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Ball pain can't wait!

Dear guys,
I got a frantic call this week from "Thomas," who had severe pain in his left ball, and pain when peeing. I told him to drop everything and haul ass to the ER--ball pain can't wait! Thomas followed up with me a couple days later, and confirmed my suspicions: he had epididymitis that was caused by an STD. After talking with Thomas, I realized that I don't talk about epididymitis, loyal readers, here's what I can tell you about this "itis."
Happy Reading,
Dr. Dick

First and foremost, if you have pain or swelling in your ball(s), don't ignore it! Ball pain can be caused by a number of conditions, and some of them need immediate treatment to prevent permanent damage. If your pain is severe, go to the emergency room ASAP.

The epididymis is a coiled tube at the back of the testicle that stores and carries sperm. When this tube gets inflamed, it's called EPIDIDYMITIS.

This "itis" is often caused by bacteria. Bacterial sexually transmitted diseases like gonorrhea and chlamydia are common causes. Epididymitis can also be caused by:
• A urinary tract infection or prostate infection
• A backflow of urine into the epididymis--often caused by heavy lifting or straining
• A groin injury

• Swollen, red, or warm scrotum
• Pain and tenderness in the testicle
• Pain when you pee or the urge to pee a lot
• Pain with sex or when you cum
• Lump on the testicle
• Lymph nodes in the groin that are bigger than normal
• Pain in the lower abdomen/pelvic area
• Blood in the semen
• Fever (not as common as the other symptoms)

Get seen by a medical provider so you know what's up. Your medical provider will probably do a variety of tests to identify the cause of your ball pain. Most likely the visit will include:
• A physical exam
• A urine test
• A blood test
• An STD test
• Possibly a rectal exam to check for an enlarged or tender prostate

• Antibiotics are used to treat epididymitis that's caused by bacteria
• If the cause of the epididymitis is an STD, your sex partners need to get treated too
• Take the entire course of antibiotics, as recommended by your medical provider, otherwise, the infection might not clear up completely, or you could develop resistance to the antibiotics
• You and your partner(s) should avoid all-types of sex until seven days after you have completed the full course of antibiotics. If you must have sex, use condoms and other barriers to reduce contact with sexual fluids
• Many people start to have less pain after 2-3 days of taking the antibiotics, but it might take several weeks for the tenderness to disappear completely

Epididymitis can be pretty painful. Here are some tips for faster healing:
+ Rest in bed when you can
+ Lie down so that your scrotum is elevated. This helps blood flow out of the testicle,
which will reduce swelling and pain
+ Apply ice packs to the scrotum based on your medical provider's recommendations
+ Wear an athletic supporter. This can help reduce jostling!
+ Avoid heavy lifting/straining
+ Avoid sex that could cause pain to your ball(s)! Ouch!

If you don't get treated for epididymitis, you could develop:
• An abscess in the scrotum. An abscess is a hard, red, painful lump filled with pus. Abscesses are serious and need medical attention!
• Reduced level of fertility (this is not very common, but it is possible)
• Epididymo-orchitis: when the inflammation spreads to the testicle

• Use condoms for anal and vaginal sex
• Use an oral sex condom when going down on a penis
• Use a dam for rimming
• Talk to your partners about your STD and HIV statuses, and how you want to keep each other safe
• Get tested every 2-3 months for STDs, AND get treated if an STD pops up

Here's to healthy balls!

Dr. Dick

The "Ins and Outs" of Booty-Bumping

Dear Readers,

Do you know the ins and outs of booty-bumping? While it may seem like a piece-of-cake, booty-bumping (keistering) is not harmless! Here's some important info to help you have a bummer-free experience:

• "Booty-bumping" refers to putting drugs in the anus (up the butt) as a way to get high. The drug solution is absorbed through the lining of the intestines (gut).

• TISSUE DAMAGE: We know that crystal-use shrinks your blood vessels. So when
you booty-bump crystal, you shrink the blood vessels in the anal cavity. This means
there's less blood to nourish that tissue. With repeated booty-bumping, the blood
supply to the inner lining of the butt is cut off and the tissue dies from lack of
• SCAR TISSUE: When the tissue in the anus gets damaged, scar tissue can build
up. If scar tissue builds up, your hole may become smaller, which can make
pooping and anal sex painful!
• HIV/STDS: Booty bumping likely increases your risk of getting HIV or other sexually
transmitted diseases (STDs) by causing small tears and other changes to the
tissue in your rectum.

• Start with a clean surface free of dirt and debris.
• Wash your hands with soap and water before preparing your hit.
• Use fresh water and a clean container for mixing your hit.

• Use a brand-new syringe with a screw-off needle. Breaking the needle off of a
syringe can create dangerous sharp edges that can tear you up!
• After you remove the needle, feel the tip of the syringe with a clean finger to ensure
there are no sharp edges. Discard the needle in a Sharps container.
• Before you booty-bump, put some Vaseline (petroleum jelly) on your finger and
coat the inner lining of the rectum. This can help create a protective seal and
prevent water-soluble crystal meth from doing as much damage to the tissue in the
anal cavity.
• Carefully do your booty-bump, then throw the syringe and plunger in a Sharps
container. Wash your hands to clean away germs.
• Some guys like to insert a vitamin E capsule (with water-based lube) in their butt
after booty-bumping to help the tissue heal.

• Booty-bumping can create small tears in the tissue of the anus and rectum (in and
around your hole). These tears make it easier for infections like HIV and STDs to
get into your body.
• Carefully clean the skin around your hole after booty-bumping.
• Use a condom and lube if you have anal sex after booty-bumping.
• Use a dam if you rim your partner after they booty-bump. You can get hepatitis A
and Shigella through fecal-oral contact (poop getting in your mouth).
• Get vaccinated for hepatitis A & B.
• Use elbow-length latex or nitrile gloves if you fist after booty-bumping. Dispose of
the gloves in a Sharps container after use.

• Booty-bumping can cause muscle contractions that give you a strong urge to
poop (like when you use an enema or douche). Be aware that you may get
intestinal cramps!
• Avoid enemas. Using an enema before booty-bumping can dehydrate you. Enemas
can also create small tears in the delicate lining of the anus and rectum. If you must
use an enema, plain warm water is the safest option.
• Give your butt a break. Try not to booty-bump very often! Switch between booty-
bumping and other methods (like smoking or snorting).
• See a medical provider if you have any concerns about your ass after you booty
• Don't use alone: have someone with you so you can take care of each other if
something goes wrong.
• Hydrate! Water and 100% juice are good options.

-Dr. Dick

Pain in the Ass

Dear Dr. Dick,
My new man and I made an adult decision to get tested together. First, we both tested positive for the clap. He also wanted to check on an issue he'd been having back there (blood and mucus when he went #2). Turns out he has proctitis! We both took antibiotics for the chlamydia....and the doc said the pills should also help his proctitis clear up. This is the first I've ever heard about proctitis. Doc, can you give me some mo' info pretty please?

Dear Guy,

Sorry to hear about your boo. Proctitis is the shits! In a nutshell, Proctitis means "inflammation of the rectum." Proctitis is a GI (gastrointestinal) syndrome that can cause the following symptoms:
• Pain in the anus and/or rectum (ouch!)
• Tenesmus (a painful feeling of needing to poop, even if your bowel is cleaned out)
• Discharge and/or bleeding from the rectum
• Diarrhea
• Pain when pooping
• Anal itching

Among MSM (Men who have Sex with Men), some of the common causes of proctitis are:
• STDs like gonorrhea, chlamydia, LGV (Lymphogranuloma Venereum), syphilis and genital herpes
• Shigella (check out my article on shigella for more info)
• Inserting harmful substances into the rectum, including some types of enemas

Other causes of proctitis can include:
• Bowel problems like IBS (Irritable Bowel Syndrome), Crohn's disease, and ulcerative colitis
• Some medications
• Radiation treatment for cancer
• Infections like salmonella

Symptoms of proctitis can be mistaken for other illnesses. If you have symptoms of proctitis, it's recommended that you see your medical provider. They may want you to have one or more of the following tests:
• Stool sample (testing your poop for disease-causing bacteria)
• Proctoscopy (carefully inserting a scope in your butt to examine your rectum)
• Rectal culture (carefully inserting a cotton swab in your butt to collect cells from the rectum. The sample is analyzed in a lab to check for bacteria and germs that could be causing proctitis)
• Sigmoidoscopy (a scope with a camera at its end is gently inserted into the anus, and then moved through the rectum and lower colon to examine the tissue)

The goal of treatment for proctitis is to reduce inflammation and symptoms, and to get rid of infection (if an infection is causing the proctitis!). Proctitis usually goes away when the cause of the problem goes away. Medication is prescribed based on the type of infection you have. If an STD like chlamydia or gonorrhea is causing the problem, treating the STD with antibiotics will usually clear the proctitis. If a viral STD is causing the problem, antivirals may be prescribed to help reduce proctitis symptoms. In addition, medicines to reduce inflammation may be provided in the form of creams, suppositories, or enemas.

• Avoid having sex until the proctitis symptoms go away
• If you have proctitis due to an STD, make sure that you and your partner(s) get treated before having sex again. If you do have sex while getting treated for STDs, use condoms to reduce the risk of re-infection.

• Condoms can help prevent proctitis, because they can prevent the spread of STDs
• The lining of the anus and rectum are delicate. Prolonged, rough crystal sex can cause trauma to this area. If you develop proctitis due to rough anal sex, consider "easing up" until your symptoms improve
• Good quality lube can help prevent friction and trauma to your anus. Check out my article Well-Oiled Machine for lube safety tips

In good health,

Dr. Dick

Gonorrhea with the wind

Dear Dr. Dick,
I've been hearing some water cooler gossip about gonorrhea going berserk. I heard there's a new strain that you can't cure with antibiotics. What do I need to do, aside from wearing a full-body condom when I P n' P?
-Worried for my Willie

Dear Willie,

I understand your fear. No one likes the thought of a "super bug"-- especially one that can spread through sex.

While gonorrhea hasn't gone bananas, there have been concerns about gonorrhea becoming harder to treat. As a result, providers now always treat gonorrhea with two different types antibiotics to ensure the patient gets cured, AND, to prevent drug resistance. Here in King County, there have been 25 cases of drug-resistant gonorrhea since February 2014. All of the cases have been in MSM (Men who have Sex with Men).

What's the big deal?? Untreated gonorrhea can cause serious and long-term health problems. Here's a little Gonorrhea 101:

Gonorrhea is a bacteria that spreads easily through anal and vaginal sex, and oral sex (including rimming). In MSM, it can infect the urethra, rectum, and throat.

Symptoms usually show up 2-7 days after a person gets exposed to the bacteria, but many people - especially guys with infections in the throat or rectum -- don't get symptoms. When people do get symptoms, they are:

• A "drip" (discharge) that comes out of the penis, vagina, and anus
• Pain or burning when you pee
• Itching around the urethra (where you pee from)
• Painful or swollen balls
• Irritation around the anus (hole)
• Bleeding and/or pain when you poop
• If gonorrhea is in the throat, it can feel like you have a sore throat


One of the best ways to prevent gonorrhea is to get tested. Guys who have sex with guys are encouraged to test for gonorrhea, chlamydia, syphilis, and HIV every 3 months--unless they're in a mutually monogamous relationship where both partners have been tested and know their statuses. At the least, test for these STDs once per year.

If you test positive for gonorrhea, connect with your medical provider right away to start treatment. It's important to take the antibiotics exactly as prescribed, and to finish the course of treatment. Don't take antibiotics that you buy online or on the street, or that aren't prescribed for you. Your sex partner(s) need to get treated too, so the bacteria doesn't keep passing back and forth. Keep it in your pants while you're taking the antibiotics---or use condoms if abstaining from sex isn't an option. Get tested again 3 months after you complete treatment for gonorrhea.

*If you are between regular STD tests, and think you have symptoms of gonorrhea, visit your medical provider right away!

Rubbers continue to be one of the most effective ways to prevent sexual bugs. Don't like "male" condoms? An insertive ("female") condom can be placed in the anus up to 8 hours before sex. Non-latex and less mess!

