The Ins and Outs of Gay Sex (34 page)

I
listened intently.
My patient was nervous, his embarrassment overcome only by his fear of not knowing for sure.

He wiped his sweaty palms against his shirt.
“The guy told me it was safe.
I’d never done it before.”

“Done what?”
I asked.
I had long ago learned never to assume anything.

“You know, oral sex.”

Still not assuming, I asked, “What kind of oral sex?”

He hesitated before adding “With water.”

“Water, as in water sports?”

His eyes widened and words poured out.
“He wanted to pee in my mouth.
First I did it to him and then he wanted to do it to me.
I’d never done that before.
He said it was safe—a lot safer than coming.”

“And now you’re worried about it.”

He nodded.
“It’s safe, right?”

For gay men, oral sex is one of our most intimate sexual acts.
And after mutual masturbation, fellatio might be an adolescent’s next tentative foray into the world of gay sex—even before that first deep kiss.

But is it safe?
Herein lies one of the most controversial
issues in gay sex; a topic debated, expounded upon, forbidden, and embraced (and often all on the same day) by homosexuals and heterosexuals alike.
The Centers for Disease Control, playing it very safe, goes so far as to say that condoms should be used for
all
oral sex.
But fellatio runs the gamut from merely taking a penis into your mouth to swallowing your partner’s semen (or urine)—and everything in between.
By definition, it also includes rimming (oral-anal sex) and even kissing.
Your risk for catching HIV and many other sexually transmitted diseases depends on where along the spectrum your proclivities lie.

I am not going to teach you how to give a blow job.
You’re probably already a pro.
But I will give you a few pointers.
Before you take your partner into your mouth, use your eyes to be sure he’s clean.
If he is uncircumcised, pull back his foreskin and take a good look.
Wipe away any smegma, but don’t embarrass him.
Disguise hygiene as part of your foreplay.

The main problem most men face during oral sex is that darn “gag” reflex.
As my grandmother used to say, “Your appetite is bigger than your stomach.”
The same holds true for gay men and oral sex.
Our mouths are only so big, while our appetites are huge—the bigger the penis, the more the thrill.
Just as we want that extra piece of chocolate cake even though we’re stuffed to the gills, we also want that extra inch even though he’s already banging our tonsils.

Your gag reflex is not merely a nuisance.
It is a highly protective neurological and muscular chain of events that prevents food from getting trapped in your trachea (windpipe) or lungs.
There are two passages at the back of your mouth:
your trachea, which carries air from the nose and
mouth to your lungs, and your esophagus, which transports food to your stomach.
When you swallow, your trachea closes, so food enters only your esophagus.
This makes it impossible to drink and breathe at the same time.
If your trachea isn’t closed and food hits the back of your throat, your brain immediately sends a signal to muscles in your chest and mouth, forcing you to gag.
This propels food out of the way.
People who lose their gag reflex (as happens to some stroke victims) often develop terrible pneumonia when food and saliva travel into their lungs (aspiration).

Gagging clearly can be suppressed—just look at sword swallowers.
Some of it is in our heads, and relaxing during oral sex may go a long way to minimizing your urge to gag.
If the very thought of oral sex is a turnoff, but you want to try because it is important to your partner, coat his penis with something delicious to eliminate any musty odors or taste.
Some men prefer a bit of jelly or honey with their penis, while fancy queens insist on caviar.
Avoid foods containing oils and fat when using a condom.

If your partner is large, you can keep from gagging by taking only part of it into your mouth.
Stimulate the base of his shaft with your free hand.
His pleasurable sensations centered mainly about his glans are probably not minimized and may even be heightened because your tongue and lips stimulate this area better.
Some men decrease gagging by breathing in through their nose while they travel downward on their partner’s shaft.
Others find just the opposite is true, that holding their breath is the answer.

If your partner is very thick as well as long, he will hit more of the back of your throat and stimulate gagging.
Sword swallowers keep from vomiting and impaling themselves on their spears by adjusting the angle of their neck so nothing touches the back of their throat.
(Unlike many gay men, they also avoid thick swords.
) Learn from these circus performers by angling your head back to change the angle
of your partner’s penetration, so his penis is better aligned with your esophagus and not the back of your throat.

Many mouthwashes or lozenges marketed as sore throat remedies contain topical anesthetics that deaden nerves at the back of your throat.
If you really want to go down on “Mr.
Big” but can’t keep from gagging, try one of these.
Remember, they will numb your throat and dull oral pleasure and taste.
A full stomach also heightens the gag reflex.
I’m not telling you to starve yourself before some hot date, but I know one man who covered his partner in a banquet of shrimp lo mein because he just had to take that extra inch!

Now some advice for the penetrator.
If your partner is skittish or prone to gagging, let him control the oral sex.
It’s his mouth and his gag reflex.
When you ram your penis in or force him to take it all, you’re sure to make him gag or, worse yet, bite down.
Force during oral sex propels your penis to the back of his throat and stimulates gagging.
Your penis covers his windpipe and he feels like he is suffocating.
Panic sets in—and that’s not conducive to good sex.
Most men enjoy fellatio as long as they don’t feel threatened.

