The Ins and Outs of Gay Sex (35 page)

HIV isn’t the only STD you can catch during oral sex.
Just about any STD present in one partner can be transmitted to the other during unprotected oral sex with or without ejaculation.
(See
Chapters 3
and
4
.
) An oral STD is
harder to diagnose, because the symptoms may be very different from those of a genital infection or can mimic other non-STD conditions (such as an ordinary sore throat).
Doctors are also less likely to think of an oral STD infection unless you tell them that you’ve had unprotected oral sex.
A condom is protective, but often it isn’t used during fellatio without ejaculation.
In addition to preventing STDs, condoms during oral sex may help a nervous partner enjoy sucking your penis more.
Not only will he feel more protected, he might also enjoy the taste if you use a flavored brand.

The oral-insertive partner is also at increased risk for developing urinary tract infections, urethritis, prostatitis, and epididymitis.
(See
Chapter 8
.
) Your partner’s mouth is a veritable garden of bacteria that, through prolonged or repeated oral sex, can travel down your urethra, causing infections.

I have treated men with nasty penile cuts and scrapes from teeth.
You might enjoy a little bite during oral sex that, as passions rise, becomes too strong.
If your partner draws blood, however, immediately stop and wash your wound thoroughly with an antibacterial soap.
Hydrogen peroxide is also a good cleanser because it helps kill oral bacteria.
Any antibiotic cream, such as Bacitracin or Neosporin, works well and should be applied at least three times a day after thorough cleansing.
If your wound reddens, swells, or begins to hurt, consult your doctor immediately.

We’ve all heard the emergency room stories about men brought in with one hand clutching their groin while the other holds a jar containing what’s left of their penis.
Can this happen?
Of course it can.
I’ve seen it once in a man who pushed in so deep that his partner began choking.
When he wouldn’t pull out he left his partner no choice.
(It was meant as a warning bite.
) When a man thinks he is choking, all rational thought disappears.
If biting down is
his only way to get a penis out of his mouth, then bite he will.
I have also heard of a patient whose partner bit his penis off because he had a seizure during oral sex.
If you do find yourself in this horrible predicament, go immediately to an emergency room with your severed anatomy wrapped in a wet cloth on ice.
Doctors can try to surgically reattach your penis.

Before moving on, it is important to address water sports.
Allowing your partner to urinate on you is safe provided you don’t have any open cuts or sores.
Although urine most often is sterile, urinary tract infections, prostatitis, epididymitis, and other genital STDs, including HIV, also infect urine.
Any of these infections can be transmitted unwittingly should your partner’s infected urine come in contact with your blood through an open sore.

Other unwanted complications can arise from drinking urine.
Urination rids the body of excess substances and dangerous wastes.
When you drink a man’s urine, your body digests it, absorbing it into your own bloodstream.
(No, it just doesn’t pass right out of you.
) While many of these substances and wastes, such as sodium, potassium, nitrogen, and ammonia, are not dangerous to healthy people, they can cause serious complications to those with kidney, liver, or heart disease.
As an example:
Men with high blood pressure must limit their salt intake.
If your lover’s urine is full of sodium, drinking it can raise your blood pressure dangerously.
A word of advice:
Before you drink up, consult your physician to make sure you’re healthy.

Whether it’s called anilingus, rimming, or anal/oral sex, the very thought of it turns off some people, while it’s a totally hot sexual act for others.
The skin around your anus extending out to your scrotum and buttocks is rich with sensory
nerve endings that, when stimulated by a finger or tongue, come alive with pleasure.
These nerves also cause reflex twitching of anal sphincters and further heighten pleasure.
Anilingus can be a prelude to anal intercourse or just an extension of fellatio as your mouth drifts posterior.

As with any sexual act, a clean partner is definitely a plus.
Some men like to douche or use a gentle enema before anilingus, but as with anal sex, liquid that isn’t completely evacuated can seep out, causing even more of a mess.
I recommend wiping your anal area with a moist, soft cloth or medicated pad such as Tucks.
Wet toilet paper flakes apart and leaves unwanted bits around your anus, which your partner’s tongue will definitely not find pleasing.
Whatever you use, don’t wipe too hard.
This isn’t the kitchen floor, and you’re not Cinderella!
Your anal skin is extremely sensitive, and any irritation will spoil sexual pleasure.
Tiny cuts or abrasions also can become infected, so be gentle, because no matter how hard you scrub it’s still going to be just an asshole and not a banquet table.
Don’t forget that you can also take charge and wash your partner if he isn’t as clean as you’d like.
Just don’t embarrass him in the process.
If you’re in the shower as a prelude to sex, don’t push irritating soap into his anal canal.

Avoid perfumes around your anus unless you know you’re not allergic.
Most contain alcohol, which stings, and they can cause anal itching.
If you use a massage oil as part of foreplay, rubbing it between your partner’s cheeks will certainly make his anus smell better, but the taste may be surprisingly bad and oils can irritate him.
As with penises, some men like to rub something sweet (honey or jam) around their opening to create a pleasant smell and taste.
Avoid oil-based food products or aromatic oils that weaken condoms in case you proceed to anal intercourse.

If you’ve resisted anilingus but sense it is important to your partner, you have two options:
You can always refuse
(that is your right), or you can take a deep breath and dive in.
You’ll find it easier if you avoid his anal opening at first, concentrating instead on his buttocks and the space between his scrotum and anus.
If you get into it, and you probably will, his anal opening will become nothing more than a natural progression of your lovemaking.

