldstone: This is a great question but very difficult to answer. You should never do anything that you don't want to do. If your partner can't accept your wishes, then you might have to move on. Counseling may be helpful for both of you. I have written a chapter in my book which addresses just this question. The issues are very complicated and too lengthy to answer in this forum. Please read the chapter, and if you still have questions, email me through my web site: www.lasersurgerycare.com.
Nick Qualiana from Brooklyn: What's the deal with fisting? Is it dangerous or okay? I like to do it and get it done, and sometimes I worry.
Stephen E. Goldstone: Fisting can hurt your anal sphincters. Men who have been fisted can have difficulty controlling their bowels in later years. Repeated insertion of large toys or fists can permanently damage your anal sphincters. As a physician, I cannot recommend fisting.
Erica Crichton from Hoboken NJ: Hi, Dr. Goldstone. My brother's gay and not quite out of the closet. I would not mind talking to him about this, but he seems to keep everything in. I know he has had lots of boyfriends, and I worry about him maybe being promiscuous. I was thinking of giving him your book so maybe we can talk and he can let me into his life. Or would this be premature? I don't want to scare him away.
Stephen E. Goldstone: By all means, give him my book. I must say that your sincerity is refreshing and your brother, whether he knows it or not, is lucky to have a sister like you. Hang in there, and I'm sure he'll open up.
Jesse from L.A.: This is completely awesome that you're here in chat. I really liked your book and all the things it taught me. Are you going to write another one? If you do, I think you should have lots of photos of cute guys in it.
Stephen E. Goldstone: Thank you for your comments. I think that we as gay men owe a lot to barnesandnoble.com for inviting me to this Auditorium. Many bookstores would never allow this topic to be discussed. Let's all let Barnes & Noble know how much we appreciate their support for gay men's health. As far as another book is concerned, I'm ready, willing, and able -- but open for suggestions.
Matt S. from New York, NY: I think your book is amazing, Dr. Goldstone. It's the first time I've read a sex book that's not about how to land a babe or how to do some uncomfortable position while licking whipped cream out of each other's armpits. What do you think about barebacking?
Stephen E. Goldstone: Whipped cream is too fattening! As far as barebacking is concerned, it is extremely risky, and I cannot advise it for casual sexual encounters.
Moderator: Thank you, Dr. Goldstone. You have shared a lot of valuable information tonight! Do you have any closing comments before we sign off?
Stephen E. Goldstone: It is so important for an author to get feedback, and I truly enjoyed this forum, both as a learning experience for me and as a chance to answer your questions. I'm sorry we couldn't get to everyone. You can contact me through my web site at www.lasersurgerycare.com. Just remember, stay healthy and enjoy.
