The Ins and Outs of Gay Sex (10 page)

1. Acidic foods and their juices (tomato, orange, grapefruit, and other citrus fruits, etc.
   )
   
2. Spicy foods (hot pepper, garlic, etc.
   )
   
3. Alcohol (Sorry, boys, no drinking—especially wine.
   )
   
4. Caffeine (Don’t forget, tea, chocolate, and colas contain caffeine.
   )
   
5. Milk products (If you don’t digest them well, bacteria in your colon convert the lactose to acid.
   ) Yogurt with natural cultures and lactose-free milk are fine.
   

Try this for a month and I am willing to bet that your itch disappears completely or at least becomes tolerable.
Once you reach this stage, begin to add back foods to your diet in the order that you miss them, one at a time.
In other words, if you can’t live without your morning coffee, then start with that.
If after a week you are still not itching, then add something else.
If your itch returns, then you can bet that you’ve discovered the culprit.
Eliminating it from your diet may leave you itch free without using messy creams.

Occasionally the itch doesn’t go away.
Please remember that I have cited only the most common irritants.
What bothers
your
skin might be unique.
I remember a young man bursting into tears when I recited my standard list of foods to avoid.
No, he wasn’t a drama queen, but he had tried everything to no avail and couldn’t take it anymore.
He even slept in gloves to keep from tearing his skin apart in his sleep.
Through careful discussion, I learned that he took many vitamins each day.
When he cut them out (vitamin C is the most irritating), his itch disappeared.
Artificial sweeteners caused the itch in another patient.
Examine your diet and eliminate anything you eat in great amounts.

And what if the itch still doesn’t go away?
See your doctor, because something more serious might be going on.
A parasite or something requiring a biopsy and prescription medication could be causing your problem.

Most of us know the embarrassment of finding brown stains in our underwear or the “skid marks” of our youth.
Often it occurs because we do not or cannot clean our anal area well enough to remove all fecal residue.
For some, it is a time issue—it takes too long to get everything off, especially when confronted with bothersome external hemorrhoids.
Just as wiping too long and too hard can damage sensitive anal skin, so too can not wiping enough.
Fecal waste, whether solid or loose, can be very caustic.
The itching or burning that results can become so severe that it interferes with your life.

When fecal soiling results from your inability to clean yourself properly, abandon toilet paper and use a wet tissue or cotton ball instead.
They are far less abrasive and better at removing solid waste.
Tucks are also effective and quite soothing.
Do not use oil-based or perfumed products, which can be more irritating.
Oils occlude pores and increase your chance of infection.

For some men, fecal soiling occurs throughout the day—especially when they pass gas.
Sometimes they actually feel liquid or mucus seep out; other times they just see a brownish stain on their underwear.
Some seepage is normal after receptive anal sex because your sphincter muscle is stretched and cannot contract, and also because fucking stimulates colonic motility, which sends feces from your colon down into your lower rectum.
If you use an enema before anal sex and are bothered by seepage afterward, stop the enemas.
An enema puts liquid into your rectum, and it is not entirely expelled before sex.

Some men have soiling even without anal sex or diarrhea.
Treatment goals include keeping their anal area dry and eliminating waste from the rectum.
After each bowel movement, wipe with a moist pad to remove any remaining
residue.
If you suffer from diarrhea, oral medications that constipate help.
I also advise a consultation with a nutritionist to eliminate foods that promote loose stool and gas.
Many times the simple act of expelling gas forces out mucus or liquid stool with it.

A diaper is rarely necessary, but you may get relief by placing a menstrual-type pad in the back of your underwear.
The pad absorbs moisture and waste and helps keep you dry.
When a patient looks at me in disbelief over the prospect of buying feminine hygiene pads, I tell him to butch it up and pretend he is the concerned spouse shopping for his wife.
(So what if your wife’s name is Tom?
)

In heavier men with a fuller “caboose,” so to speak, pads may not reach their anal opening well enough to keep them dry.
In these individuals, a pad plus a fluffed-up cotton ball placed directly against their opening helps absorb moisture throughout the day.
A mild steroid cream or Balneol may be needed, at least initially, if skin irritation is severe.

If soiling persists, I suggest a course of rectal wash-outs to remove residual feces after bowel movements.
Particularly in patients with solid stools, seepage can occur because a bowel movement ends too soon, leaving waste in the rectum that leaks out at inopportune moments.
The treatment?
Insert an ear syringe filled with warm water and coated with a water-soluble lubricant into your rectum.
(See
Chapter 1
.
) Squeeze it gently several times to wash out any residual feces from your anal canal.
Try this after each bowel movement for several days, then wait to see if your problem has resolved.
Frequent irrigations are rarely necessary and do not have the same detrimental effect on your colon as full enemas do.

Profuse sweating in hot weather or after strenuous exercise loosens fecal residue present on your perianal skin and can be confused with fecal seepage.
In this instance, your
problem is not caused by seepage but by improper cleansing.
For relief, wipe well before exercise and use a fluffed-up cotton ball to absorb sweat.

Although fungal dermatitis is infectious, it is not sexually transmitted, so I am including it in this section.
Two types of fungus infections typically involve your anogenital region.
Tinea cruris, or jock itch as it is commonly called, typically occurs in sweat-prone areas with deep skin folds.
Your anus and groin are prime targets, and you’ll notice reddened skin and severe itch.
Over-the-counter preparations such as Cruex and Lotrimin, to name just a few, are a good treatment for jock itch.
I find that creams work better than sprays or powders for active infections.

Candida infections are also common in the anogenital region, particularly in men with HIV and diabetes.
Those prone to chronic soiling or needing sitz baths who do not dry themselves properly afterward are also at risk.
Redness and burning are the principal symptoms of fungal infection caused by
Candida albicans.
Skin is raw, and the infection acquires a well-demarcated red line at its outer border.
It is important to differentiate a candida infection from jock itch, because treatment is different.
Prescription antifungal creams such as nystatin or miconazole cure candida infections.

Bacterial dermatitis is a nonsexually transmitted infection.
It occurs particularly after shaving, scratching, or rubbing your anogenital area and involves infection of the skin, hair follicles, and/or glands with streptococcus and staphylococcus bacteria.
After shaving, nicks and follicles become infected
and tiny pustules appear.
Prescription antibiotics are required (oral or topical), and you must stop shaving until it heals.

At some point in your life you probably will develop a problem in your anus or rectum.
Straight men as well as gay men suffer from anorectal disorders, and embarrassment should not prevent you from seeking medical attention.
Most of the time anal sex did
not
cause your problem.

Rectal bleeding that persists for more than three days or returns should be evaluated by a physician.


Stool softeners and bulk agents combined with steroid creams or suppositories will cure most anorectal disorders.
Surgery is rarely necessary.


Fever or severe pain requiring analgesic medication (even aspirin or acetaminophen) is a serious symptom.
See a physician immediately.


Ignoring a problem increases your risk that surgery will be needed.


If you are HIV positive and a surgeon tells you that there is nothing to be done, get another opinion.


If surgery is considered, be sure to discuss all options with your doctor so you can determine which procedure is best for you.


If you’ve had anal sex, tell your doctor.
If you can’t, then find a doctor you can be honest with.