Month: October 2020

Sexual Health For Gay and Bisexual Men

Sexual Health For Gay and Bisexual Men

Having unprotected penetrative sex is the most likely way to pass on a sexually transmitted infection (STI).

Using a condom helps protect against HIV and lowers the risk of getting many other STIs.

A survey of gay and bisexual men by Stonewall revealed that 1 in 3 men had never had an HIV test, and 1 in 4 had never been tested for any STI.

Men who have sex with men (MSM) should have a check-up at least every 6 months at a sexual health or genitourinary medicine (GUM) clinic. This is important, as some STIs do not cause any symptoms.

Hepatitis A

Hepatitis A is a liver infection that's spread by a virus in poo.

The infection is usually spread in contaminated food or drink, or by poor hand-washing. However you can also get hepatitis A through sex, including oral-anal sex ("rimming") and giving oral sex after anal sex. MSM with multiple partners are particularly at risk.

Symptoms of hepatitis A can appear up to 8 weeks after sex and include tiredness and feeling sick (nausea).

Hepatitis A is not usually life-threatening and most people make a full recovery within a couple of months.

MSM can avoid getting hepatitis A by:

  • washing hands after sex (bottom, groin and penis too by taking a shower, if you can)
  • changing condoms between anal and oral sex
  • using a barrier (such as a condom cut into a square) for rimming
  • using latex or non-latex gloves for fingering or fisting
  • not sharing sex toys
  • asking about the hepatitis A vaccine at a sexual health or GUM clinic

If you think you might have hepatitis A, or have any questions, visit a sexual health or GUM clinic. The hepatitis A vaccine is available for people travelling to countries where the disease is common.

Hepatitis B

Hepatitis B is a viral infection that causes inflammation of the liver. It does not usually cause obvious symptoms and may pass in a few months without treatment. However in some cases the infection can persist and cause serious liver disease, including cirrhosis and liver cancer.

Hepatitis B is spread through contact with the blood or body fluids of an infected person. MSM are at risk of hepatitis B but they can be protected by the hepatitis B vaccination.

Vaccination for MSM is available from sexual health clinics, genitourinary medicine (GUM) clinics or from GPs.

Hepatitis C

Hepatitis C is a viral infection that causes inflammation of the liver. It often does not cause any obvious symptoms at first, but it can lead to serious liver disease if left untreated.

It is spread through contact with the blood of an infected person. Men who are concerned they are at risk should consult their doctor or sexual health clinic.

Hepatitis C can be treated and is curable in many cases. Find your local hepatitis C support service.

Gonorrhoea

This bacterial infection causes stinging when you pee, or the feeling that you want to pee but are unable to. It's passed on through anal, oral or vaginal sex with an infected person.

Gonorrhoea is treated with antibiotics.

Non-specific urethritis (NSU)

This is inflammation of the urethra (the tube that carries urine from the bladder out of the body) caused by bacteria. It is also called non-gonococcal urethritis (NGU) when the condition is not caused by gonorrhoea.

NSU is passed on in the same way as gonorrhoea and often has similar symptoms. It can also be caused by having lots of sex or masturbating a lot, which can make the urethra inflamed.

It can be treated with antibiotics.

Chlamydia

This is a bacterial infection of the urethra or bottom (rectum). It can also affect the throat, but this is less common. Chlamydia may cause a discharge, pain when you pee, or pain in the testicles. However, not everyone has symptoms.

It can be passed on during sex with an infected person in the same way as gonorrhoea. It's treated with antibiotics.

Shigella

This is a bacterial infection of the intestine that causes severe diarrhoea and stomach cramps. It is often mistaken for food poisoning.

It can be passed on during sex, including anal-oral sex ("rimming") and giving oral sex after anal sex. It is spread very easily – all it takes is a tiny amount of infected poo getting into your mouth.

A person with shigella can be infectious for up to a month. It can be treated with antibiotics. Men who suspect they have shigella should visit a sexual health clinic or their GP to get tested.

Men can avoid getting shigella by washing their hands after sex (bottom, groin and penis too by taking a shower, if you can), and changing condoms between anal and oral sex.

Using latex or non-latex gloves for fingering or fisting offers protection. And do not share sex toys or douching equipment.

