Rest of the Story…

Hello Readers,My name is Ty and I am a medical professional from Charleston, WV.I am hoping to assist the gay, lesbian, bisexual and transgender community by providing “factual information” to the public and answer questions that you may have on certain medical topics!Thanks Jamie for the following idea for a topic this week, I hope this will answer your question….I learned some things this week that even amazed me, I had never heard some of this terminology. Condoms? Are they protecting me while having safe sex? Well, first I need to discuss safe sexual practices in some detail and then lead into the use and protection of condoms….Make condoms a habit and put your mind at ease. 

In the United States and Australia, the human immunodeficiency virus (HIV) is most commonly spread through unprotected anal or vaginal intercourse with an infected person. Gay HIV positive men with HIV negative partners can still enjoy physically intimate relationships if they follow safe sex practices. It is important to remember that the virus is transmitted by bodily fluids – for men this includes, blood, ejaculate and pre-ejaculate – entering the bloodstream. Remember that the risk goes both ways – for example, it is commonly believed that only the partner who is penetrated (the ‘bottom/catcher’) is at risk, but the HIV virus can be transmitted to the partner who penetrates (the ‘top/pitcher’) via small cuts and abrasions on his penis. Unsafe sexual activities Unsafe sexual activities include:  Unprotected anal sex, since the virus can enter the bloodstream via mucus membranes or small cuts or abrasions.Withdrawing before ejaculation, since pre-ejaculate fluid can contain the virus.Using pre-ejaculate as a lubricant prior to anal intercourse.Sucking ejaculate from the anus (felching).Activities involving razors or shaving, as blood can be drawn from small nicks and cuts.Any sexual activity that draws blood.  Safe sexual activities Sexual activities that are considered safe include:  KissingCuddlingStroking and massageMasturbationMutual masturbationEjaculating on unbroken skinUrinating on unbroken skinProtected anal intercourse (using condoms). Safe sex suggestions: Some suggestions for safe sex, including when to avoid some practices: Anal sex – use condoms and plenty of water based lubricant. Oral sex – there are a small number of recorded cases of people getting HIV from performing oral sex and taking ejaculate into their mouth. In almost all of these cases, the person had herpes sores, wounds, cuts or infections in their mouth. It isn’t easy for HIV to enter the bloodstream via the mouth or throat when sucking. However, to be sure of being safe, the HIV positive partner shouldn’t ejaculate into their partner’s mouth. To further reduce the risk, a condom can be worn. The HIV negative partner should avoid performing oral sex if they have cuts or sores in their mouth, a throat infection, have recently undergone dental work, or have just brushed or flossed their teeth.Penetration of the anus with finger or fist – avoid if there are cuts or abrasions on the fingers, hand or arm. To be absolutely sure, wear a latex glove. Licking and kissing the anus (oral–anal contact, or ‘rimming’) – The HIV virus isn’t as easily transmitted via oral–anal contact, but other diseases can, such as hepatitis A and intestinal parasites and bacteria (for example, shigella). Use a barrier such as a dental dam or clear plastic wrap (but not the ‘microwave safe’ variety – it has tiny holes in it). Urinating on skin (Golden Showers)– avoid this practice if there are cuts or abrasions on the skin. Don’t allow urine to come in contact with the eyes or mouth, in case there is blood in the urine.Feces – HIV can be transmitted if there is blood in the feces. Don’t allow feces to come in contact with the eyes, mouth or cuts on the skin. Feces can also transmit other illnesses, such as hepatitis and intestinal parasites.Sex toys – always put a condom on any sex toy (such as a dildo) before use. Wash all sex toys after use with warm water and anti-bacterial soap. Consider having a separate collection of sex toys for each partner. What you can do after unprotected sex Sometimes; a couple may slip and have some form of unprotected sex. Suggestions include: If the broken skin of the HIV negative partner comes in contact with the ejaculate, blood, urine or feces of their HIV positive partner, wash well with warm water and soap.Seek advice from your doctor. Post exposure prophylaxis (PEP) is a month-long course of medications for people who have been exposed to the HIV virus. To be most effective, they should be commenced within 72 hours of exposure. It is best to take them as early as possible after exposure. These drugs can be toxic on the body with unpleasant side effects such as vomiting, nausea and lethargy. PEP is not an alternative to safe sex. If you think you have been exposed to HIV, or think you need help, call 1-800-889-887. This is a 24-hour telephone service.Talk about the factors that led to the unprotected sex, and work out ways to avoid the same mistake in future. HIV and your relationship: HIV can trigger various relationship problems including: Fear- both partners could be fearful of the HIV positive partner developing AIDS, or of the HIV negative partner contracting the virus. Sexual problems – some people may feel bored and                              frustrated by the constraints of always practicing safe sex, which can cause tension within the relationship. Sometimes, treatments may also affect the HIV positive partner’s libido. Insecurity – the person with HIV may feel insecure, and worry that their partner may leave them because of their HIV status.