Untreated gonorrhea can increase your chances of getting or spreading HIV. Consider the following:

Guys who are HIV-negative and at high risk for getting HIV can take PrEP. How does it work? You take a pill once a day, every day, to lower your risk of getting HIV. It's important to keep in mind that PrEP alone won't stop you from getting infected with HIV.
It's strongly recommended that guys who take PrEP also do the following:
• Use condoms every time for anal and vaginal sex
• Talk to their partners about their HIV status and using protection
• Get tested regularly for STDs, and get treated if an STD pops up
• Get tested every 2-3 months for HIV
• Take their PrEP meds every day
• Use brand new needles and works every time they inject
TALK TO YOUR MEDICAL PROVIDER if you are interested in PrEP. For more info about PrEP, check out my article That Little Pill.

If you're negative for HIV, and think you might have come in contact with HIV through condomless sex, a condom break, or a needle stick, you might consider getting on PEP (Post-Exposure Prophylaxis). PEP can lower your chances of getting infected with HIV. How does it work? You take a 28-day course of HIV medication to decrease the chance that the virus will settle in your body.
If you feel you might have been exposed to HIV, go to the emergency room at Harborview within 24 hours of the exposure, to get a prescription for PEP. You can also see your primary care provider, if they can see you immediately. PEP works best when started right away, and will not be prescribed for you after 72 hours (3 days). For more info on PEP, check out my article Feelin' Peppy.
Let's hope that this will be a case of gonorrhea with the wind! Take care,

-Dr. Dick

Data and information source: Gonorrhea Health Advisory, Public Health - Seattle & King County, July 20, 2015

Sh-sh-sh Shigella

Dr. Dick,
The other night one of my roommates starting having out of control diarrhea. At first the guys and I thought it was hilarious...but when he started seeing blood, we took his ass to the ER. He didn't get better so they kept him overnight. Turns out he has something called Shigellosis! The doc gave him some antibiotics, and told him to be careful because he was still contagious. Now we're all paranoid that we're going to get it. We share everything: pipes, partners, you name it...
-Scared Shitless

My Dear Friend,
I'm sorry you're scared shitless. It sounds like your roommate has a nasty case of the runs! Shigellosis is a contagious diarrheal disease caused by Shigella bacteria. Anyone can get Shigellosis, but it's especially common among guys who have sex with guys. In fact, several shigellosis outbreaks in this population have happened around the world in recent years. Here's what you should know:

Shigella bacteria spreads easily through poop. Rimming and putting your mouth on dirty skin of the butt, groin, balls, and dick can spread the bacteria easily.

Shigellosis can also spread when an infected person doesn't clean their hands after using the bathroom, then prepares food or drinks for someone else. The bacteria can also spread for up to two weeks after a person is no longer sick with shigellosis symptoms.

Symptoms include diarrhea (sometimes bloody); fever, and stomach cramps. Some people also get what's called Tenesmus, a painful urge to poop even when the colon (bowel) is cleaned out.

If you start having symptoms of shigellosis, it's very important to see a medical provider so they can find out for sure what's wrong. People with compromised immune systems (like through HIV infection) may have more severe symptoms that last longer than normal. Your medical provider might ask you to provide a sample of your poop so that it can be tested for specific bacteria.

For most people infected with shigella, symptoms usually go away in five to seven (5-7) days. Drinking lots of fluids and resting are important ways to care for yourself. Avoid over the counter drugs to slow down the diarrhea (e.g. loperamide) as these can prolong symptoms. If you can, take a break from partying, which will run your immune system down further.

Sometimes the diarrhea is severe enough that you will need a prescription for antibiotics. Take the antibiotics exactly as directed! *Do not try to treat yourself with antibiotics that you buy online or on the street. Treatment requires a specific type of antibiotics, under the care of a medical provider. If you do receive antibiotics and do not feel better in a couple of days, tell your medical provider as there have been reports of antibiotic resistant shigella.

Most people who get shigellosis infection make a full recovery, but sometimes it can take months for a person's poop schedule to get back to normal. Reinfection with the same type of shigella bacteria usually won't happen to a person for several years. However, a person can get infected with one of the other types of shigella (there are four strains of the bacteria).

There is no vaccine for shigellosis. Safer sex practices and careful handwashing are some of the best ways to prevent this bug.
• Try a dam for rimming: Dams are made of latex or polyurethane (for our friends who have latex allergies), and placed over the anus or vagina to shield one another from fluids, sores, and skin-to-skin contact. You can also get Hepatitis A and intestinal parasites from rimming. Like condoms, dams should be used once, and then thrown away.
• Oral sex condoms are non-lubricated and flavored. Add some water-based lube inside the condom to increase sensation for your partner. Put some flavored lube on the outside of the condom to make it a juicier experience for you.
• P n' P can spread shigellosis like wildfire. Stock up on supplies like dams and condoms before you jump into the ring. Use your own pipe and keep all other paraphernalia to yourself.
• Having sex while you have diarrhea isn't a good idea (and frankly doesn't sound like much fun). Avoid having sex if you have diarrhea, and try to wait for at least one week after symptoms are gone, to ensure that you aren't contagious anymore.
• If you do have sex while you have symptoms, use condoms for sex; dams for rimming; and gloves/fisting gloves for fisting and fingering.
• Wash your hands with soap and warm water after sexual activity. This is important after touching items like sex toys, condoms, etc; after using the toilet; and before preparing and handling food and drinks. Clean sex toys before use, according to manufacturer's instructions.
• Tell your sexual contacts about your infection, so they have some information if they start getting symptoms. Shigellosis can be rough on the body, and connecting with a medical provider is important!

Be well!
Dr. Dick

More info from Public Health--Seattle & King County :
Sex and shigellosis_04-15.pdf

Community alert_final.pdf

The H Word...

Dear Readers,

Your plumber might have it....your roommate might have it....your former fuck buddy might have it...even the dick doctor might have it!

You might have guessed that I'm talking about herpes--the H Word that doesn't get talked about enough (in my opinion). People shy away from the H Word, when it's actually super common. Did you know that an estimated 90% of Americans have been exposed to Herpes Simplex Virus Type 1 (HSV-1)? That's a butt-load of people!

I got diagnosed with genital herpes when I was in my teens, and I remember being confused and super embarrassed. But over the years, I've learned a lot about it, treated lots of patients, and learned how to live with the virus. Herpes can't be cured, but it can be managed with a little TLC.

Here's a little herpes self-care 101...

Outbreaks can happen at any time, but they may be more likely to happen when:
• You first get the herpes virus from a partner (outbreaks generally get less common after you've had the infection for more years).
• You have a compromised immune system, from HIV infection or from taking medications that suppress the immune system, like chemotherapy.
• You have an infection with HSV-2 compared to HSV-1.

Some people notice situations that seem to bring on outbreaks. These can include:
• Fatigue (tired/exhausted/too much P & P).
• Stress (emotional, mental, or physical).
• Getting too much sun.
• Irritating your penis or vagina (longer, rougher, crystal sex. ouch!).
• Menstrual periods (our female-bodied friends).

An outbreak of herpes blisters can be painful. Try the following:

Medical Treatments:
• Take medication for herpes. This is especially important if you are having your first outbreak. Many people with herpes either take medication every day to avoid having outbreaks or have medication on hand to start as soon as they think they are beginning to have an outbreak.
• An over-the-counter pain reliever like acetaminophen (Tylenol), can reduce pain. Use only as directed!

Caring for Herpes Sores:
• Dip a washcloth in cool water, wring it out, and place it on the sores. Do this several times per day, to reduce pain and itching (keep this washcloth to yourself, so you don't spread the virus).
• Wash sores gently with soap and water, then pat dry. Put on loose-fitting cotton underwear, and loose-fitting pants. Leave the sores uncovered--bandages may slow the healing process!
o Wash your hands with soap and water before and after touching sores; touching your eyes or genitals; and touching a contact lens.
• Leave the sores alone. Touching or picking at them will slow the healing process. Don't put a lotion or ointment on sores unless your medical provider has prescribed it.
• Sex can irritate the sores, and expose your partner(s) to infection. Give your genitals, anus, or mouth a rest when you have blisters. If you do have sex, use a barrier like a condom to reduce the chance of spreading herpes. Use water-based lube to reduce friction that can irritate the skin, leading to an outbreak.

Care For Yourself:
• Treat yourself to a nap, a warm bath, or a movie (porn optional). Your self-care is important!
• Try to eat balanced, healthy meals. Your body will thank you!
• Try to get a good night of sleep every night.
• Try a meditation or relaxation exercise. Some people experience additional emotional stress when they have an outbreak.
• Use sunscreen to reduce stress to your skin.
• Have a heart-to-heart with a friend/loved one who can offer you emotional support.
• Did you know there are in-person and online support groups for individuals who have herpes infection?
• Think about couples counseling. You can talk about sex and intimacy, and learn about reducing the risk of transmission to your partner.

• Condoms and oral barriers like dams provide the most coverage and protection against skin-to-skin contact that can spread herpes. Check out my article Mouthing Off, for more oral sex safety tips.
• Use water-based lube to reduce friction during sex. Friction can irritate the skin in the genital area, which can lead to an outbreak.
• People who have HSV-2 can also reduce the likelihood of transmitting HSV-2 to a partner by taking antiviral medications. Antivirals can also make outbreaks less painful and happen less often. Medications can reduce outbreaks by up to 80%. Some of these medications are meant to be taken every day, others are meant to be taken at the first sign of a herpes outbreak. Talk with your medical provider to see if antivirals are right for you.
• Having herpes can make it easier to spread or get HIV. That's because herpes sores can bleed or create tiny breaks in the skin or mucous membranes--making it easier for HIV to get in/out.

• You may feel camaraderie passing the pipe around, but sharing can spread herpes. Consider getting your own pipe, or if you are going to share, discreetly wiping it off with your sleeve or an alcohol wipe.
• If you're using, you may get run-down from lack of sleep, poor nutrition, and dehydration. Try to plan out your use. Seattle Counseling Service offers FREE one-on-one assessments for guys who want to cut back or quit crystal, or just talk about options.

Be kind to yourself and each other. In good health,

Dr. Dick

Prince Uranus

Dear Dr. Dick,

What's the difference between an anal fissure and a hemorrhoid? Lately I've had bleeding and a sharp pain when I go number 2, and sometimes after anal sex. I don't want to scare away a partner by leaving them with a bloody dick. Any advice is much appreciated. Thanks doc!

Prince Uranus

Dear Prince,

Aw, shit! Sounds like your delicate flower got a little too much wear-and-tear. Ouch! I suggest two things: seeing a medical provider so you know what's up, and holding off on being bottom until you get some relief.

Thanks for asking about fissures vs. hemorrhoids! Here's the difference:

An anal fissure is a small tear in the skin that lines your hole. A fissure can cause a severe stabbing pain when you go number 2. You might also notice some bright red blood on the toilet paper when you wipe, or on the surface of your poop. The pain can last from a couple minutes to several hours--which makes anal sex or a lap dance an uncomfortable prospect.

An anal fissure is most often caused by passing a hard, dry stool. It can also be caused by anal sex and fingering, persistent diarrhea, straining when you poop, constipation, and putting objects in the butt. Less often, certain sexually transmitted infections, particularly herpes, can cause anal pain that can be confused with the pain from anal fissures. Syphilis can cause sores on the butt, though they usually don't hurt. Rarely, fissures can result from more serious autoimmune diseases. In general, if you have something that you think is a fissure, you should have a medical provider take a look.

An anal fissure can be hard to heal because the wrenching pain can cause the anal sphincter muscle to spasm. The spasm reduces the amount of blood flow to the fissure, which slows down healing of the wound. The next time you poop, the pain-spasm cycle continues, and the fissure just can't heal. Sometimes an anal fissure will result in a skin tag outside or just inside the anus.

Most anal fissures can be treated without surgery. Often times, your medical provider will prescribe a fiber supplement or high-fiber diet to make your poop bulkier; this will allow the anus to gently expand and stretch. Also, it can help to soak your butt in warm water after a bowel movement.