Your partner may be too embarrassed to tell you that he wants you to rim him.
Always be mindful of nonverbal cues during sex.
If you find him arching his back, raising his legs in the air, or gently nudging your head lower while you’re sucking away on his penis, take the hint.
He’s probably not going to ask.
If it’s your first time, tell him, so that he can help you through it.
If you’re the one trying to get your partner to dive in, be understanding.
Force only turns him away.
Make sure you’re clean, and try a little honey or jam to sweeten the experience.

Fingers can injure sensitive tissues in his anal area.
Your tongue, however, won’t do any damage.
It is soft and pliable and won’t tear sphincters or anal skin.
But beware of tongue, lip, and chin piercings or a scratchy beard, which can cause nasty scrapes and cuts.

So now that we’ve discussed the finer points of munching on your boyfriend’s tushy, is it safe?
As far as the risk of HIV transmission is concerned, anilingus represents a
very
low-risk activity.
Clearly if you bite a partner who is HIV positive
and
take his blood into your mouth
and
you have an open sore in your mouth, you can catch the virus.
Of course, there are a lot of “ands” in this equation, making your risk quite low.
I have not seen a case of documented anilingus HIV transmission in the medical literature, but there are men who catch the virus and deny anal sex.
How did they get it?
Probably they’re lying about abstaining from anal sex or maybe they did get it from anilingus.
For now it is best to think of anilingus as probably safe but still with a slight chance of transmitting HIV.

Anilingus can pass virtually any other STD, though, and as we saw in earlier chapters, these STDs, while not carrying the same grave prognosis as AIDS, can be debilitating.
And if you get one in your mouth (gonorrhea, herpes, or condyloma, to name just a few), the likelihood that your doctor will make the correct diagnosis is small.
So before you go for the old “tongue in cheek,” as my friend likes to call it, take a good look and make sure your partner is free of any cuts or discharge.

Hepatitis A and B can both be transmitted by anilingus, and your partner may be contagious before he even knows he’s sick.
It is questionable whether hepatitis C can be transmitted in this manner.

Like hepatitis, parasites and bacteria are frequent infectious complications of anilingus, and your partner may not exhibit any outward symptoms.
Most often these infections produce diarrhea, which can be profuse and debilitating.
Giardia and amebiasis are the most common parasitic illnesses transmitted through rimming, while salmonella, shigella, and campylobacter are the most common intestinal bacterial pathogens.

Amebiasis or amebic dysentery, as it is frequently called, is caused by the parasite
Entamoeba histolytica.
It is found most commonly in Third World countries where clean water and proper sanitation are frequent problems.
In the United States, amebiasis is seen among immigrant populations who carry the disease from their homeland.
Gay men are also frequent targets of parasites because they pass between partners during anilingus.
The parasite resides in your colon and either it or its reproductive cysts wash out in your stool.
If your partner ingests the organism, it will grow in his colon.
Unfortunately, most men infected with parasites are not symptomatic and unwittingly pass them to their partners.
Symptoms, when they occur, include crampy abdominal pain, diarrhea (frequently bloody), and
a low-grade fever.
In its most severe state, diarrhea and colitis can be severe, leading to death if untreated.
On rare occasions, the parasite can break out of the colon and travel to the liver, where abscesses develop.

Amebiasis is diagnosed when either a blood test is positive for parasite antibodies or a purged fecal sample (after laxatives) demonstrates the parasite.
The antibiotic metronidazole (Flagyl) cures the infection.

Giardiasis is another parasitic infection passed between partners during anilingus.
Caused by the parasite
Giardia lamblia,
it is the most common parasitic infection in the United States.
Unlike amebiasis, giardia resides in the small intestine, and not the colon.
Parasitic cysts leave the body in your stool and can be ingested by your partner.
Although many men are symptom free, common complaints include upper abdominal pain, nausea, and nonbloody diarrhea.
A doctor diagnoses this parasite by sending you to a laboratory for an examination of your stool after you have taken laxatives.
As with amebiasis, metronidazole cures the infection.

Although infectious bacterial diarrhea from salmonella, shigella, and campylobacter occur most frequently after ingesting contaminated foods (undercooked eggs, poultry, meats, and dairy products), they also can be passed between partners during anilingus.
Bacteria invade your colon, multiply, and cause diarrhea (sometimes bloody), crampy pain, fever, and vomiting.
Although these infections are usually self-limited (go away even without treatment), in severe cases and in men with AIDS, antibiotics are often necessary.
A doctor makes the diagnosis by stool culture, but frequently the diarrhea resolves or you’ve already been treated by the time the culture comes back positive.
Ciprofloxacin (Cipro) is a good antibiotic when treatment is necessary.
The downside to routine antibiotic therapy is that while you feel better quicker, it can lead to a prolonged carrier
state.
Carriers are people who feel fine yet shed live bacteria in their stool and have the potential of infecting others.

Some “safe-sex” experts advise using some form of barrier for anilingus.
Whether it’s a piece of plastic wrap, a cut-open condom, or a dental dam, place the barrier over your partner’s hole and enjoy.
Unfortunately, the barrier significantly reduces your enjoyment and his.
People who like anilingus like its taste, smell, and feel, all of which are sorely altered by a piece of latex or plastic.
In the end, men often discard the shield long before oral sex is complete, so they lose any protection.
If you want to rim your partner, understand the risks and do your best to ensure he’s clean.
For most men, using a barrier is probably not a feasible solution.