 As Western societies have developed and diversified over the past centuries, homosexuals have made tremendous strides in gaining the recognition and acceptance they deserve. While one’s preference of romantic and physical involvement with someone of the same sex used to be kept silent, gays and lesbians now occupy a place of stature in the modern world. Their relationships are now slowly being given the respect and recognition that any mature sexual relationship should be given.Homosexuality involves different sexual norms and activities since it involves two members of the same gender. Anal sex is a sexual practice associated with gay male couples. Though gay men may not immediately think of anal sex whenever they meet potential partners, some will express that it is an integral part of a gay relationship.However, with this practice come several associated issues. One is the concern over the rising incidence and prevalence of HIV infection among gay men. Despite numerous HIV awareness and AIDS prevention programs, there are still some gays who prefer to go “bare backing”, the colloquial term for anal sex without the use of condom. Several reasons for this mindset include recklessness, the feeling of invincibility, and fatalism. As AIDS prevention programs have long been rampant, nobody practicing gay sex can claim ignorance to risk factors associated with this disease.However, these public health programs on AIDS prevention have also brought on some positive results. Increased understanding of HIV, including its transmission and risk factors, has provided incentives for most gay men to practice safer sex. Those responsible enough to care for their health and that of their partner always make it a point to use condom and lubricants every time they have a sexual act. Even oral sex is done with condoms. This initiative is proven to be effective enough in AIDS prevention campaigns, preventing HIV transmission from one infected person to his uninfected partner. One important factor to consider when engaging in protected anal sex is the selection of the right condom, preferably one that is thick enough to withstand the pressure of gliding in and out of the rectum, with the aid of large amount of water-based lubricants. Oil-based lubricants are not advisable, as Vaseline, creams, and baby oil can degrade the latex structure, making it prone to breakage. There are a lot of brands available in the market specifically designed for condoms. Even online retailers offer several brands of lubricants. Some lubricants even have exotic flavors to maximize enjoyment during sex. Another way to procure lubricants is to make one yourself, by boiling cornstarch in water until a gel is obtained. It would be good to note, though, that lubricants are meant to enhance the sexual act itself, and in no way contribute to the prevention of STDs and pregnancies.Another term that emphasizes the link between HIV, gay sex, and condom is ‘men on the down low.’ Though originally used within the African-American community, this term has reached popular recognition and means the behavior of men engaging in sexual acts with other men though they don’t openly acknowledge their homosexuality or even bisexuality. These men need to practice safe sex for AIDS prevention, as they can be used as mode of viral transmission from an infected male to his female partner, who does not have a clue as to his other sexual activities. The nondisclosure of sexual history and activities has long been a stumbling block in AIDS prevention efforts and needs to be addressed.Though the prevalence of HIV and other STDs are not as high among lesbians, it does not mean that they are immune to it. Among lesbians, the practice of safe sex include the use of female condoms and lubricants when performing oral sex, putting male condoms on dildos and vibrators, using latex gloves when manually stimulating your partner, and abstaining from sex during menstruation. The wisdom in all this is to minimize, if not completely avoid, the transfer of bodily fluids and contact with open sores around the genitals, the mouth, or the anus. Lesbian couples must realize that they are not exempted from AIDS prevention efforts and must practice safe sex.And when you notice something out of the ordinary, like itching and burning sensation in genitals, as well as the appearance of sores, seek medical help immediately. Whether you’re straight, gay or lesbian, it still pays to know the necessary steps in AIDS prevention, take care of your well-being and your partner’s, and heed whatever warning signs sent out by your bodies. STDs Associated with Specific Sexual Behaviors:Anal stimulation with fingers
STD risks include: Hepatitis A, B, and CHIV Parasites (intestinal protozoa; e.g., Giardia lamblia, Entameba histolitica, Cryptosporidium parum; spread by fecal-oral transmission)As long as the skin of the fingers and anus is intact (wound free), there is little risk associated with finger-to-anus stimulation. If the fingers are cut or the anus torn, this method of stimulation is not advised. The above STDs can be spread through blood, semen, and body fluid.