You might also get a prescription for a cream to insert into the anus to help with the healing process. Keep the applicator to yourself and wash your hands before and after using the cream.

The problem can pop up again easily, and it's important to keep eating a high-fiber diet, and practice good bowel habits (avoid straining or sitting on the toilet for long periods of time, etc). Visit a medical provider if you continue to have problems with constipation or bowel movements.

If these treatments do not work, a surgery might be necessary to remove the fissure. These are usually done in an outpatient setting, and result in quick relief.

There are two kinds of people in the world: those who have hemorrhoids, and those who will get them. In fact, more than ½ the world's population will get hemorrhoids, usually after the magic age of 30.

Hemorrhoids are enlarged, swollen blood vessels in the anus and lower rectum. They can be external or internal.

External (outside) hemorrhoids pop up near the anus and are covered by thin, sensitive skin. These usually do not hurt, but if a blood clot develops in the hemorrhoid, it leads to a painful, hard lump. The hemorrhoid might also bleed if it ruptures, which could happen with anal sex or straining.

Internal (inside) hemorrhoids develop under the lining of the anus. These can cause bleeding (usually without pain) and can also protrude (stick out of the anal opening) during a bowel movement. If the hemorrhoid protrudes from the anal opening and can't be pushed back inside, severe pain can occur.

• Bleeding when you poop
• Itching in the anal area
• Pain in the affected area
• Sensitive lumps in the affected area
• Protrusion of the hemorrhoid during bowel movements (hemorrhoid sticks out of the anus)

A hemorrhoid is caused when the tissues that support the blood vessels get stretched. When the vessels stretch and expand, their walls become thin and bleed. The blood vessels will then protrude (stick out) if the stretching and pressure continue. Straining during bowel movements, constipation, diarrhea, and spending a long time on the toilet are the major causes of hemorrhoids.

• Hemorrhoids can usually get better when you eat a high-fiber diet. Drinking plenty of water each day can also help reduce your chance of having hard, dry, bowel movements.
• Try not to strain when you poop. Straining puts extra pressure on the hemorrhoid!
• Some people find relief from Sitz baths---sitting in plain, warm water for 10 minutes each day.

Severe hemorrhoids may need to be removed by a medical provider, which can usually be done in an outpatient setting.

Since fissures and hemorrhoids can cause bleeding, you might be more susceptible to getting or spreading an infection like HIV. Here are some tips:

• Are you or your partner(s) POZ? Talk to each other about taking HIV medications. U.S. National HIV treatment guidelines now recommend that everyone with HIV take antiretroviral therapy (medicines that fight HIV). Those medications will help you and/or your partner stay healthy. They can also help protect a person who is POZ from spreading HIV. We don't know exactly how effective HIV meds are in protecting men who have sex with men. Still, the meds probably help a lot and it would be best if you and/or your partner were on meds and had an undetectable viral load (a blood test showing you have no HIV in your blood).
• Use water-based lube with condoms to prevent tearing your delicate flower.
• Use condoms for anal, vaginal, and oral sex, and use a dam for rimming.
• If you are HIV-negative, think about getting on PrEP (Pre-Exposure Prophylaxis). Guys who are HIV-negative and at high risk for getting HIV can take PrEP. How does it work? You take a pill once a day, every day, to lower your risk of getting HIV. The pill contains HIV medicines that prevent HIV from making copies of itself when it gets in the body. TALK TO YOUR DOCTOR if you are interested in PrEP, and read more about it in my article That Little Pill.
• Test every 3 months for HIV and STIs like chlamydia, gonorrhea, syphilis, and herpes. If you test positive for an STI, connect with a medical provider right away for treatment.
• PEP (Post-Exposure Prophylaxis) can also lower your risk of getting HIV. PEP is the use of an HIV drug after a possible exposure to HIV. If a person feels that they might have been exposed to HIV (like through a condom break or needle stick) go to the emergency room at Harborview within 24 hours of the exposure. PEP works best when started immediately, and will not be prescribed after 72 hours.
• If you're using crystal, and worried about remembering to use a condom, try an insertive condom. You can put one in up to 8 hours before sex!

Be well,

Dr. Dick

Well-Oiled Machine

Dear Dr. Dick,

I'm kinda embarrassed to ask, but what are "Crisco Balls?"

-Big Mac

Dear Mac,

Thanks for asking! I guarantee you're not the only one in the dark. Some guys use Crisco Balls for fisting and anal sex. They're made by shaping the popular baking shortening into balls, and then freezing. Before sex play, a frozen ball is put into the anus, where it warms up and lubricates the rectum. Guys tell me they choose Crisco because it's thick, cushiony, and long-lasting.

It may sound like I'm endorsing Crisco, but actually, I tell guys to try to avoid it. Oil-based products like Crisco, Vaseline, baby oil, lip balm, and oil-based lubes can leave a coating in the rectum. This coating can cause bacterial infections and other bugs. Plus, they can leave a nasty-ass smell.

Oil-based products also damage latex barriers like condoms, dams, gloves, and finger condoms; they can also lead to condom breakage.

So, what are safer options? Use condoms for sex and elbow-length gloves for fisting.  There's a lot we don't know about lubes and which ones are safest.  Still, we have decent evidence that not all lubes are safe! While more research is needed, here's what we know so far: some lubes have been found to hurt the cells in the lining of the rectum, and other lubes may increase HIV replication (the virus making copies of itself).  It's a good idea to look at the lube ingredients before you buy one.


Here's some more info:

  • Stay away from lubricants that contain nonoxynol-9. Nonoxynol-9 is a spermicide that can hurt the delicate lining of the rectum and vagina, increasing the risk of HIV and other STIs.
  • Some evidence suggests that lubricants containing an ingredient called polyquaternium-15 may INCREASE HIV replication. Some of the lubricants that contain polyquaternium-15 are in the Astroglide family of lubes: Astroglide Liquid, Astroglide Warming Liquid, Astroglide Glycerin and Paraben-Free Liquid, and Astroglide Silken Secret.  It's probably best to avoid these.
  • Steer clear of lubes that contain sugars. Lubes with sugar can increase the chance of an infection in the rectum and vagina.
  • Some evidence suggests that certain lubricants can damage the cells in the lining of the rectum. These lubricants include: Astroglide, Elbow Grease, Gynol II, KY Jelly, Replens, and Boy Butter.
  • Water-based lube is probably the safest option.

Here's to a great lube job!

-Dr. Dick


Giving the finger...


Dear Dr. Dick,


What is the point of "finger condoms?" I can't even finger someone without having to use protection? What will they come up with next...




Deeply Troubled


Dear Troubled,


I understand your disenchantment. It seems like everywhere you turn, there's a new device for covering up. Of course it's anyone's choice to use a finger condom, but it's good to know they're an option.


Would you want your doctor to give you a rectal exam without wearing gloves? Ok, forget the naughty nurse or doctor fantasy for a second. Finger condoms can help prevent you from getting bacteria or viruses that spread through contact with skin, or very small breaks in the skin.  These bugs include STIs like herpes, syphilis, and human papilloma virus (also known as HPV, the virus that can cause warts, anal cancer, and cervical cancer). 


If you put your fingers in someone's anus, finger condoms might also prevent you from touching bacteria that can cause diarrhea or hepatitis A. In addition, dirt under the fingernails can spread infection. You never know where someone's hand has been. *Although it is possible to get HIV or Hepatitis C through a sore on your finger touching a bloody area inside someone's anus or vagina, the risk is probably very small.


Finger condoms, (also called finger cots), look like mini condoms. They fit smoothly over a finger, and come in latex and non-latex varieties. They can also be used on small sex toys to prevent the spread of germs, bacteria, and sexual bugs. Add some sensual lube to increase pleasure (just make sure it's water or silicone-based).


To use, wash your hands, place the finger condom on the tip of your finger, and roll it down so that it touches the base of your finger. After use, carefully roll the condom up your finger to prevent touching the contaminated side, and throw away in the trash. 


Take care,


Dr. Dick





Chains and Whips Excite Me: Part 2


Now that you know a bit more about what BDSM is and is NOT, you'll want to get familiar with key terms for a scene:


MASOCHIST: A person who feels pleasure by receiving intense sensation/pain in a scene.


MISTRESS/MASTER: One who enjoys being serviced by another person.


SADIST: A person who feels pleasure by inflicting intense sensation/pain on another person in a scene.


SLAVE: A person who is in service to a Master or Mistress.


SUBMISSIVE: A person who feels satisfaction from being verbally or physically controlled during a scene.


BOTTOM: Basic term for the person having something done to them (masochist, slave, submissive, etc.).


DOMINANT: One who feels pleasure from verbally or physically controlling another in a scene.


NEGOTIATION: A conversation with your partner about a scene. Negotiation should take place before you start any BDSM play.


SWITCH: A person who enjoys any role (top or bottom) as they prefer from scene to scene or within a particular scene.


TOP: Generic term for the person doing something to someone (sadist, dominant, dominatrix, owner, master, mistress, etc.


SAFEWORD: A safeword is a safety signal used by the bottom/sub to stop a scene either temporarily or permanently. Some common safewords are "red" for stop and "yellow" for slowdown. "Stop" or "no,"  are not good words to use, for example if one is role playing. Some participants like to use a set signal instead, such as dropping a bell or other object. Discuss safewords during negotiation, and before you start any BDSM activity. If you're at a party, decide on a house safeword. That way, anyone in attendance can respond if they hear the word.




Negotiation should take place before you start any BDSM play. It's a time for you and your partner to sit down together for some thoughtful, respectful discussion. If you try to skip negotiation, your partner might run out faster than you can say "bondage." Negotiation can also take the form of a written questionnaire (you can find one you like online). Once you've both written your answers, sit down together and talk about your responses.


1)      Talk about your BDSM desires and limits. What are your hard limits (things you'll never ever do), and soft limits? (things you might be open to but are unsure of at the moment).


2)      Talk about titles. What will you call each other when you play? (master, mistress, etc.).   


3)      Be open about your medical conditions and make a safety plan. What if your partner ties you up and then collapses due to a heart condition??

a)      Talk about what's going on in your brain and body. What's your mood like? Are you getting over an illness or health problem?

b)      Talk about your HIV/STI status, or better yet, get tested together. You may come into contact with body fluids, especially with blood play and impact play (more later).


4)      Talk about your terms. What do terms like "flogging" mean for both of you? What does it mean to "whip" someone?


5)      Talk about making the switch. Are you going to switch roles in a scene? Switching can happen in a scene, or in a person's lifetime.


6)      Talk about safe sex. What does safer-sex look like to both of you? Get on the same page about your terms. What types of barriers will you both agree to use? Will you choose to get tested together? The person with the strictest rules about safer-sex wins (for example, if one partner requires use of a condom or dam, you should use a condom or dam!). Don't compromise on your safety. You won't enjoy the experience if you aren't on the same page about safety.


                              WRAP IT UP

        Condoms, dams, and lube are important. Keep them on hand, even if you don't plan to make sex part of your BDSM scene or aftercare.


                              PrEP & PEP

        HIV-negative guys who are at high risk for getting HIV can take PrEP (Pre-Exposure Prophylaxis). PrEP involves taking a pill once a day, every day, to help prevent getting HIV. Guys who take PrEP should also use condoms & get tested often for HIV and other STDs.

Talk to your medical provider if you are interested in PrEP. For more info about PrEP, go to:  and click on PrEP Q & A: Using HIV Drugs to Prevent HIV Infection.


        PEP (Post-Exposure Prophylaxis) can also lower your risk of getting HIV. PEP is the use of an HIV drug after a possible exposure to HIV. If you feel you might have been exposed to HIV, visit your medical provider ASAP. PEP needs to be started within a couple days of being exposed to HIV.  For more info on PEP, go to



Negotiations should take place in a neutral environment. Be equals when you negotiate. Do not take on your roles until you're done with negotiation (such as top or bottom).  


You will also want to negotiate your aftercare. Aftercare is a time to cool-down and reconnect after a scene. It can take many forms. For some couples it means sex, for others it could be cuddling or eating a piece of chocolate. Some scenes can make people very emotional, so take care of each other and respond to each others' needs.


