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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.

WHERE TO START: NEGOTATION

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

ÿ 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

ÿ 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: http://www.kingcounty.gov/healthservices/health/communicable/hiv.aspx and click on PrEP Q & A: Using HIV Drugs to Prevent HIV Infection.

ÿ 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 http://www.kingcounty.gov/healthservices/health/communicable/hiv/links/pep.aspx

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

DISCLAIMER:

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?

Sincerely,

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?"

WHAT BDSM IS NOT

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.

KEEP A CLEAR HEAD

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:

ÿ 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).

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

ÿ 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).

ÿ 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.

Dr. Dick on Blow Jobs: Before you lick, check the dick

Hey Doc!

I give great head and lots of it! But I hate condoms. One day I hear blow jobs are safe. The next day I hear they aren't. So what's the bottom line on giving head? Can you please settle this issue once and for all?

Gratefully,

I. Lovedick

Well, every guy needs a hobby now doesn't he? And you're right, the issue of safety and blow jobs can be downright confusing. So let's try to make it simple.

The one who gives the blow job gets more of the risk. Your lucky recipient has less to worry about (HIV and some STIs can be transmitted to the receiver; it's not as common, but it is possible.) Today we'll just talk about giving blow jobs, not getting them.

Yes, there is clear risk for STIs. Gonorrhea, chlamydia, syphilis, and herpes can be shared when giving head. You can become infected if your mouth touches any sores, rashes, bumps, fluids, etc. So a thorough penis inspection is always smart before you begin. And play with any foreskins to check them out also. You can easily disguise it as teasing or foreplay. But inspecting a penis isn't guaranteed to make you safe! You can pick up an STI even if you don't see any symptoms! So be careful- there can be more than meets the eye!

Hepatitis is also a risk. But you can eliminate or reduce this risk by getting vaccinated for hep A and B. Even though it's not very common, it is possible to get hepatitis C through sex.

There have been reported cases of HIV transmission through oral sex. However, the number of cases is small compared to the whopping number of blow jobs that happen every day!

The experts agree on two points:

ÿ You are less likely to get HIV from oral sex than anal sex,

and

ÿ HIV risk is virtually zero if you use a condom when you give head

Your risks for any STI or HIV increase if:

ÿ You have open sores or cuts in your mouth. These are the express lanes for infection! And since crystal is famous for causing gum problems and loose teeth, your mouth could be in serious trouble!

ÿ You have just brushed or flossed. Scratches or tiny cuts in your gums can easily invite infection.

ÿ You take cum in your mouth. Therefore, a lot of guys agree on this before the action begins. And many men prefer to "let it fly" anyway so it could be a win-win for you both!

So here's my free advice to lovers of dick everywhere:

ÿ Have an honest conversation about your STI statuses. For example, you might say "I was negative for chlamydia, gonorrhea, etc...when I got tested last month."

ÿ Check your own mouth. Don't brush or floss before or just after giving head. Crystal users - take EXTRA steps to avoid gum disease and tooth decay!

ÿ Check your partner's dick, especially under any foreskins. If you see anything unusual, play it safer. Use a condom or pass on giving head.

ÿ Don't take cum in your mouth.

ÿ When in doubt, use a condom. The flavored ones (and lubes) can be deliciously tasty. So why not give them a try?!

ÿ Get vaccinated against hepatitis A and B

Well, fellatio fans, I hope this clears up the confusion.

Until next time

Dr. Dick

Edited and reposted 4/29/13

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:

KNOW YOUR BOOTY

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!

WARM UP

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.

JUST SAY NO TO NUMBING CREAMS

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.

COMMUNICATE

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 BARRIER

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

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.

USE LUBE

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 a bit more info:

· If you are using condoms, don't use oil-based lube--which breaks down condoms. Crisco, Vaseline, and chapstick (lip balms) are oil-based and are NOT good options--even if you're desperate!!

· Stay away from lubricants that contain nonoxynol-9. Nonoxynol-9 is a spermicide that can irritate the delicate lining of the rectum, increasing the risk of HIV and other STIs.

· Some evidence suggests that lubricants containing an ingredient called polyquaternium-15 may boost HIV replication. Some of the lubricants that contain polyquaternium-15 are: Astroglide Liquid, Astroglide Warming Liquid, Astroglide Glycerin and Paraben-Free Liquid, and Astroglide Silken Secret.

· 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, Relpens, and Boy Butter.

Some evidence points to the following lubricants as safer choices: Good Clean Love, PRE, FC 2 lubricant, and Wet Platinum.

GET TESTED

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

Uncovered in the U District

Dear Dr. Dick,

I'm a bi guy who has a couple of intimate partners (both men and women). At this time of year when it's freezing out, it's basically a 24/7 orgy. We all tested negative two months ago, and we're good about getting tested regularly. I feel like I don't have to worry too much about getting HIV. The only thing is, I really don't like condoms. They don't feel good and I have a hard time getting off when I use them. My partners are OK with me not using them. Two of us use crystal, but we smoke only (we don't inject or booty-bump).

How worried should I be about getting HIV? Dr. Dick, I'm not about to start covering myself up. Is there anything I can do to play it safer?

Sincerely,

Uncovered in the U District

Dear Uncovered,

I'm glad you brought this up! While condoms can make sex a whole lot safer--it's important to acknowledge that some people just don't like them or use them. For many guys, sex without condoms just feels better---but it can come with a price (pardon the pun). If you're NOT in a monogamous relationship (where you and your partner only sleep with each other, and are sure you are both HIV/STI free) --- barebacking is risky.