It may be safer to use one hand to stimulate a partner’s anus while avoiding anal contact with the other hand. The hand used for anal stimulation should be kept away from the mouth and should be washed afterwards, to minimize the chance of spreading parasites.

 Penis-to-anus penetration without a condom, with or without ejaculation:
STD risks include: Anogenital warts (human papillomavirus, HPV; causes anogenital warts associated with genital and reproductive cancers)Chlamydia (Chlamydia trachomatis; genital bacterial infection causing discharge)Genital herpes (herpes simplex virus, HSV; causes genital sores)Gonorrhea(Neisseria gonorrhea; bacterial infection of genital mucosa causing discharge)Hepatitis B and CHIVSyphilis (Treponema pallidum; bacterial infection causing lesions; may affect nervous system and heart)
Some STDs produce lesions or a discharge that is noticeable on the penis or anus and some do not. Asking a partner if he has a history of warts, sores, or discharge before sex is a good practice. Before anal intercourse, partners should examine one another’s penis and anus for lesions, growths, or torn skin and each should ask about the other’s health history. Although sex is safer with a latex condom, either partner should be comfortable abstaining from sex when there are signs of STDs.Some people believe that it is safe to have anal sex without a condom if they are taking antibiotics for an STD. This is not true. The risk for transmission exists until the course or treatment is completed.People with HIV should share their status with their partners and their partners should ask. HIV-positive people can contract new strains of HIV, which can worsen an existing condition and complicate treatment. If both partners are HIV-negative, there is no risk of contracting the disease.Before anal intercourse, the anus should be relaxed by massaging it with a liberal amount of water-based lubricant (e.g., KY Jelly®) that does not contain nonoxonyl-9 (N9). This reduces the chance for tearing and bleeding and minimizes the risk for STDs. Anal sex, especially without lubricant, can cause rips and lesions and exacerbates hemorrhoids. Lubricants containing N9 are actually associated with an increased risk of HIV transmission.Some medical centers offer postexposure prophylaxis (PEP), medication that reduces the chance of becoming HIV-positive if started within 72 hours after exposure to the virus. Penis-to-anus penetration with a latex condom
STD risks include: Anogenital warts (HPV)Genital herpesSyphilis Wearing a latex condom significantly reduces the risk of exposure to HIV, gonorrhea, chlamydia, and hepatitis B and C but does not eliminate it because condoms can break. If a condom rips during anal intercourse, the penis should be withdrawn and the condom replaced. Condoms should be worn prior to penis-to-anus contact. Contrary to what some people believe, wearing two condoms to maximize protection actually increases the likelihood that one or both will rip. Petroleum jellies (e.g., Vaseline®, baby oil) are not suitable lubricants because they destroy latex. The lubricant should be water-based and the condoms should be a nationally recognized brand.Receivers are advised to keep one hand on their partner’s penis during initial penetration to ensure that the condom is on. One partner should grasp it during withdrawal to make sure that it does not slip off in the anal canal or rectum. Reading the instructions that come with nationally recognized brands of condoms is advised. Fingers, sex toys, or anything else that could tear the condom should be kept away from the anus and penis prior to and during anal intercourse. Cuddling
STD risks include: Crabs (pediculosis pubis: crab louse) are lice that predominantly infest the pubic region and can affect other hairy places on the body. They cause severe itching and must be treated with medicated shampoos. Physical removal of the eggs (nits) attached to the hair follicles must be done with a special comb to prevent subsequent infection when the eggs hatch.Scabies (sarcoptes scabiei) are arachnid mites that burrow under the skin and reproduce. They cause severe itching, pain, and slightly elongated red lines and spots on the skin. They are treatable with medication. Both parasites are transmitted through skin-to-skin contact or clothes, but crabs can be contracted through contact with infected sheets or toilet seats. If a partner is infected, cuddling with clothes on is the safest behavior. If you’re HIV- having intercourse with another guy up the anus without a condom is another likely way of getting HIV.  If you’re not 100% certain of your sex partner’s HIV status, or if you know your sex partner is HIV+. Many guys think that because they’re the one doing the topping, the HIV can’t enter their body.  But it can enter the cock through the opening at the tip (the meatus), or through tiny cuts or scratches on the cock. Reduce the chances of getting or giving HIV by using a condom and a water-based lubricant every time.Try experimenting with condoms before using them for sex.  Masturbate with them on. Try tearing one or two while you’ve got them on, so that you can feel what that’s like. You can feel the difference, so that if a condom tears when you’re having sex, you’ll know when to pull out.Put the condom on before starting to have sexual intercourse, not just before you’re about to cum.When putting the condom on, squeeze the air out of the tip first. Roll the condom all the way down to the base of your cock to prevent it slipping off.If you’re uncircumcised, pull your foreskin back before fitting the condom on. You might need to practice to find out how to get a condom to stay on.