Sometimes aftercare continues to the next day. Maybe it means the top will call the bottom to check-in. E-mailing and meeting up in person are other ways to check-in.



Stay tuned for Part 3 next week!


Dr. Dick

Chains and Whips Excite Me: BDSM 101



If you choose to engage in BDSM, you do so at your own risk. Project NEON shall not be held liable in any way for any injury incurred while engaging in BDSM.


Dear Dr. Dick,


I'm what you might call a more traditional & chivalrous lover--I just adore romancing a gorgeous man. But, I'm ready to dive into something a little kinkier. What can you tell me about BDSM? Can I indulge in BDSM and still be a gentleman? Where do I start, and how do I figure out what I like?    




Lover in Ballard


Dear Lover,


You can and absolutely should be a gentleman while engaging in BDSM. You'll be thrilled to hear that BDSM is all about trust and respect (and it might be a welcome addition to the sex life of someone chivalrous like yourself).


First things first, the basic BDSM terms.


B/D, Bondage/Discipline


D/S, Dominance/Submission: The consensual use of power for pleasure.


S/M, Sadism/Masochism: The consensual use of extreme sensation for pleasure.


new sensations

BDSM is a way to explore body sensations through many different types of play. Some people like BDSM because they get a rush of endorphins. Endorphins are chemicals that are released from stress, fear, or pain, and they can trigger a positive feeling in the body that some people describe as "euphoric". Ever had the "runners high?"



BDSM is NOT about abuse. Just because you're a top or a master doesn't mean you can be an ass-wipe. No matter what role you take on, BDSM requires you to listen and respect one another. Don't be an abuser.


It's also important to mention that BDSM does not have to be sexual. Some folks have a purely non-sexual BDSM relationship---which can take many forms (more info to come). There is something for everyone.



Having a clear head (no pun intended) is important. It is strongly advised that you do not play if you're high, tweaked out, or using other substances. Just as crystal can lead to less-safe, marathon sex sessions, it can potentially cause harm when engaging in BDSM. Here's why:

        You could play past your limits (playing or having sex for hours which could cause tissue damage, like skin tears in the lining of your hole).  

        You may not practice safe sex (you might be so horny that you'll jump on a guy without using condoms and lube).

        You could be more likely to hurt yourself or your partner (trying something new like bondage---making you more likely to put yourself in danger).

        You may not remember or recognize safe words if you're tweaked out (leading to potential harm, or not respecting your partner).


During negotiation (more info to come, in Part 2 of this article), a lot of people agree not to play after or while using substances. Substances like crystal cause mental and physical changes that might make a scene unsafe and un-enjoyable (and also defeat the purpose of BDSM). You wouldn't make an important decision after waking up from anesthesia right?? You should be fully present and mindful with BDSM.


Stay tuned for Part 2 next week, 


-Dr. Dick



 *A special thank you to Allena Gabosch, Director of the Center for Sex Positive Culture, for your contributions to this article. For more info about the Center for Sex Positive Culture, visit CSPC.


Grievous Bodily Harm?


Dr. Dick,


My gorgeous Seattle hunk wants to introduce me to GHB. I think I'll try it, but first I want to know what I'm getting myself into.







Dear Curious,


Thank you for bringing up this hot topic. GHB can indeed cause Grievous Bodily Harm--so it's great that you're asking questions before you try it. Here's some basic info that you should know about the drug:


GHB is a nervous system depressant, so it slows down brain activity. People use GHB for the calming side effects it can create when it's taken in lower doses--such as euphoria (a feeling of ecstasy or extreme joy), reduced anxiety, and drowsiness. Some also say it makes you want to mount every hottie you see. This might sound great to some guys. Only thing is, no matter the size dose you take, GHB can be downright hazardous. Even a small amount can cause dangerous side-effects or lead to overdose.


GHB affects every person differently, and no two trips are ever the same. After use, some people have withdrawal effects like insomnia, anxiety, tremors, and sweating.  When you take a bigger dose or add alcohol or crystal to the mix, things can get even more hairy. Higher doses can lead to sleep, coma, or death. You might have hallucinations, slurred speech, headaches, amnesia (memory loss), and a hard time thinking clearly. *This makes the drug perfect for someone to take advantage of you, whether it's sexually, emotionally, monetarily, etc.


Now, down to the nitty gritty. Other names for GHB are Grievous Bodily Harm, Georgia Home Boy, Liquid Ecstasy, Goop, Liquid X, G, Scoop, & Easy Lay ( to name a few). GHB is sold as a liquid (usually packaged in small vials or water bottles); or in tablets, white powder, or capsules. It can be snorted, smoked, or mixed into drinks. In liquid form GHB has no color or smell, and for that reason it's sometimes used as a date rape drug. GHB has a salty taste which people mask by diluting with liquids (like alcohol, juice, or water).


So, what does this mean for you? If you're partying and decide to try GHB, there are things you can do to stay safer. Here are some harm reduction tips to keep in mind:



Let a friend know where you'll be, and who you'll be with. Pick a time to check-in with each other. Definitely don't use alone, because you could pass out or stop breathing altogether.



GHB + alcohol = not-so-fun side effects. You might throw up, have a hard time breathing, and lose muscle control (not a good thing when you're trying to cut a rug on the dance floor). 


Don't accept a drink if you didn't see it made, or aren't sure of the contents. It sounds clich, but try not to set your drink down; GHB is easy to slip into the drink of an unsuspecting cutie. Remember, GHB has no color or smell--so you can't tell by looking at your vodka cran if you're safe.



Like crystal, GHB can lead to riskier sex (not using condoms, having anonymous partners, using not-so-safe lube like Vaseline, etc.). Get tested every 2-3 months, or as recommended by your medical provider.



Have condoms, dams, and lube on hand. Ever tried an insertive condom? You can put one in eight hours before sex. That way you'll be covered when you're in the heat of the moment.



If you think you've been date raped, seek medical care immediately. Date rape is a crime. Remember, no one EVER asks to be sexually assaulted or taken advantage of. Click for more Date Rape Info.



GHB overdose can mean unconsciousness, slowed heart rate & breathing, vomiting, coma, seizures, and death. Currently, there is no antidote for GHB-overdose. If you think someone has overdosed on GHB, call 911 immediately. Don't let the person "sleep it off." Keep them as alert and awake as possible, and stay with them until help arrives.



I hope this helps. Take care of yourself, and each other!


-Dr. Dick


Don't Be Silly, Wrap Your Willie

Dear Dr. Dick,

I'm HIV-poz and I only sleep with poz guys. Why should I use protection?

-Ben Dover


Dear Ben,

That's a very good question, and I'm glad you asked it. You might be thinking that you already have the most serious STI (sexually transmitted infection) so why worry about protection? This seems to make sense except, when you are HIV positive, other STIs can still cause serious problems for you.


If you become infected with a viral STI like genital herpes, you can be sure that it'll put some major stress on your immune system. Viral STIs can be managed with medications, but cannot be cured; in essence, a viral STI stays in your body forever. If you are HIV positive, a virus like herpes can become harder to treat and the symptom outbreaks can be longer and more painful. The bottom line is that if you're having sex, you could become infected with another STI that is incurable.


Here's a bit more info about genital herpes:


Genital herpes is spread by direct skin-to-skin contact, (such as you and your partner's genitals rubbing together), most often during anal or vaginal sex. You can also spread herpes through oral sex (f.e., your partner has genital herpes and you give them head). Genital herpes is most contagious when the sores are open and haven't healed yet. Keep in mind that herpes can be spread even when you don't have any herpes sores. Just because you don't see any sores or bumps on your partner's dick, it doesn't mean they don't have an STI.


The first symptom of herpes is a cluster of sores that appear on the penis, vagina, cervix, anus, or butt. Rarely, sores appear on other areas of the body. They start as small pimples or blisters, and soon become open, painful sores.


Other common symptoms of herpes include:

?        Pain around the genitals, butt, or legs

?        Flu-like symptoms (fever, chills, headache or body aches)

?        Swollen lymph nodes in the groin

?        Itching or burning when you pee

?        A hard time having a bowel movement or peeing


Bacterial STIs like chlamydia, gonorrhea, or syphilis can cause very serious infections in your penis, mouth, or butt that can be harder to treat if you are HIV-positive. Bacterial STIs can be cured, but the longer you wait for treatment, the more likely are you are to end up with permanent damage or complications.


If you are HIV positive and your partner is not, (or the other way around), STIs can make it easier for you or your partner to get infected with HIV. STIs can create breaks in the skin, which make "portals of entry" for HIV (HIV will have an easier time getting into your body). Additionally, inflammation from STIs causes more of the STI-infected cells to be hanging out in your genital secretions. These cells then serve as "targets" for HIV infection. Furthermore, HIV-positive individuals who are infected with other STIs, are more likely to shed HIV in their genital secretions (semen, pre-cum, or vaginal secretions). There are also multiple strains of HIV, and you could get infected by a different strain if you don't use protection. 


The bottom line--protection is key! Unless you are in a committed, monogamous relationship where you and your partner only have sex with each other, and are sure of each other's statuses, condoms and other barriers are important.


With that said, whether or not you decide to use condoms, GET TESTED. Regular testing can catch sexual bugs early, so that you and your partner(s) can get proper treatment. Test for STIs and Hep C every 2-3 months, or based on your medical provider's recommendation.


Remember that we can care for our sexual health in many ways, by asking questions, talking to friends, protecting ourselves and our partners, and getting STI checkups.


Take care,


Dr. Dick



For more info about STIs, visit: STI Info_Public Health Seattle King County


For info about FREE testing for HIV, STIs, and Hep C, visit: Where to get tested in Seattle/King County or join NEON and Gay City for TGIF, Fridays from 3-5 p.m. at Seattle Counseling Service. Get free, confidential testing for HIV, STIs, and Hep C, eats, films and workshops, and more!


Updated and Reposted 3/7/13


Never been kissed, never been poked.

Dear Dr. Dick,

Lately I've been experimenting with dudes for the first time in my life. I've topped and given head---but I still haven't been poked yet. I pretend I don't like it or don't want to do it. I'm honestly freaked out. Isn't it going to hurt?!? I'm not sure I want to know...

Scared of Booty


Dear SOB,

It's common to hear about the pain felt by women during their "first time," but too often we don't acknowledge that for men, getting poked can also take some getting used to. We can't expect men to be smooth-operating anal sex-machines from the get-go!!  First things first, it's absolutely normal and very common to feel nervous about anal sex.

Remember this: if you don't want to be the receiving partner, you don't have to. It's your body and your sex life, and you don't have to do anything you don't want to do! If you do decide you want to try being on the receiving end, here are my recommendations:



What do you know about your hole and your gut? Your hole (anus) is 2 to 3 centimeters long. Above that, the rectum is about 12 centimeters long, and has a thick layer of muscle. The rectum has two muscular rings--the external and internal anal sphincters.  

Closest to your hole is the external anal sphincter. You control movement of this sphincter (such as when you poop). A little higher up is the internal anal sphincter. Movement of this sphincter is involuntary, meaning you don't control it. When you put something in your butt like a penis or a dildo, it passes by both the external and anal sphincters.

Our butts do not make their own lubrication. Friction happens with anal sex--especially if it's rougher, marathon crystal sex. Keep in mind that you'll need good quality lube to reduce friction (see the lube section at the end of this column).

The lining of the anus and rectum are delicate. Micro tears can happen easily, which increase your chances of getting or spreading HIV or another STI. Unless you're in a monogamous relationship--where 1) you and your partner only have sex with each other, 2) get tested regularly, 3) and are sure you don't have HIV or other STIs--use condoms for anal sex!



Start by putting in a finger, not a dick. This can be your finger or a partner's. Use some lube and be gentle. Remember to relax and breathe. When you're ready for a penis or a dildo, go slow. Stop and relax after you pass the first anal sphincter. Insert the rest of the way when you're ready.  

If you do use a dildo, make sure it has a base or a retrieval handle. No one wants to report to the emergency room with an object lost in their butt.