Genital herpes

Genital herpes is a viral infection. Symptoms can include painful blisters and ulcers on or around the penis or bottom (anus), although some men have no symptoms.

The virus stays in the body and can cause outbreaks of blisters.

Genital herpes can be passed on through oral sex with someone who has a cold sore around or in their mouth, or by skin-to-skin genital contact with someone who has genital herpes.

Antiviral tablets and creams from a GP or sexual health clinic can help the symptoms.

Syphilis

Syphilis is a bacterial infection that causes a painless ulcer, usually in the genital area. The ulcer will disappear on its own but other symptoms may appear, such as a rash on the body and swollen glands.

In its early stages, syphilis is very infectious and can be passed on by close skin contact during sex. If you do not treat it, the infection can eventually spread to the brain or other parts of the body and cause serious, long-term problems.

Treatment is with antibiotic injections or tablets.

Genital warts

This is a common viral infection caused by the human papillomavirus (HPV). It appears a few weeks or months after sex with an infected person. It can cause pinhead-size growths, mostly on or around the head of the penis but also in and around the bottom (anus).

The sooner warts are treated, the easier they are to manage. You cannot treat genital warts with the same type of cream you use for warts on other parts of your body. A doctor will freeze them or prescribe a cream to remove them.

You can reduce your risk of getting genital warts by getting the HPV vaccine.

MSM up to and including the age of 45 become eligible for free HPV vaccination on the NHS when they visit a sexual health or HIV clinic in England.

Pubic lice

Public lice (also known as "crabs") are small, parasitic insects that live in body hair.

They are very small (only 2mm), so they can be difficult to see, although their tiny dark eggs can be seen stuck to hair.

Pubic lice prefer the pubic hair around your testicles and bottom but may also be found in body hair. They are not found on your scalp.

The lice are spread through close bodily contact with an infected person. They can also be spread by sharing clothes, towels or bedding, but this is rare. Symptoms include itching or a rash.

Treatment can be done at home with lotions or creams bought from a pharmacy (no prescription is needed).

Scabies

This is an infection caused by tiny mites that burrow under the skin. It causes intense itching for most people (though some hardly notice it).

Itching usually starts 2 or more weeks after sex with an infected person. You can also get scabies from sharing beds and towels, but this is less common.

Treatment is similar to treating pubic lice, although you may continue to itch for a few weeks after the mites have been removed.

Get tested

If you have any of the symptoms above or are worried you may have an STI, speak to your GP or visit a sexual health or GUM clinic.

Getting tested regularly is a good way to ensure you have a healthy sex life. NHS services are free.

The Gay Man’s Good Sex Guide

The Gay Man’s Good Sex Guide

I’m scared of bottoming

Most gay men will consider bottoming at some time. However, the thought of doing it for the first time can be scary. Don’t let that put you off.

You may prefer to douche before bottoming, especially if indulging in deep arse play like fisting or with large dicks/toys. Use plain, clean water, preferably at body temperature. Avoid using shower attachments - the water pressure can be dangerous. You can get douche bulbs online or from any good sex shop. Try not to go overboard and irritate the lining of your arse, as this can make you more vulnerable to STIs.

Get yourself relaxed with lots of foreplay like rimming or fingering. Some men do use amyl nitrate (poppers) to relax the muscles around their arse but there are two major health warnings. Poppers:

  • have been linked with an increased risk of HIV transmission
  • don’t mix with erection drugs like Viagra and may cause a heart attack.

Deep breathing is far safer, helps you to relax and relaxes the arse too.

Find a position that suits the size, angle and curvature of your partner’s dick. Any position where your knees are bent and drawn into your chest, whether you are kneeling, lying on your back or on your side, will probably lead to more comfortable sex, or will be a good position to start from.

There’s no such thing as too much lube. It just makes everything more slippery, which isn’t a bad thing. Use water- or silicone-based lubricants if you're using latex condoms. Avoid any lube with nonoxynol-9. It irritates the lining of the arse, may make sex more painful and also increases your risk of HIV.

Look after your arse. You can't get a new one. So know your limits. With time you may be able to take larger objects but there's always a maximum size: about 4-5 inches diameter (the width of your pelvic opening).

How can I be a great top?

Take your time and listen to your partner. This is as much about the emotional as the physical side. If he’s nervous, he might want reassuring that you’re not going to hurt him and that he’s in control.