Choose a brand of condoms that suits your cock size and shape.

 

What are condoms?

A condom is a tube made of thin, flexible material. It is closed at one end. Condoms have been used for hundreds of years to prevent pregnancy by keeping a man’s semen out of a woman’s vagina. Condoms also help prevent diseases that are spread by semen or by contact with infected sores in the genital area, including HIV. Most condoms go over a man’s penis. A new type of condom was designed to fit into a woman’s vagina. This “female” condom can also be used to protect the rectum.

 

What are they made of?

Condoms used to be made of natural skin (including lambskin) or of rubber. That’s why they are called “rubbers.” Most condoms today are latex or polyurethane.Lambskin condoms can prevent pregnancy. However, they have tiny holes (pores) that are large enough for HIV to get through. Lambskin condoms do not prevent the spread of HIV.Latex is the most common material for condoms. Viruses cannot get through it. Latex is inexpensive and available in many styles. It has two drawbacks: oils make it fall apart, and some people are allergic to it.Polyurethane is an option for people who are allergic to latex. One brand of female condom and one brand of male condom are made of polyurethane 

Pulling out: Withdrawal (pulling out before cumming) does not protect you from giving or getting HIV. Some guys do this as a way to have the thrill of ejaculation without using condoms, thinking that if the person topping pulls out in time, this counts as safe sex. This isn’t true. Withdrawal can still lead to HIV being passed on because:If you’re the active partner (the one doing the topping/pitcher) blood from your partner’s rectum can still enter the hole at the tip of your cock, or get into tiny scratches or cuts on your cock.If you’re the passive partner (the one being bottom/catcher), there’s no guarantee that your partner won’t cum in rectum. Withdrawal before orgasm is a very difficult thing to time perfectly! Again, using condoms and a water-based lubricant can prevent this risk. Many gay men who have recently tested HIV+ reported that they thought withdrawal was safe.  Condom Hints:  Some people will tell you that condoms often break. However, often the mistakes that people make that lead to condom breakage can be easily corrected. Condoms aren’t 98-100% reliable, but using them correctly is the best way to stay safe.  Remember the following:  Use lots of water-based lubricant such as KY jelly, Wet Stuff, Glyde or Lubiflex. Some people mistakenly use oil based lubricants like Vaseline, baby oil, hand creams, Intensive Care or other oil based lubes, without realizing that these actually dissolve the latex of the condom, leading to breakages.Check the use by date on your condoms. Avoid using out-of-date condoms.Be sure to buy condoms made to US or Australian standards-check the outside of the pack.Never leave condoms out in the sun, or near any sharp objects that might damage them, or in the glove box of your car for a prolonged period of time.Don’t store your condoms near extreme heat or cold. Don’t use ultra-thin condoms as these are designed for vaginal sex. Anal sex puts more stress on condoms. Use extra strength condoms for anal sex.