You might also want to warm-up by trying a butt plug; this is an old porn star trick. Plugs are used to keep the ass muscles open and relaxed---ready for whatever comes their way. 

 *Keep sex toys to yourself, and make sure to clean them after each use, according to manufacturer instructions.



Imagine getting a tear in your hole and not being able to feel it! You won't get the pain signal from your body if something is wrong (like a tear or a colon rupture). A numbing cream will also numb the good feelings. You don't want to miss out on any fab sensations that might arise.



Your partner should respect you, and be willing to go at your own pace. Talk about sex beforehand. You might try saying "Anal sex is new for me. Let's go slow."



Use a condom for anal sex. The lining of the anus is thin and delicate, and a condom is your best protection from sores, fluids, hemorrhoids, and other things that might be in the behind.

Ever had a naughty nurse fantasy? Latex gloves can be used for fingering - especially if your partner has any cuts or sores on their finger.

If rimming is part of your "sexcapades," give a damn, use a dam. Dams come in many tasty flavors, and you'll still get the heat and warmth of touch. Try using some flavored lube to make things more interesting.


Anal Sex and Crystal

Crystal sex can be long and rough. If you're using crystal, prepare for sex ahead of time. Do you have condoms and lube? Change condoms when you stop to rest or switch positions, and add more lube from time to time.



Poppers are a liquid form of amyl or butyl nitrite. Some guys inhale the fumes during sex to relax their ass muscles, prolong sex, or have screaming orgasms. If you do plan to use poppers, I don't recommend it being the first time you bottom. Prolonged popper-sex wouldn't be good for someone who isn't used to having a dick in their butt. Poppers open your blood vessels, sending more blood to areas like your nether regions. This raises the risk of HIV and STIs getting in your bloodstream. Check out NEON's brochure Crystal, Poppers & Boner-Uppers for more info.



Some guys use lube because they feel like it decreases friction and trauma to the skin. Not all lubes are safe though! Some lubes hurt the lining of the rectum and may increase HIV replication (the virus making copies of itself). 

Here's some more info:

  • Stay away from lubricants that contain nonoxynol-9. Nonoxynol-9 is a spermicide that can hurt the delicate lining of the rectum and vagina, increasing the risk of HIV and other STIs.
  • Some evidence suggests that lubricants containing an ingredient called polyquaternium-15 may INCREASE HIV replication. Some of the lubricants that contain polyquaternium-15 are in the Astroglide family of lubes: Astroglide Liquid, Astroglide Warming Liquid, Astroglide Glycerin and Paraben-Free Liquid, and Astroglide Silken Secret.  It's probably best to avoid these.
  • Steer clear of lubes that contain sugars. Lubes with sugar can increase the chance of an infection in the rectum and vagina.
  • Some evidence suggests that certain lubricants can damage the cells in the lining of the rectum. These lubricants include: Astroglide, Elbow Grease, Gynol II, KY Jelly, Replens, and Boy Butter.
  • Water-based lube is probably the safest option.



Guys who have sex with guys should get tested every 2-3 months. Make this a regular part of your health routine. Your doctor may have different recommendations for how often you should test---but the bottom line is that you need to test!


 I hope this helps!

 Dr. Dick


Show Your Balls Some Love!


Your testicles may be worth $1 Million...but to most men, they're priceless! You love them and protect them at all costs! But, I'm always surprised by how little most of my patients know about their balls. Testicle injury, cancer, and other ball problems happen more than you might think!


Below is a short list of common ball problems I see:



1) Too much wear and tear from rougher, marathon crystal sex. My advice: take the weekend off!


2) Torsion. The testicle receives its blood supply through the spermatic cord. Sometimes during strenuous activity like (s)exercise, or from trauma, the spermatic cord gets twisted, and blood supply gets cut-off to the testicle and surrounding structures in the scrotum (ball sack). Severe pain in the testicle comes on quickly, and might be joined by swelling in the scrotum, nausea, vomiting, and lightheadedness. If not treated right away, the testicle can die! Get to the emergency room ASAP!


3) "Blue Balls." Men often use this term to describe when their balls hurt during or after sex where they didn't ejaculate. The pain is simply caused by blood backed up in your erect dick and balls. For relief, let your erection go down a bit or self-stimulate so you can cum.


4) Epididymitis is an infection of your (you guessed it) epididymis-- the mass of tiny tubes on the top and back of your testicles. It can cause pain, swelling, or sensitivity in your testicles. Epididymitis is often caused by untreated STDs like chlamydia and gonorrhea. If epididymitis doesn't get treated, it could lead to problems like chronic pain (pain that doesn't go away).


In many cases, epididymitis can be prevented. Use condoms to lower your risk of getting an STD, and get tested regularly. Guys who have sex with guys should test every 3-6 months (or as recommended by your healthcare provider). 


5) Testicular Cancer

This is the most common cancer in men ages 15-34 - but it's good to know that cure rates for testicular cancer are very high. Symptoms of testicular cancer can be: discomfort or pain in the testicles, lower back pain, enlargement of the testicles, & a lump or swelling in the testicles. It's important to examine your balls each month, so that you can check for any changes (see below for more information). If you think you might have any of the symptoms for testicular cancer, make an appointment to see your healthcare provider for a check-up.


Get to know your balls

Get to know what your balls normally feel like--that way you can notice anything that doesn't seem right or normal. It's nice that we have two, because we can compare one to the other! All men should do self-exams once a month. Some guys like to check their balls when they're in the shower, or lying in bed. Here's how:


1)      Carefully hold one of your balls between your thumb and index finger.

2)      Feel your way from back to front, and bottom to top.

3)      Repeat with your other ball.



You can also ask your partner to help you check. You might even choose to make it part of your shower sexcapades!!!


If you feel anything that doesn't feel normal, don't freak out.  There are many things that can happen to your balls, and you should see a healthcare provider if you notice something that doesn't seem right. You'll feel better once you get it checked out.


Take care,  


Dr. Dick



Updated and Reposted 1/4/13

Keep your Frenemies close & your Enemas closer


Dear Dr. Dick,


I recently met the man of my dreams, and it's been quite a ride. Everything's going well between us--except that lately I've been feeling really constipated, and it's cramping my style. I've heard some of my friends talk about using enemas, but the thought leaves me feeling they work? Help!




Stopped Up



Dear Stopped Up,                     


I'm sorry to hear that you're clenched. Now that you're in love, your fitness and nutrition habits might have gone out the window. Everyone gets constipated at some point in their lives, and it's downright annoying. Constipation means that you're having fewer bowel movements than you usually have. Symptoms include hard, dry bowel movements; having to strain when you poop; and feeling bloated.


Men use enemas (also called "anal douches") for several reasons--to help them have a bowel movement, and to clean out the lower part of their gut before anal sex. I've heard several guys say they won't have anal sex without first using an enema, to avoid "shit dick." An enema involves inserting liquid into the gut through the anus. Water is often used, but sometimes other substances are added. The volume of liquid causes the lower intestinal tract to expand, and often causes bloating, cramping, a strong urge to poop, and finally, a bowel movement.


You could be constipated for several reasons:


1)      You're not eating enough fiber


2)      You might not be exercising enough to get things moving


3)      You're eating too many high-fat foods


4)      You may be taking a medication that causes constipation


5)      You might be dehydrated



Constipation is usually easy to fix, and there are several more "natural" ways to get regular. I don't recommend enemas and here's why:


1)      Your gut naturally cleans itself out--especially when you eat a diet high in fiber. Enemas just aren't necessary!


2)      Enemas can irritate the skin and lining of your anus, which increases your chance of getting or spreading HIV and other STDs. The tissue around your hole is thin and delicate, and you could easily tear it by using an enema.



When you need to clean out your gutter, try the following:


1)      Eat more fiber! Aim for 20-35 grams of fiber per day. Foods with lots of fiber include whole grains, beans, peas, fruits, vegetables, and nuts. If you visit, you can enter the foods you eat each day in a tracker, and find out how many grams of fiber and other nutrients you're eating. It's a great way to track your diet in general.


Try to replace some refined grains with whole grains. Refined grains are found in products like cakes, cookies, white bread, and pizza. Refined grains have little fiber and won't help move things along. Whole grains include foods like oatmeal, whole wheat pasta, and brown rice.  Eating more whole grains is as easy as asking for brown rice instead of white when you go out for dinner.


Other foods with little to no fiber that can make you more constipated are: ice cream, cheese, meat, and processed foods.


2)             Take a walk. Try to get at least 30 minutes of exercise 5 days a week. This could be a brisk � hour walk every day during the week. You can also break it up into 10-minute sessions, 3 times a day. Couples who work out together stay together!


3)             Stay hydrated. Water is your best friend. Juice is the next best option. Water adds fluid to your gut and bulk to your bowel movements, which makes them softer and easier to pass.


Drinks with alcohol will dehydrate you. Follow them up with plenty of water! 


Constipation can also be a side effect of some medications. If you're taking a medication that you think might be causing constipation, talk to your doctor. If you feel like you absolutely must use an enema to clean yourself out, I recommend using warm water only. If you have concerns about your constipation, or if it doesn't get better, definitely visit your doctor. I hope this helps get things moving!




Dr. Dick





Bite me!

Dear Dr Dick,


Once again I have a couple small red spots on my body that look like insect bites. I had something similar a couple of months ago, but I think those were abscesses.


I don't have health insurance so can not see a doctor about it. I the meantime, am I exposing my sex partners to anything serious?




Bitten, smitten but not forgittin' in Seattle


 Dear Bitten, smitten but not forgittin' in Seattle


Thank you for your question!


To start an abscess is a pocket of pus. Pus means you have an infection. Pus is made of dead tissue, germs (bacteria), and white blood cells. An abscess usually appears as a hard, reddish, tender and painful lump, usually at the injection site, but it can also pop up in other places.


There are of course many different insects whose bits range from harmless to extremely dangerous. It is important to remember that winter is bed bug season, if they look like insect bites they could be a sign of bed bugs. Bed Bugs are small, elusive, and parasitic insects. They live strictly by feeding on the blood of humans and other warm-blooded animals. The name 'bed bug' is derived from the insect's preferred habitat infesting houses and especially beds or other common areas where people may sleep. Bedbugs, though not strictly nocturnal, are mainly active at night and are capable of feeding unnoticed on their hosts.


Of course, the only way to be sure is to be seen by a medical professional. You can also periodically inspect your sleeping area for bed bugs. It is a good idea to refrain from having sexual contact until you get to the bottom (no pun intended) of what these spots are.


The STD clinic at 9th and Jefferson is a great resource for men who have sex with men.  


Dr. Dick



Here's a helpful link from Public Health about bed bugs:


And if health insurance is an issue, here's a couple of helpful links:

Dear Dr. Dick, his profile says he's negative...

Dear Dr Dick,

Like so many other gay and bisexual men in Seattle I spend a great deal of time online looking for hookups. It seems that is where all the HOT guys hang out. When I hookup with guys from websites I practice safe sex. However, recently I met two guys online that I'm considering barebacking with. That's cool if all parties involved are HIV negative right? Both of the guys have posted the following statement in their online profiles: "HIV NEG as of November 2011."

So here's my question: is it safe to bareback with them?
Hooked on the Man Hunt

Dear Hooked on the Man Hunt,

Thank you for your question!

The short answer is, no, barebacking (intentional unprotected anal sex) is a very risky sexual practice. Barebacking can easily transmit HIV, along with several other sexually transmitted infections. These potential partners say they are HIV-negative but they were negative as of a year ago, so consider these facts:

In 2010, men who have sex with men accounted for 78% of all new HIV cases among males in the US, and 63% of all new infections in the US. Other studies have shown that recently HIV-infected guys are the most infectious, because they have very high levels of virus in their blood and semen in the first few months after being infected--before their bodies have brought the infection under some control.

Knowing your own and your partner's HIV status is an important part of maintaining one's overall health. However, just because one advertises their year-old HIV status in an online profile or in person does not necessarily mean it is accurate, and frankly you are probably taking a big chance.