Find out what he likes. For some guys, topping is about being dominant (and some bottoms like that), but for others, it’s a two-way street. Ask him how he likes it. Listen to his reactions too. If he’s making noises that suggest he's in pain, ease up a bit.

The first time you top, you may be a little anxious. This may make your erection less hard than usual. Relax – you're both there to enjoy yourselves. If you have erection problems, concentrate on something else like kissing for a while. (If getting or staying hard is a regular problem, see our section on ED on page 6.)

Our advice above on lubes and position apply as much to tops as to bottoms. Lube is essential when topping. If you have a bigger than average cock, any position where the cheeks of his arse can provide a buffer to your length (like him lying face down) will be a good bet until he’s used to it.

Remember: It’s not only bottoms at risk of HIV. Tops are at risk too, although it’s statistically less likely. Anal mucus can carry high concentrations of HIV, and the membrane just inside the tip of your cock and the foreskin can absorb that directly into the bloodstream if you fuck a guy's arse without a condom. You know the solution. Rubber up.

What is the Male G-Spot?

Some gay men call the prostate the ‘male G-spot’ as it is responsible for a lot of the pleasure you feel when getting fucked. Substances like steroids can also cause the prostate to enlarge. But there’s no evidence gay men are more or less likely to get prostate problems than straight men.

I'm going cruising

Don't put sex before safety. Trust your instinct about where and what isn't safe. Carry condoms and lube. (If bottoming, you might want to put the condom on the top yourself.)

Don't flash cash and make sure you know where the exits are.

What about HIV?

Men who have sex with men account for over half of HIV diagnoses in the UK.

It’s possible to have HIV without knowing it. Most men experience some symptoms around two to six weeks after infection (such as a sore throat, fever, body aches or rash). These symptoms are common to other illnesses and many people do not realise they could be a sign of HIV infection.

It’s estimated that 16% of HIV-positive gay men don’t know they have the virus.

If left untreated, HIV attacks the body’s immune system, leaving it vulnerable to infections we would normally fight off. There is no cure but, if you are diagnosed with HIV and treated, you should have a normal life expectancy.

HIV lives in the blood and in some body fluids. To get HIV, one of these fluids from someone with HIV has to get into your blood:

  • cum and precum
  • anal mucus (found inside your arse)
  • blood.

Sex without condoms is the most likely way for gay men to become infected with HIV.

HIV can also be found in vaginal fluids, including menstrual blood, and breast milk.

You can’t get HIV from:

  • kissing
  • spitting
  • being bitten
  • contact with unbroken, healthy skin
  • being sneezed on
  • sharing baths, towels or cutlery
  • using the same toilets and swimming pools
  • mouth-to-mouth resuscitation
  • animals or insects like mosquitoes.

The more HIV someone has in their bodily fluids, the more infectious they are, and the more likely they are to have serious health problems. HIV treatment lowers the levels of HIV in the body and can make the carrier less infectious, but it won’t get rid of the virus completely.

Men who have sex with men should get tested roughly every six months for HIV. You can get tested at any sexual health clinic. A lot of places do one-hour testing or even quicker. It just involves a finger prick, so no worries about needles. You can also get home testing kits by post.

If you think you’ve been exposed to HIV, go to your local sexual health clinic or A&E as soon as possible, preferably within 48 hours. They will be able to prescribe you with a 28-day course of anti-HIV medication called post-exposure prophylaxis (PEP), which may prevent you from becoming infected with HIV.

HIV isn’t a death sentence, and many people with HIV live long and healthy lives with the right care. But that doesn’t mean it’s trivial. GMFA provides information and advice for gay men living with HIV on their website.

What is hepatitis?

Like HIV, the only signs of hepatitis — a blood-borne liver disease — may be a short flu-like illness. There are three sexually-transmitted forms of hepatitis (hep): A, B and C.

There are vaccines for Hep A and B. These will usually clear up on their own (although you should seek advice just in case yours doesn’t).

Less common but potentially more serious is Hep C. There is no vaccine and it won’t clear up on its own.

All of these activities can transmit hepatitis:

  • unprotected sex
  • rimming
  • fingering
  • sharing toys
  • fisting
  • group sex
  • sex without condoms
  • sharing needles or drug straws.