 

Sex Without Condoms! (Barebacking, BB, bb):“Negotiated Safety”:  Some people who share the same known HIV status choose to have intercourse without condoms. This can only be safe when you both know for certain that you’re both HIV- or both HIV+. Discuss with your partner how important it is for you to have sex without condoms. If it’s not that important, then keep using them. If you want to have sex without condoms, then here are some steps you could follow:   If you’re both HIV+:   Talk with your doctor about the possible effects of being exposed to another strain of the virus. It’s your choice to enjoy unprotected sex with another HIV+ person if you both want to.   If you think you’re both HIV-:  If you both want to perform without condoms, then both get tested for HIV. Be completely honest about your results, or agree to go and get tested and collect your results together. What would it mean if one of you had HIV and the other didn’t? Talk about this first. If it would mean the end of the relationship then maybe you should just keep using condoms? Continue to use condoms every time you have intercourse for 3 months after either of you could possibly have come into contact with HIV. After 3 months, both get tested again.If one of you has HIV and the other does not Keep using condoms and water-based lubricant every time you have sex.   If you know you’re both HIV+:  Discuss your future plans. Make a commitment to each other that you’ll avoid playing outside of your relationship (this strategy is more successful) or that if either of you cheat with anyone else you will use condoms (this strategy is less successful). You will need to make a decision about trusting each other. Make a commitment that if either of you has a slip-up or an accident that results in unsafe sex outside of the relationship; you’ll agree to tell the other immediately. You’ll need to go back to safe sex until you’ve both been tested twice again 3 months apart.Talk with each other about how slip-ups or accidents might happen. Agree in advance that it won’t mean the end of your relationship. Don’t punish your partner for being honest.You might want to agree in advance that either partner can insist on using condoms again, without having to explain why. If all of this seems like too much to handle, then keep using condoms whenever you have sexual relations.