Additionally, someone who is HIV negative can have another sexually transmitted infection (STI) present. Anal, oral (including rimming), and vaginal sex can spread infections such as syphilis, gonorrhea, chlamydia, and herpes. Using barriers for all types of sex can make getting-it-on a whole lot safer.

Be sure to talk more about this with your partners and even your doctor to settle on a decision that works best for all parties.


Dr. Dick

updated and reposted 1/13/14

Ohh no, a Wart!!

Dear Dr. Dick,

The other night I took home a date from the bar. He was giving me head when he felt a wart-like thing on my pole. I turned on the lights and there it was! It doesn't hurt, itch or ooze and it is pretty small - but it wasn't there before - Dr. WHAT is it?


Dear Magnum,

Thanks for your question!

First things first, have a doctor take a look at it to be sure!
In the mean time, it sounds like you might have acquired Genital Human Papillomavirus Virus (HPV). HPV is the most common sexually transmitted virus in the United States. At least 50% of sexually active people will have genital HPV at some time in their lives, and often acquire HPV in the first few months/years of sexual activity, as it's easily spread. Most people who have genital HPV don't even know they have it. There are often no symptoms, and the warts which are an expression of HPV usually go away on their own--without causing any serious health problems.

HPV is passed on through genital contact (such as vagina, oral, and anal sex) and without even knowing it. There is no cure for the infection itself, HPV, but there are treatments for the health problems that some types of HPV can cause, like genital warts. The warts are usually painless and not a serious problem. They can be flat or raised, single or in groups, and small or large. And, they can be caused by many different kinds of HPV, only some of which are associated with more serious disease, like anal and cervical cancer and cancer of the throat.

Without treatment, the warts may grow in size and number, or (again) they may go away on their own. Since you possibly have acquired genital HPV infection and may have a wart, see your doctor about available tests for genital HPV. Although there is no treatment for that cures HPV itself, there are treatments for genital warts such as laser removal, burning, cutting, topical chemotherapy, or freezing them off. Even after genital warts are treated, the virus remains in the body. This means that you may still pass HPV to your sex partners, even when you don't see any warts.

So, Magnum go see a doctor (in-person) and have it looked at - that is the best way to know for sure. In the meantime, be sure to wear a condom if you do have sex with anyone else.
And, since HPV can be spread orally even without warts being present, a condom for oral sex would help protect your partner.

All the best,

Dr. Dick

Anal Fissure

Pride & My Ass

Dear Dr. Dick,

If this Pride season is anything like the last one - my ass is going to be very busy housing bursting buldges - literally! Last year, amidst all my safety tactics I still managed to get an anal fissure! While it has healed considerably since then, I am worried I might not be doing enough to have an exciting, safer and healthy pride season!

Robbie Rumpsworth!

Dear Robbie Rumpsworth,

I am glad to hear your anal fissure has healed considerably! For those readers who have not heard that term before, an anal fissure is a tear in the skin of anal canal. Most anal fissures are caused by severe stretching of the anal lining. Symptoms of an anal fissure include bright red bleeding from the anus, most noticeable on the toilet tissue or on the toilet.

Striking pain and/or consistent discomfort during anal sex should be a strong indication to inspect your ass hole. Or better yet, since someone has to be very flexible to really examine their own ass, go visit a doctor or knowledgeable health care provider and let them examine you carefully. If you plan on taking multiple dicks with lots of girth or even getting fisted -it is recommended that you do some anal prepping on your own. Get a butt plug or even use your own fingers and water-based lube to safely stretch your hole before the main event!

Given that a fissure is a tear in the anal skin, and that that provides ready access to your blood, you are at increased risk of acquiring infection by bacteria and/or virus' such as HIV, Syphilis, or Gonorrhea -if one of your partners is so infected, of course. And any partners who have direct access to your blood may more easily acquire a blood-borne infection, like HIV or hepatitis B or C, from you if you've already become infected.

Remember the old adage: Healthy pink parts contribute to a healthy sex life! So, stock up on water-based lube and condoms of all sizes, colors and feels for those bursting buldges! And, don't have too much fun, unless you're being very careful with yourself and with your partner(s).

Dr. Dick


Too Shy To Show

Dear Dr. Dick,

I'm a 25 year old techno-savvy guy - I'm cool at work, great to be with - the girls just adore me. But, I like guys and prefer guys - but nobody knows in my family, friends - at home or at work, even socially.

I've been messing around with guys for months now. I guess, you'd call me straight-curious. I'm not gay - I top only, occasionally I'll suck a nice small cock or rim a nice bubble butt. I haven't been using condoms since I'm not gonna get the guys pregnant, right!?

I'm too shy to go in to my doctor's to get checked and stuff though. So, I'm checking in with you. What should I be worried about? I don't really hear much about any gay scares.

Too Shy To Show

Dear TSTS,

I'm not one for labels myself - whether you're straight, gay, bisexual, straight-curious, etc - you like who you like - and that's that! However, if you are going to express your sexual interest in someone (or something), SEXUAL SAFETY is the one thing I am sure to remind guys about. And, guys who have sex with guys are at considerably greater risk for sexually transmitted bugs than guys who only play with girls - 400 times greater risk, for example, for acquiring HIV, even if you're mostly a top.

HIV, STD or any sexual "bug" for that matter DOES NOT discriminate. Just because you may not identify as gay does not mean you're immune to acquiring HIV. But, some people do think that and word does get around as fast as syphilis or gonorrhea spreads around!

Gettin' it on with a guy or an occasional gal - you MUST get tested regularly. Whether it's oral or anal - STD risks are there. Get tested regularly every 3 months for the following:

HIV, Syphilis, Chlamydia, Gonorrhea AND Hepatitis

Especially if you have multiple partners!

Start with having conversations around your sexual safety guidelines as much as you talk about acting out your fantasies. And, tell your partners when you were last tested and your results, even if they were all negative. Saying "I was HIV negative as of last month" will help your partner disclose to you whether he/she has been tested and when the last test was. Also, it sounds odd to some people, but you might be surprised at how many folks are actually comfortable wearing condoms for sex, even blowjobs and such.

Online resources are definitely out there - but doctors and specialists are trained with years of education and practice to know what an STD looks, feels and smells like - so I encourage you to go in. There are a lot of weird and fake online resources out there - as much as there are online chat spammers.

If it feels uncomfortable seeing your doctor - there are other options locally. You can schedule an appointment at the following:

  • Gay City Wellness Center - 511 E. Pike St - 206.860.6969
  • Harborview STD Clinic - 325 9th Ave - 206.744.3590
  • Or if you go to bathhouses and sex clubs, most of these locations offer free, confidential and anonymous testing.

For now - always clean underwear and buckle up - take care of yourself!

Dr. Dick


Dear Dr. Dick,
With the sun comin' out - I thought I should get myself a new buddy: a new pet and a fuck buddy for the summer. I like walkin' the dog, and fuckin' my bud. Thought I was bein' safe - but now I have scabies! I don't know which bitch I got it from. What's an urban bunny to do?
Urban Bunny Princess

Dear Urban Bunny Princess, Dogs [and cats] are infected by different types of mites than those which infect humans. So, you got it from the other bitch, as you put it. Scabies is one of the more common infections, because it is easily passed on through skin contact between men [or person to person], not men and dogs [although men can be dogs!]. Most men, once they found out they are infected, treat themselves at home or their doctor treats them. The mites can't be seen.

Itching can be so mild that you don't realize you have scabies, it's good now that you know, so you can better take care of yourself.

Your fuck buddy could have given it to you either or both of these ways:

  • through body contact during sex.
  • through sharing clothes, towels and bedding (but this is unlikely).

Now that you know for sure that you have scabies: There's no way to stop infection but this will stop it from spreading to others:

  • Get treated if you know you've had sex with or shared a bed, towels, clothing or bedding with someone with scabies.
  • Any and all shared clothing, bedding and towels should be washed on a hot wash.
  • And if you're into BDSM, leather clothing can be dry cleaned.

Here are some useful signs and symptoms that you may have scabies:

  • For some people the itching can be intense, usually starting two to six weeks after infection.
  • The mites burrowing under the skin can leave red lines, especially between fingers and around wrists.
  • Mites can also be found on your feet, buttocks, stomach, ass, cock and balls.

Here are some more helpful hints to take care of yourself:

  • Lotions are available for scabies through a pharmacy. Several lotions are available to treat scabies. Always follow the directions provided by your physician or the directions on the package insert.
  • You spread the lotion over your whole body, including palms of your hands, soles of your feet and between fingers and toes - but not your face or head.
  • You leave it on for 24 hours. Even when the treatment works you may still itch for several weeks.
  • If after two weeks you still itch, call your doctor or pharmacist for advise .
  • Only repeat the treatment if a doctor tells you to, as too much lotion can irritate your skin.

No one is immune to scabies. If you had them before you can get them again.

-Dr. Dick


Dear Dr. Dick,
So, I've got MRSA - well at least my doc said so. I am just frantic and freaking out over it. People say you only get it at hospitals, but then I my friends say it's an STD! What's going on? Is this the new gay disease? I don't have time to deal with this.
Frantic & Freakin'

Dear F&F,
MRSA [Methicillin Resistant Staphylococcus Aureus] is an increasingly common cause of skin infection. These infections can affect ANYONE, gay, straight, and kids who haven't even begun having sex.

Although recent research shows that MRSA does affect MSM (men-who-have-sex-with-men) populations, it certainly still affects others. We don't know how specifically most men who have sex with men got it, but it can be pretty easily acquired by skin-to-skin contact, which would include sex, but would also include wrestling and totally safe sex, and use of someone's contaminated towels, or facecloth, or sleeping in someone's bed could also be ways to spread MRSA regardless of population.

These MRSA bacteria are resistant to some of the standard antibiotics, but they are nevertheless quite treatable. Treatment with the antibiotics used to treat the typical staph infections won't work, so providers must suspect a resistant strain of staph, get appropriate cultures, and start the right treatment. And you need to take the treatment just as prescribed, otherwise you're helping these bugs develop additional resistance.

MRSA is typically transmitted through skin-to-skin contact, which occurs during a variety of activities, including SEX. But [pun-intended] this does not mean MRSA is a sexually-transmitted disease or infection.

Early-on a MRSA infection often looks like an angry bite from a spider or some other insect, as the skin is raised, looks reddish, feels warm and may be tender to the touch; but instead of gradually fading like most
bites, it will keep getting bigger until it gets treated. Infections often start around hair follicles, particularly in warm, moist areas and around hair follicles, e.g., in the groin, and pockets of pus may develop. Any growing area like this, especially if associated with a fever or chills, needs immediate medical attention.

You can prevent spreading staph or MRSA skin infections to others
by following these CDC guidelines:

  1. Cover your wound. Keep wounds that are draining or have pus covered with clean, dry bandages. Follow your healthcare provider's instructions on proper care of the wound. Pus from infected wounds can contain staph and MRSA, so keeping wounds covered will help prevent the spread to others. Bandages or tape can be discarded with
  2. the regular trash.
  3. Clean your hands thoroughly and frequently. You, your family, and others in close contact should wash their hands frequently with soap and warm water or use an alcohol-based hand sanitizer, especially after changing the bandage or touching the infected wounds. If you find yourself feeling the bandages, wounds, or scratching the area, wash you hands, before contaminating someone's skin or some other surface.
  4. Do not share personal items. Avoid sharing personal items such as towels, washcloths,
  5. razors, clothing, or uniforms that any that may have had contact with infected wounds or bandages. Wash sheets, towels, and clothes that become soiled with water and laundry detergent. Drying clothes in a hot dryer, rather than air-drying, also helps kill bacteria in clothes.
  6. Talk to your doctor. Tell any healthcare providers who treat you that you have or had a staph or MRSA skin infection.

Hope this makes your more relaxed & informed, F&F!

