The Ins and Outs of Gay Sex (5 page)

As with all aspects of anal sex, the common-sense rule again applies.
If your partner pounds you senseless, then trauma and bleeding are more likely to occur.
It is understandable that when you make the decision to have anal sex, your state of sexual arousal is at a feverish pitch.
You may have sex several times in a night, and as we all know, the more often you come, the longer it takes to come again.
Your partner’s constant pounding places your anal canal at a greater risk for injury, and you should stop the moment sex ceases to be pleasurable.
Drug use also increases the risks associated with anal sex.
Drugs dull sensation, so something that should hurt doesn’t.
They further increase danger by distorting judgment and allowing you to have sex in ways you ordinarily wouldn’t.
Drug use fosters unsafe sex.
(See
Chapter 11
.
)

PERFORATION
   
By the time his friend brought him to the emergency room, he could no longer stand.
His pulse raced over 100 and his blood pressure barely hit 80.
His skin burned with fever and the slightest touch to his abdomen made him scream.
An older man probably would have been dead by now; only his youth had kept him alive this long.
“What happened?”
I asked.

His lips were dry and his voice faint as he spoke.
“I fell off a ladder and landed on a broom.
It went up my butt.”

Now I’d heard everything.
“Did someone do this to you?”
I
asked.
He shook his head.
Even with his body overrun with infection, he wouldn’t tell the truth.
“How long ago did this happen?”

“Three days.”

Although a total (transmural) perforation of your anus or rectum is possible during anal sex, thankfully it is quite rare.
Perforation, however, is much more frequent when hands (fisting) or sex toys are inserted into the rectum.
These objects tend to be longer, thicker, and less pliable than a penis.
If perforation occurs, pain usually is the first symptom.
Although it begins immediately, you might barely notice it.
The pain progressively worsens as you notice other hallmarks of infection:
fever, swelling, and reddening of your buttocks.
If the perforation is high up in your rectum, a deadly complication, your buttocks may look normal, and pain, fever, and a sense of pelvic pressure are the only signs.
Most often neither you nor your physician can see the actual hole or holes.
Typically they are quite small and hidden in the myriad folds in the normal colon lining.

Treatment of a transmural perforation often requires emergency hospitalization, intravenous antibiotics, and surgery to clean out the infection.
Unfortunately, most men delay treatment for many reasons:
embarrassment, an unwillingness to discuss the problem with their doctor, and/or the unrealistic hope that it will go away on its own.
This is an extremely dangerous course to follow as the colon is filled with deadly bacteria that can cause devastating infection once they escape the colon.
In extreme situations, ignoring the signs and symptoms of a perforation can cause a colostomy to be needed until the infection heals.

INCONTINENCE
   Incontinence is the medical term for the inability to control either feces or gas.
Doctors describe many degrees of incontinence.
In its mildest form, it can be an inability to control gas (which everyone seems to complain
of) or a sense of urgency to move your bowels.
You feel that if you don’t get to a bathroom immediately, you’ll soil yourself.
In severe cases, people lack the ability to sense stool in their rectum and cannot prevent it from escaping.
Clearly, an inability to control gas is more embarrassing than debilitating; complete fecal incontinence, however, can be quite devastating.
It requires significant lifestyle changes:
a diaper and occasionally a colostomy.

Most people experience episodes of fecal incontinence at some point in their lives, typically during severe bouts of diarrhea.
You can’t control the diarrhea because your sphincter muscles are not strong enough to hold back the sheer volume of liquid or to prevent its watery consistency from slipping out.
Although this type of incontinence is normal and infrequent, it presents a problem for HIV-positive men prone to diarrhea or who take diarrhea-inducing medications (which many antiviral drugs are).

In one medical study of men who practiced anoreceptive intercourse, 25 percent reported at least isolated episodes of fecal incontinence.
An age-similar group of heterosexual men had only a 3 percent incontinence rate.
When the researchers studied patients with AIDS, the incidence of incontinence rose to 50 percent and probably resulted from a higher rate of frequent loose bowel movements in these individuals.

What does this mean to men who enjoy anal sex?
Although the threat of incontinence is small, it is present nonetheless.
Incontinence in men who practice anal sex is thought to result from repeated injury to their internal spincter muscle, not the external sphincter, which comes under their voluntary control.
Again, although a penis is often the size of a large bowel movement, your sphincter involuntarily relaxes to allow the bowel movement to pass and your muscle is not injured.
Insertion of a penis, however, causes your muscle to contract involuntarily.
Repeated
insertion through a contracted internal sphincter muscle may cause cumulative damage so that the muscle loses its ability to seal the anorectal canal tightly.

Incontinence from anal sex appears to be rare enough so that you probably won’t have a problem if you protect your internal sphincter as described.
Incontinence rates do increase in proportion to the number of sexual partners a man has.
Whether this implies that sex with many partners causes more frequent sphincter injury over a longer period of time or that men with more partners are prone to rougher sexual practices causing more injury is unknown.

Fisting and insertion of extremely large sex toys into the anus results in a much higher incidence of incontinence and is definitely
not
recommended.
Incontinence in men who practice either of these types of sex is thought to result from increased damage to their internal sphincter muscles by the large-diameter object.

Anal stimulation and sex can be pleasurable and safe if practiced properly.
The common-sense rule must be applied at all times:
If it hurts, don’t do it.

Listen to your partner.
Respect his wishes.


If it hurts or you notice blood, stop immediately.


Always use a condom even if only rubbing is anticipated.


Protect fingers with gloves or finger cots.


Do not pass sex toys back and forth between partners.


If complications arise, see an understanding physician.


Fisting and inserting large toys promote incontinence.