 Condoms feel tight: Use a larger brands like Trojan Magnum, Maxx, Pleasure Plus, or Lifestyles Tuxedo. These bigger brands can fit anybody, regardless of size, since the ring at the base is not any bigger. Put a drop of water based lube inside the tip to help conduct heat and help the end to move around more. Lube also reduces friction and risk of breakage. Make sure the ring is completely unrolled to the base of the penis. In order to unroll the condom all the way, unroll it with your fingers before putting it on the penis. Then put it on like you would a sock or “tights” hehe. Be careful not to tear the condom with your fingernails. “No” sensation while wearing a condom: Try a thinner, higher quality condom such as Beyond Seven, Maxx, or Kimono. Try condoms and lubes without nonoxinol 9 spermicide. Nonoxinol 9 can irritate the lining of the vagina or anus and cause numbness and it tastes and smells awful. For the same reasons, use lubes without spermicide. For those of us who grew up with the older, thicker type of condoms, it’s no wonder we hate condoms. Condoms are a lot better nowadays. They are not only thinner, they are more reliable. More than anything, a drop of lube in the tip will make it feel more natural. Water conducts heat better than latex, and more play in tip means more sensation on the most sensitive part of the penis. Condoms break: Make sure you don’t leave any air pockets in the tip of the condom. There should be a loose little reservoir at the tip. To make a reservoir, pinch the tip as you unroll it and work out any air bubbles by rubbing the shaft down. Use a few drops of lube in tip before you put the condom on. Use good quality condoms known for their reliability. Avoid keeping them in a warm place and always check the expiration date before opening the package. If you’re having a marathon session, check that the condom is holding up and change it once in a while. No condoms around when I need them: Keep them in a handy place in your bag, coat pocket, and by the bed. Don’t keep them in your car or wallet since exposure to heat will weaken your condoms. Think ahead if you are going to drink or use drugs to make condoms easy to find. Don’t worry about your reputation just because you carry around condoms with you. Your partners will just as likely be relieved that you thought of protecting both of you and even more impressed that you had the good sense to bring it up before having sex. I might be allergic to latex: Allergies to latex are increasingly common, but even more common is an allergy to the spermicide (Nonoxynol-9) found in most spermicidal lubricants. Try condoms and lube without spermicide. If you still suspect an allergy to latex, you might want to try Avanti condoms made of plastic which are very thin, and can be used with oil-based lubes. Much like the “female” internal condom, the plastic Avanti condoms are not stretchy like latex so they tend to get baggy and slip off. Use Avanti as a last resort because they have a higher breakage rate than latex condoms. If I ask him to use one he’ll go limp again: This problem is usually due to a break in the momentum when one of you goes to find condoms or has trouble getting the thing on. Nerves also play a part, especially when you’re with a new partner. Condoms can also be a turn-off at first because we have so many bad associations with them. The best way to get over this kind of safer sex performance anxiety is to practice by yourself (yeah, that’s right) so you can get used to the feel and learn different ways to put it on (rolling it down or pulling it on like a sock). Get your partner involved in getting the condom on to make it more fun (a third hand is always useful to squeeze the tip to keep air out). Just because you or your partner got soft in a condom once, doesn’t mean that that’s it for condoms. Talk it over with each other and try it a different way. Practice makes perfect. Remember that your brain is your biggest sex organ. Make condoms a habit and put your mind at ease. Condom slips off: Hold the base of the penis when pulling out. There is a brand (Mentor) of condom designed for heavy duty use and has an adhesive at the base. Don’t linger inside your partner once you come — pull out before the condom gets loose and slips off. Should I use Condoms For Oral Sex? This is controversial (See How safe is oral sex?) A few men have been infected from sucking and swallowing the cum or pre-cum but such cases often involve cofactors such as throat infections, bleeding, or trauma to the lining of the throat. If you don’t let your partner cum in your mouth, then you Being committed to safe sex all the time isn’t easy. There are always going to be times when it’s hard to stick to safe sex. It’s important to be able to talk about this with people we trust. We should not be judgmental if friends tell us that they have had a slip-up. Most gay men can remember or imagine what leads to an unsafe incidenare already having safer oral sex. This is just one good strategy. You can also avoid sucking the tip of the penis, or use a non-lubricated condom like Lifestyles Kiss of Mint. Oral-vaginal sex (cunnilingus) with someone of unknown HIV status is also relatively low risk. The risk of infection with STD’s is higher if there is menstrual blood or an unusual vaginal discharge. Make your partner a Saran Wrap panty or use a latex dental dam with a harness for even safer oral sex (oh my!). Take good care of your teeth and gums in general but don’t brush or floss right before sex. Use mouthwash or gum to freshen your breath instead. One clever suggestion for a barrier comes from a client: Place non-lubed condom inside out like a little cap over the head of the penis. Whatever method you try, avoid getting cum in your mouth. Arrange with your partner to pull out before and finish the job with your hands. If you get cum in your mouth, the idea is to “swallow or spit, just don’t let it sit.”  Remember that slip-ups don’t mean we’ve gone off the rails or that we are bad. Just make the decision to have safe sex in future-for a long life enjoying sex without regret.  “Remember what you do today, will always affect your tomorrow!”

As always take care, TY, RN CEN MSHS

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