-Dr. Dick

Itchy Rectum

Dear Dr. Dick,
I'm a bit embarrassed to ask you--thank heavens for email though--but, [pun intended] I started dating this guy I met online, you know--one of those free personal ad websites, and we met face to face after a week of chatting--had a nice date, coffee & chat, and went to my place for "dessert." We didn't have sex--well, at least not butt sex--and just made out...I gave him a nice blowjob, and he rimmed me. So, I'm gonna see him again. Thing is--about a couple days later [and I haven't seen anyone but him], my hole's been really itchy, and I can't really tell, but there might be some weird discharge, too. But, it's hard to tell when I poop and stuff--and it's been hurtin' lately! Should I tell the guy? What if it's not him? I don't want to embarrass myself further. Oh, what to do?
--Embarrassed Bung Hole

Dear EBH,
It can be embarrassing to tell some you just met about intimate details even though you've made out with him already. But, better safe than sorry... Let's start with you: it sounds like you "might" have symptoms of rectal gonorrhea, because your symptoms are compatible with that infection, even though it probably doesn't get transmitted to the anal area by rimming very often.

Symptoms usually develop 2 days to 10 days after catching the infection. These are the main symptoms from anal infection, shown from most common to less common:

  • Discharge from the anus
  • Painful bowel movements
  • Anal itching
  • Blood or mucus on the feces

Gonorrhea is generally transmitted through anal sex, and sometimes oral sex--such as rimming. Go to your doctor or nearest clinic, such as the STD Clinic at Harborview (HIV/STD Hotline: 206-205-STDS) to get tested & treated immediately. The infection may spread inside the body if it is not treated. There, it can cause epididymitis in men, a very serious illness. Rarely, the gonococcus can get into the blood and cause a kind of arthritis and other problems.

Gonorrhea usually is treated with a single dose of an antibiotic. Treatment usually can be given by mouth, but sometimes an injection is required. Because gonorrhea and Chlamydia often occur together, persons with gonorrhea usually are also treated with an antibiotic against Chlamydia.

*Important: Many common antibiotics do not work against gonorrhea. Never treat yourself with an antibiotic left over from another prescription.

People should not have sex for 7 days after treatment is completed. Recent sex partners must also be treated, since there is a high likelihood that they also have gonorrhea, and many people with gonorrhea have few or no symptoms, but could continue to be at risk for complications and spreading the infection to others. Sex partners must not have sex until both have completed treatment; otherwise they may re-infect one another.

Follow-up: Everyone with gonorrhea should be re-tested 3-4 months after treatment. Public Health routinely contacts patients or their health care providers after three months to remind them about repeat testing.

It would be wise to let him know of your situation, so he can get tested & treated right away, too. Who knows, this could be a really nice ice-breaker for you both and the start of a great relationship of honesty and caring. I hear autumn's going be pretty cold this year... better make reservations for a nice bear hug! And have a nice tasty & safe dessert!
Sweetly yours,
-Dr. Dick

Is Urine Okay?

Dear Dr. Dick,
Is urine okay?

Dear Arnold,
Safety-wise, urine is essentially sterile; it's not necessarily free of HIV, so it's not safer sex to drink someone else's urine. Also, urine contains mostly salts that your body is trying to eliminate, so drinking it again will strain your kidneys. If you're drinking urine, make sure to drink lots of water as well. -Dr. Dick


Dear Dr. Dick,
It's all over the newsstands and TV, and friends from New York are talking about "MDR HIV." I'm freaking out!!! What gives?
--Freaked Out and Horny

Dear FOH,
I'm really glad you asked. It's ok to be freaked out, but if we keep ourselves well-informed we can better manage our choices. MDR HIV means "Multi-Drug Resistant HIV [Human Immunodeficiency Virus]." These forms of the 'HIV' are resistant to multiple classes of anti-HIV medications. There are 4 classes: protease inhibitors, nucleotide transcriptase inhibitors (NRTIs), non-nucleoside reverse transcriptase inhibitors (NNRTIs), and fusion inhibitors (which includes just the one drug Fuseon, or T-20). These four cases were resistant to practically all of the PI and NNRTI drugs, and to some of the NRTI drugs, meaning that it may be hard to find a treatment that will work when these guys need treatment. I've asked my colleagues at Public Health here in Seattle to help me address this concern in a more consistent message.

What does "drug resistant" mean?
There are four classes of anti-HIV drugs (also called "antiretrovirals" or "ARVs"), with several drugs in three of the classes. When HIV meets an anti-HIV drug, it tries to survive by changing its genetic code. Over time, the HIV virus often changes enough to get around the drug and keep making copies of itself. When HIV can resist one drug, it can often resist other drugs in the same class. Sometimes HIV can be "drug-resistant" to several drugs across two or more classes. This kind of HIV is called "multi-drug resistant HIV" or "MDR-HIV." HIV treatment is very complex, and people with HIV must take medications on a very strict schedule. Resistance can build up if a person does not follow this schedule or if he/she is not on the correct treatment program.

How did Public Health find out about these cases?
Since around 2000, Public Health has been looking for cases of drug resistance among people newly-diagnosed with HIV. Two of the four cases were found during this routine lab testing. The last two cases were found by medical providers who then alerted Public Health.

Where did this MDR HIV come from?
There is no way to know for sure. We do not know where this strain started (i.e., who had it first) or how many people in this network came in contact with this strain through unprotected sex or sharing injection equipment.

Is this a new problem?
Drug resistance is not new. Since 2000, Public Health has identified 16 total cases of multiple class drug-resistant HIV in people recently diagnosed with HIV in King County. None of the past 12 cases looked as similar to each other as the current four. About 11% of people recently diagnosed with HIV who haven't started treatment have at least some high-level resistance to at least one of the ARV drugs used for HIV. 3% have shown high-level resistance to one or more drugs in two or more drug classes. These rates are similar to other urban areas and have not changed locally over time. However, the current 4 cases look very similar and share many of the same patterns of drug resistance. They are highly resistant to two ARV drug classes and somewhat resistant to a third. Tests on the 4th class are not back yet. These viruses are closely linked to each other and may still be in the community.

How do you know this MDR HIV is being spread?
Because the genetic make up of these four cases looks so similar, it is unlikely that each person developed the exact same resistance pattern on his own. Also, at least three of the four cases were recent infections. So this highly resistant strain does seem to be in the community, but we don't know how easily it spreads from person to person.

Why does Public Health track HIV drug resistance?
Public Health tracks HIV drug resistance among people who have not started HIV treatment. This helps Public Health learn what kind of HIV is being transmitted, how common drug resistance is, and which drugs might become less useful over time. This information helps medical providers prescribe HIV therapy more effectively.

Is there more drug resistance happening?
The longer people live with HIV, the longer they are taking HIV drugs. As more people use more HIV drugs, the chance of drug resistance increases. Over time, there will be a larger pool of people who might have HIV that is harder to treat and who may pass HIV to others. Also, regional testing for resistance is not comprehensive and has not been conducted steadily since 2000. There are likely to be more cases than the ones we have been found. We are likely to find more cases of resistance now that we are looking harder for them.

Does this mean that people with MDR HIV will not be able to get treatment?
No. Some antiretrovirals may still work against MDR HIV, but we don't know how well they might work. With MDR HIV, there are fewer drugs to choose from. These options may also be harder to use, cost more or cause more side effects.

Does MDR HIV progress faster to AIDS?
We do not know how quickly these virus strains will progress to AIDS. We have observed these four cases for only a short time, which is too short to tell how their disease may progress. At present, each of these cases is early in HIV infection and does not yet need treatment.

Can people who already have HIV get "re-infected" with MDR HIV?
Yes. People who already have one strain of HIV can get a different strain, usually within some months of the first infection. The second strain could be drug-resistant or not. Getting MDR HIV on top of existing HIV may cause current medications to stop working. It could also limit future treatment options and impact health.

What is happening with these individuals?
Public Health is working with these individuals and their medical providers to locate and test sexual and drug partners for HIV infection and drug resistance.

What Should I Do?

If you are a medical provider:

  • Conduct genetic drug resistance testing in all patients with newly-identified HIV.
  • Report all cases of multi-drug resistant HIV to Public Health.

If you are HIV-negative or have not tested in the last 6 months:

  • Use condoms every time you have sex.
  • Use your own drug injection equipment.
  • Ask sex and drug partners about their HIV status. Find out your current
  • status and share that with your partners.
  • Get tested regularly for HIV. How often is that?: Every 3 months for gay and bisexually active men who:
    • Have had anal sex without a condom with a man who has HIV or whose
    • HIV status is unknown.
    • Have recently had a sexually transmitted disease (STD).
    • Use methamphetamine.
    • Once a year for other people at sexual or drug-related risk for HIV
    • (i.e., people who inject drugs, have STDs, or have multiple sex partners).

If you are living with HIV:

  • Use condoms every time you have sex, even if your partner has HIV too!
  • Use your own drug injection equipment.
  • Share your HIV status with sex or drug partners. Ask them about their status.
  • Find out if you have drug resistance before starting treatment or
  • if your anti-HIV drugs don't seem to be working.
  • Take your medications on schedule. If that's hard to do, talk to your doctor about options.

For more information about drug-resistant HIV or where to get tested for HIV, call the HIV/STD Hotline Monday-Friday, 9am-4pm:
(206) 205-6105 1-800-678-1595 (206) 296-4843 TTY

Other useful websites:

What is MRSA?

Dear Dr. Dick,
I'd say I'm a fairly attractive guy in his early 30's. Sex is not an issue, especially when I'm out at the baths. I get tested for STD's every 3 months or so, but I've been hearing a lot about MRSA. What is it? I hear it's pretty scary.
--Fabulous And Gorgeous

Dear F.A.G.,
It's great to hear you are comfortable with your sexuality. Kudos to your regular STD testing! MRSA is an acronym. It stands for Methicillin-Resistant Staphylococcus Aureus.

Yes, I know BIG words for bacteria. Simply, it means it is a type of 'staph'(a bacteria commonly found on human skin and on lots of other surfaces that is resistant to a common antibiotic-- Methicillin, that in the past was quite effective in treating staph infections.

MRSA can still be treated with other antibiotics. It may just take longer and be more expensive and often it takes a while for your care provider to discover that it's MRSA that's causing the infection, which can delay selection of the best treatment. MRSA can be found inside the nose, armpit, groin and genital area.

Symptoms include:

  • Redness, warmth, swelling, tenderness of the skin, and boils or blisters
  • Sometimes its' appearance can be mistake for 'spider bites'
  • Frequently fever and chills

MRSA is acquired by "close contact" with a MRSA-infected person. Close contact which has resulted in transmission of MRSA has included sex and even wrestling matches. You can also get it from "MRSA-contaminated objects and surfaces," like towels, soaps, sheets, clothes, benches in saunas or hot tubs and athletic equipment. Baths and gyms can sometimes be risky, and not just from sex.

Once MRSA is confirmed, it can be treated with proper wound and skin care and antibiotics, specifically active against MRSA. A healthcare provider can drain the pus from the infected area if necessary. This procedure is called I&D--incision and drainage. But some infections may require intravenous antibiotic administration and hospitalization.

If you think you may have MRSA-go to your health care provider right away. Appropriate treatment can help prevent it from getting worse. Follow your doctor's instructions carefully, and especially take your antibiotics for the full course, even when you start to feel better.

-Dr. Dick

Talking with your Doc: What to tell your doctor about your Crystal use.

Dear Dr. Dick,
I'm Poz. Should I tell my doc about my crystal use and how?
- Concerned Chris

Yes, always be honest about crystal use. There are a lot of health problems you can have as a result of crystal, HIV, or both. If your doctor doesn't know about your use of crystal, you might not get the right diagnosis or treatment. Also, some HIV meds don't mix well with crystal. And using crystal can increase your viral load. Especially, if you are skipping meds while high.


Let's face it, crystal isn't healthy.

Doctors wish you wouldn't use it. But some doctors are more accepting than others. Most drug users are afraid of being judged or preached to. But give your doctor a try.


-Find a doctor by asking other users. If they like their doctor, you might too. & Start by asking, "Can I be honest with you about something?" This shows you are sincere and willing to talk. Even if you feel uncomfortable.

-TELL THE TRUTH, THE WHOLE TRUTH AND NOTHING BUT THE TRUTH. Why bring it up at all if you can't tell the whole story?

-If you don't want to be treated like a psycho tweaker or junkie, don't act like one!

