The Ins and Outs of Gay Sex (2 page)

During my own coming out I attributed every rash, itch, and sore throat I got to my sexual experiences.
Before AIDS, I searched bookstores for answers, worried that doing “this” or trying “that” had dealt me a lethal blow.
I found how-to books filled with tantalizing pictures, but I already knew how-to.
I needed to know what-if.
Now, many years later, as I walk through stores, shelves overflow with books on HIV and the joys of gay sex but little has been written about the many other sexually related problems gay men face.
Most gay men still don’t know the answers to their questions even many years after escaping the closet.
And contrary to that popular saying, ignorance is never bliss.

As a physician, every day I see how this dangerous lack of knowledge impacts on our health.
Sure, we know about HIV, but what about the more than twenty other sexually transmitted diseases (STDs) infecting over 12 million Americans each year?
Although these other STDs may not carry the same grave prognosis as HIV, many are just as incurable and all of them can make you miserable.
Day after day men come to my office and ask the same question:
“I have safe sex, so how did I get this?”
I wrote this book to answer that question.

Most physicians freely admit that they know little about gay sex other than its implication as a cause of AIDS.
I recall a young man sitting in my office, having heard rumors that I was definitely gay-friendly and possibly even gay.
He came to me as a last resort,
having been told by a different surgeon that he required a drastic operation to treat an anal disorder he had ignored for too long.
The proposed surgery was so radical that the man’s anus might never be normal again.
When he asked if he would ever be able to have anal sex again, that surgeon replied, “I hope not.
That’s what got you into this terrible predicament in the first place.”

I wish I could tell you that this story is pure fiction, but it’s not.
I wish I could tell you that it happened many years ago, in a less enlightened time.
Sorry, I heard it only a few weeks ago.
I wish I could tell you that the young man came to me from some small town buried deep in the Bible Belt.
I can’t.
He lived less than ten miles outside of a city boasting the largest gay population and possibly the best medical care found in the United States.
Sadly, homophobia is rampant in this country, as is a general lack of knowledge about STDs.
I wrote this book to help you before and after you see your doctor.

Throughout this book, I’ve used stories to illustrate key points.
Although the names—and sometimes much more—have most definitely been changed to protect the not-so-innocent, they are all based in fact.
The word “gay” appears throughout these pages, but the text is meant for all men who have sex with men, no matter how they classify their sexual preference.

Before going forward with this book, prepare yourself for some graphic depictions of diseases, bodily functions, and parts of your male anatomy that may seem far afield from the topic of gay sex.
They’re not.
Sexual gratification is no small feat.
It’s dependent on a complex chain of events, and understanding how it all fits together can maximize your pleasure and protect you from harm.

I can’t promise that, by reading this book, you’ll never be treated unfairly by a doctor or healthcare worker, but at least you’ll know when you are and what to do about it.
I also can’t promise that learning from this book will protect you from an STD, but at least you’ll enter every sexual relationship armed with enough knowledge to minimize your risk.
Know how to make your sex hot, and safe—and not just from HIV.

When I was coming out, no book had the answers I needed, and even today, none is available.
That’s why I wrote this book for you.

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.

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.

Before moving on, I must write a few words about hygiene.
Most men who enjoy anal sex or anal stimulation are fastidious about keeping this area clean, and, in fact, they can be
too
fastidious.
I remember a patient who came to me for treatment of pain and bleeding with his bowel movements.
When I examined him, I noticed deep cuts in the skin surrounding his anus.
Upon questioning, I discovered that he wiped so hard with toilet paper to get clean before anal sex that he was quite literally wiping away his skin.
Well, I am sorry to report that no matter how hard you try, an anus is still an anus, and it will never be the silk purse you’ve dreamed of.
Before sex, I recommend that you gently wipe away any fecal residue from your outer skin with a moist tissue.
Wet cotton balls or Tucks do an excellent job, but stay away from those baby-wipe–type towels.
Most contain perfumes that can irritate your sensitive skin.