If the very idea of going down on you is not something your partner relishes, then talk about it but don’t force him.
Find out what it is he doesn’t like.
If he criticizes your hygiene, then instead of getting embarrassed and defensive, listen to what he has to say and discuss what you can do about it.
Your groin is covered with bacteria and sweat glands.
While some men find natural odors a turn-on, they are not everyone’s cup of tea.
If you have a fungal infection (jock itch or crotch rot), get rid of it before questioning your partner’s devotion.
A hot shower or bath taken together and a strategically placed dab of cologne can also heighten desire.

And be responsive to your partner’s needs.
Contrary to
what you may believe, he wasn’t placed on this earth just to suck your penis.
(Well, maybe he was.
) After a while his jaw muscles fatigue, and if you force him to keep going, it hurts.
Although you may want to believe that the mere presence of your penis in his mouth is stimulation enough to keep him aroused, it may not be.
Don’t forget his sexual needs, and use your hands or your own mouth to keep him turned on too.
The same holds true even if you’re the one on your knees; your mouth may not be stimulating enough.
Sure it is at the beginning, but after a while your partner may get bored.
Use your tongue and lips to heighten his pleasure.
Pay particular attention to stimulating the sensitive frenulum at the base of his glans.
(See
Figure 8.
2
.
) Be careful your teeth or scratchy beard don’t irritate or cut his sensitive skin.
Your five o’clock shadow may look hot in a bar, but in bed it can burn.

And use your hands.
So his penis is in your mouth; it doesn’t mean that your hands are on vacation.
Let them roam over his body hunting out his most sensitive spots.
Your hand can be an effective mouth extension, keeping you from gagging while at the same time driving him wild.

But is fellatio safe?
That is the question that every gay man loses sleep over.
Maybe your partner came in your mouth or maybe he had so much pre-cum that now you’re worried that you’re at risk.
I wish I could give you a straightforward answer that yes, oral sex is 100 percent safe or no, it’s not, but I can’t.
Researchers have proven definitively that unprotected anal sex and intravenous drug use are the two highest-risk behaviors that transmit HIV.
We also know that the risk for HIV infection rises in proportion to the number of different sexual partners you’ve had.
So if we know all this, why don’t we know if oral sex is safe?
When HIV first exploded, scientists frantically searched to find causes.
Surveys explored gay sexual practices at a time of unsurpassed sexual freedom.
Virtually everyone who
tested positive for HIV related a history of numerous unprotected oral and anal sexual encounters.
This made separating risks impossible.

Research in the late 1980s focused on detailing sexual practices of HIV-negative men who later became positive.
Doctors hoped that by doing so, they would learn if men who practiced oral but not anal sex contracted HIV.
Sounds fine, but the numbers of HIV-negative gay men who had only oral sex and still became positive was fairly low, making statistical analysis of risk factors difficult.

Medical literature certainly cites anecdotal cases where HIV infection was presumed to be transmitted through oral sex, but isolated incidents do not provide an answer with any kind of certainty.
Most scientific studies that looked at HIV transmission through oral sex failed to document a significant rate of HIV infection.
Although some men believe they contracted HIV from oral sex, transmission rates are essentially no different from those of men who also deny unprotected anal sex.
I know it sounds illogical, but men questioned about sexual practices lie.
As one research study showed, many men surveyed by medical personnel were too embarrassed to admit to having unprotected anal sex; thus it appears that these men were infected after seemingly safe sex when in fact unprotected anal sex was the more likely route.

A large medical study looking at men in San Francisco concluded that there is a risk of HIV infection after oral sex but that it is much lower than with receptive anal sex.
Surprisingly, this study also found that ejaculation into your mouth did not increase risk.
This does not mean that it’s safe to allow anyone to come in your mouth.
As with many things in medicine, you can find data supporting both sides of the HIV/oral sex argument.

Suffice it to say that most physicians agree that there is a slight risk of HIV infection after unprotected oral sex and
that the risk increases if your partner ejaculates into your mouth or if you have sores or bleeding gums.
One of my patients explained that he doesn’t brush his teeth for an entire day before a night of cruising.
Obviously his hope is that by avoiding brushing, he will also avoid creating sores on sensitive gums.
Although this sounds like a good idea (he does use mouthwash), in practice, most oral sores implicated in HIV infection are very tiny,
chronic
irritations at the gum line and they are present whether you brush or not.
We don’t know if not brushing affords you any additional protection.

Condoms clearly reduce the already low but possible risk of HIV transmission during fellatio,
and the Centers for Disease Control recommends using condoms for all oral sex.
Clearly, most HIV enters your mouth as part of your partner’s semen, but don’t forget that his pre-cum contains virus as well.
Unprotected oral sex even without ejaculation may not be safe enough.
If your HIV-positive partner is rough and injures your throat, he can increase your chances of infection.
Some men believe that not swallowing a partner’s semen decreases their chances of HIV infection.
Probably not true—especially if they let semen sit in their mouth exposed to oral sores while they run to the bathroom.
Acid in the stomach kills HIV and makes infection almost impossible.
So swallowing or not swallowing has very little effect on HIV transmission—the main risk occurs when he ejaculates into your mouth.
One final warning:
Although the risk of contracting HIV via oral sex is low, it undoubtedly increases in direct proportion to the number of different penises you suck and the number of men who ejaculate into your mouth.