  • Don't focus too much on getting pills to fix your problems.
  • Don't beg for 'painkillers' just to sell or trade for crystal.
  • Show up for appointments on time.
  • Be respectful and don't show attitude.
  • Crystal can be a harmful drug. Don't pretend it isn't.

If your doctor doesn't return your respect and honesty, GET A NEW ONE! There are lots of really supportive, caring doctors out there, just like ME!

You love me, you really love me!
Dr. Dick


Hey Doc!
Is it bad to give yourself enemas? I like to do several before I get fucked, so I'm doing them all the time. What is the negative impact of enema abuse?
- Clayton

A clean butt does add to the romance, doesn't it? But enemas, or anal douching, are NOT the way to go. Using enemas over time can cause severe constipation. In worst cases, men become so hooked on enemas that they cannot move their bowels without them.

Enemas can also increase your chance of HIV infection because they irritate the lining of your colon. And don't douche after sex. You may only push the semen, and HIV, further into your body.

If you feel you must wash out your rectum before sex, use an "ear syringe." (NOT your other syringe, please!) You can buy ear syringes in drug stores. Look for the ones with the long, tapered end. Put in warm water (water only), lubricate the tip, and then insert it into your butt. Gently squeeze the bulb a few times. Doing this one time is enough and milder than an enema. And you are more likely to get rid of the liquid and feces more fully.

Crystal slows down or even stops bowel movements when you're high. You can keep your colon happier by drinking more water--something all crystal users should do anyway! Eating more fruit or using fiber supplements like Metamucil can also help.

Until next time,

Dr. Dick on testicle health: Epididymitis

It's 10:00. Do you know where YOUR epididymis is?

Welcome to the second half of our talk about testicle health. Yes, each of you has an epididymis (ep-i-DID-i-mis) - in fact two! They are the coiled mass of tubes that drape over the back of each testicle. This is where young sperm grow and mature for several months before their Big Curtain Call!

When these tubes get infected, that's called epididymitis
(ep-i-did-i-MY-tis). It can easily spread down through your balls and turn your scrotum red. Sometimes, an abscess can even develop in your scrotum that needs to be surgically drained (YIKES!!).

What causes epididymitis?
For younger guys, the usual cause is an untreated STD, often chlamydia or gonorrhea. For older men, bladder or prostate infections are more common causes. (Although older guys can and do get STDs too). Epididymitis can also develop days to weeks after untreated urethritis (infection in your pee tube). And it's easy to have urethritis and not
even know it!

Symptoms of epididymitis include:

  • Fever
  • Swelling or discharge from your dick
  • Tenderness, pain, or heaviness behind your balls

What can you do?

  • Protect yourself against STDS. Condoms are handy like that!
  • Get tested every 3-6 months for STDs, even if you don't see symptoms.
  • Watch for signs of urethritis: pain when you pee or a yellow-green discharge from your penis. Get treated right away!

Call the doctor! Quick!
Warm soaks and pain medication may help ease your symptoms. But you still need to get rid of the infection. If you see your doctor early, oral antibiotics will usually be enough. Make sure you take your entire course of antibiotics-even if you think the problem has gone away! See your doctor early before you need more serious treatment or surgery!

Your epididymis needs your love, even if you can't pronounce it!

Until next time, Dick

Dr. Dick on testicle health

Your Testicles may be worth $1 Million...
But for most men, they're priceless! We love them and protect them at all costs! But most of my patients know very little about their balls.

Testicle injury, cancer, and other diseases are more common than you might think!

Pain is a typical symptom. It can mean many things:
Too much wear and tear from rougher, marathon crystal sex. Take the weekend off!

Torsion. Each testicle hangs on a tube that contains an artery, vein
and sperm duct. Sometimes during strenuous activity this tube can get twisted and cut off blood supply. Severe pain comes on quickly. If not treated right away, the testicle can die! Get to the emergency room ASAP!

"Blue Balls." Men often use this term to describe when their balls hurt during or after sex that didn't result in ejaculation. The pain is simply caused by blood backed up in your erect dick and balls. (They don't really turn blue.) For relief, let your erection go down a bit or cum.

Epididymitis is an infection of your-- you guessed it --epididymis (the mass of tiny tubes on the top and back of your testicles). You may feel pain, swelling, or sensitivity behind your balls. If ignored, the infection can spread to the whole testicle. A common cause of epididymitis is untreated STDs.

Testicular Cancer
This is the most common cancer in men ages 20-34. It starts as a painless, solid mass that grows slowly at first. But by the time you can feel a lump, it can grow rapidly. If caught early, cure rates are very high. So regular self-exams are critical.

Get to know your balls.
All men should do self-exams once a month. It's easy to do in the shower or before bed. Get familiar with what your balls normally feel like. That way you can notice anything out of the ordinary. Carefully hold each testicle between your thumb and forefinger. Then feel your
way from back to front and bottom to top. Nice that we have two, because we can compare one to the other! Show any hard lumps or irregularities to your doctor at once.

There are other testicle conditions that should be diagnosed by a doctor. Self-exams and regular doctor check-ups can help stop a problem
from becoming serious or even fatal.

Next issue: Dr. Dick asks: It's 10:00. Do you know where your
epididymis is?

Testicle Trivia:
Your balls produce sperm and testosterone.

The average testicle is the size of a walnut. Size has nothing to do with dick size, fertility, or "manliness."

Dr. Dick Circles your Anus: Some of the more common anal health problems among gay, bi, and trans guys.

Last issue, Dr. Dick answered a reader's question about anal pain. Now, Dr. Dick will take you on a guided galactic tour of anal health concerns.

Gonorrhea, Chlamydia, Herpes, and Syphilis.
These STDs are common among gay and bisexual men who have anal sex without condoms. These STDs don't always have symptoms. If you have anal sex without condoms, it's best to get tested regularly for all STDs every 3 to 6 months. (Call 206-205-7837 to get a test.)

To find out if you have an STD, the doctor or clinician may insert a finger or maybe a small scope to look around. Most likely, she or he will collect any pus or discharge on a tiny swab. The swab will then be dabbed on a "culture" plate or on a slide to see if any bacteria can be identified. If you've had unprotected anal sex recently, the doctor may prescribe antibiotics to get rid of any possible infections. Make sure to take all the medication your doctor prescribes - even if the symptoms clear up! That way you won't develop a "drug resistant" STD.

Sometimes gonorrhea and chlamydia symptoms go away on their own, but the infection will still be present. Syphilis generally causes no signs or symptoms in the rectum. You can have it without ever knowing it. Even if you don't have symptoms or if symptoms go away, untreated STDs can cause permanent damage to your body.

Anal Warts.
This STD is caused by human papilloma virus (HPV). Warts are small fleshy growths on the outside or just inside the butt. Not everyone who has the "wart virus" will develop warts. But even guys with HPV who don't have "visible" warts can pass the virus on to their sex partners. For example, a partner with HPV can pass the virus on to you if his genitals (penis, anus, and perineum) come into contact with your genitals. Using condoms will reduce your chances of getting warts. But
condoms won't eliminate all the risk because condoms don't cover all the areas where warts can be present.

Anal warts can be removed several ways. They can be frozen off with liquid nitrogen or burned off using "electrocautery." Topical medicines can also be used. But only trained medical staff should do these treatments. Don't try to treat yourself. And never use over-the-counter wart treatments on genital warts. If you are HIV positive or your immune system is compromised for other reasons, you may be more likely to develop anal or penile warts. HPV has also been linked to anal cancer among gay and bisexual men. Anal pap smears are being studied to see if they can detect early forms of cancer in the rectum. So, if you have anal sex, talk with your doctor. You can also call the STD Hotline (206) 205-7837 and ask about enrolling in clinical studies for the anal pap smear.

Anal Fissures.
These are small tears or rips in the surface of the anus. The lining of your ass is moist tissue that can be damaged easily. Fucking, fingerplay, and using toys or dildos can cause small tears. You may notice a small amount of blood on the surface of your shit after a tear occurs, but many people don't feel any symptoms. Tears will generally heal by themselves, but can easily be reopened and enlarged. These tears can also become infected - after all, the ass isn't the cleanest part of your body! When an infection like this occurs, it can be really bad news. Sometimes a painful peri-rectal abscess may develop. Other times, the infection can spread into your body. If this occurs, a doctor will prescribe antibiotics and may need to hospitalize you. Usually, small anal tears will heal over time if you stop having anal sex for a while. Large anal fissures and extensive infections may require hospitalization & surgery to correct.

There are two kinds of people in the world: those who have hemorrhoids, and those who will get them. Hemorrhoids are enlarged veins. They can occur on the outside of the rectum or just inside the anus. These enlarged veins can be painful or just itchy. You will usually be able to feel an enlarged vein or lump with your finger either outside or just inside the anus. Hemorrhoids can become red and swollen if you strain when you take a shit. A stool softener like Colace can be helpful, to limit further irritation. Hemorrhoids can become red and swollen during anal intercourse. This can also happen with other types of ass play like fingering, fisting, and using sex toys or dildos.

Most hemorrhoids are easily treated with creams, lotions and suppositories from your local pharmacy or grocery store. Sitting in hot water in the bathtub can also help. These treatments may decrease the itching, swelling and pain. For some individuals, over-the-counter medications may not be effective in reducing symptoms. If this is the case, a doctor or clinician may prescribe a stronger medication to assist in the healing process. Some guys will need to have hemorrhoids banded or removed surgically. Surgery is used for those with recurring problems and is a quick but somewhat painful procedure. Until hemorrhoids have had a chance to heal, it's a good idea to avoid anal sex.

So guys- for Dr. Dick's sake- Get your butt examined! And don't forget to wear your rubber space suit when exploring Uranus or other heavenly bodies!

Too Embarrassed: Anal Pain and Common STDs

Dear Dr. Dick,
Before I started getting high I would only let a guy screw me until I came, usually about 20 minutes or so. Since crystal has joined the party, I love to get screwed for hours.

Lately though, I've been having a lot of pain after I get topped. I've tried creams like Preparation H to help ease the pain but the only thing that really helps is to take it easy for a few days. The pain is slowly getting worse but I can't imagine giving up anal sex. I have a doctor that I like but I am way too embarrassed to talk with her about it. What should I do?
Too Embarrassed

Over the years, I have used humor to address the sensitive topics and questions sent in to AMPHETAZINE. This topic requires a different kind of bedside manner. Too often, feelings of shame and embarrassment make it difficult for guys to seek proper medical care for "sexually related pain." Feelings of shame are quite common.

As you know, it is difficult to ignore rectal pain. Many things can go wrong with your butt - it is important that you don't try to diagnose and treat problems on your own. A good rule of thumb is that if you have rectal pain that lasts for more than two days, you must speak with a doctor about it and get an exam! For many folks, having a doctor that you "like" is important. What is more important is that you have established an open line of communication with her or him. Find out early in your relationship if they are someone you can trust. If you can't talk openly with your doctor about your drug use and the sex you enjoy, you should find a different doctor.

Besides pain, other rectal signs and symptoms can include the presence of blood, mucus discharge, sores, incontinence (loss of shit when you aren't trying to take a crap), and cramping. If you have any of these, it's time to see your doctor.

As you pointed out, use of crystal (and other drugs) can lead to longer bouts of anal sex. Crystal can block the body's "pain" signals that normally limit the amount of anal sex you have. Also, some crystal users like to get fucked "harder." Having longer and harder screwing sessions will make it more likely that your butt will become damaged. It is important to recognize the limits of your body and your butt -- unfortunately crystal can make it difficult to recognize and stay within your limits. Learn to listen to your body -- if you've been having rectal pain it's telling you to "lay off".

Again, it is important to find a doctor or clinician that you feel comfortable with. Someone you can share your medically related "secrets" with. You should be able to discuss your drug use, sexual practices and any symptoms you are having in an open way. Before you go in to see your doctor, try writing down your symptoms on a piece of paper. That way, if you get nervous, you won't forget. If you're not comfortable going to your doctor, consider visiting the Harborview STD clinic (see insert) or call the HIV/STD hotline at (206)205-7837 for a referral.