Here's Why:

1) The lining of the anus and vagina are delicate. Micro tears can happen easily (especially with rougher, prolonged crystal sex), which leaves you and your partners vulnerable to HIV and other sexual bugs.

2) It's always a possibility that your partners have other partners. Even though you trust them, you should never assume you're 100% safe when it comes to sex. Whether its oral, anal, or vaginal sex, all sex carries some risk.

3) Even though you and your partners test often, people are most infectious in the weeks right after they get infected with HIV. If one of your partners gets infected and doesn't yet know it, they could infect you.

With that said, if you're sure that you're never going to use a condom---consider the following tips for safer sex:

1) SKIP DOUCHING:

Douching (using an enema) damages the skin in and around your hole--making it easier to spread or get an STI. If you absolutely MUST douche before sex, use warm water only. Check out my recent article on enemas for more info.

2) SMOKE SAFER:

Talk about sex before you smoke. Do you have the supplies you need? (water-based or silicone-based lube etc.). Crystal can make you forget everything when you're caught in a moment of passion.

Try to use your own pipe only. Passing the pipe around can expose you to diseases and infections that can weaken your immune system.

3) TEST:

Test every 2-3 months

If you test positive for an STI--connect with a medical provider ASAP. You and your partners must all get treated. Otherwise, the bacteria/bug will continue to be spread back and forth. Your immune system will also be more compromised---which will make barebacking riskier.

4) EXPLORE YOUR OPTIONS:

Have you thought about trying an insertive condom? Insertive condoms are used in the anus or vagina, and offer protection against HIV, pregnancy, and STIs. You can put one in yourself, or ask your partner to do it. This is a great option for guys who have a difficult time staying hard with condoms on. Have fun with them by making them a part of foreplay.

For more info, see my recent article Too Big to Fit in Here.

5) REDUCE:

Have fewer partners. Fewer partners = less chance of getting or spreading a sexual bug.

6) PrEP & PEP:

PrEP

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.

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.

7) COMMUNICATE:

It sounds like you're doing a superb job of talking with your partners. Keep it up. Talk about your HIV and STI status with your current partners--and if/when you get a new partner. You might say "I tested negative for HIV 2 months ago." If you don't talk with your partners, you don't have the chance to find out their status or sexual history.

8) LUBE:

Some guys use lube because they feel like it decreases friction and trauma to the skin. Friction can tear the lining of the anus or vagina, which makes you or a partner more likely to get a sexual bug.

We really have no idea whether lube increases the risk of HIV and other STIs, decreases the risk, or has no effect. More research is needed in this area. Your risk of spreading or getting HIV and other STIs may depend more on the kind of lube you use.

Not all lubes are safe! Some lubes hurt the lining of the rectum and may increase HIV replication (the virus making copies of itself). Here's a bit more info:

· If you are using condoms, don't use oil-based lube--which breaks down condoms. Crisco, Vaseline, and chapstick (lip balms) are oil-based and are NOT good options--even if you're desperate!!

· Stay away from lubricants that contain nonoxynol-9. Nonoxynol-9 is a spermicide that can irritate the delicate lining of the rectum and vagina, increasing the risk of HIV and other STIs.

· Some evidence points to the following lubricants as safer choices: Good Clean Love, PRE, FC 2 lubricant, and Wet Platinum.

9) CONSIDER THIS:

Have you thought about how important it is to you to stay HIV-negative? What would you do if you tested positive? It's worth thinking about....

Here's to safer humping.

Dr. Dick

*For more info on PrEP and PEP visit

PrEP

Go to: http://www.kingcounty.gov/healthservices/health/communicable/hiv.aspx

& click on PrEP Q&A: Using HIV Drugs to Prevent HIV Infection.

PEP

Go to: http://www.kingcounty.gov/healthservices/health/communicable/hiv/links/pep.aspx

& http://www.cdc.gov/hiv/topics/treatment/post-exposure-prophylaxis.htm

Hard Times

Dear Dr. Dick,

I never thought it would happen to me, but I think I've got a bad case of crystal dick. No matter what I do, I can't get it up anymore. I've heard about this happening with other guys who shoot crystal, but I've been partying for years and never had a problem before. I tried Viagra, but that didn't really help. I'm super embarrassed... Is this a permanent thing?

- One Panicked Penis

Dear Panicked,

Ah, good ol' crystal dick! Speed's little practical joke isn't so amusing when it happens to you, is it? Not all crystal users will develop erection problems, but it does happen more often with long-term or high-dose users. And you guessed it - that usually means injectors. Erection problems are one of the real downsides of shooting crystal, but you do have some sex-saving options!

Your garden-variety erection happens when specific brain chemicals (mostly serotonin and dopamine) react to things that turn you on. When you see a hot guy or he starts rubbing your crotch, your brain sets off signals to the muscles and blood vessels in your pelvis that cause you to get hard. The rest, as they say, is history.

There are many things that can affect your ability to get hard. Your testosterone or hormone levels may be low, especially if you have HIV or AIDS. Levels can also be low if you are taking certain medications or have other health problems. And, erection problems become more common as we get older. Your medical provider can help sort it all out. But back to crystal - it is the factor we're most concerned about here.

Crystal causes huge changes in dopamine and serotonin. Over time, your brain can have trouble sending the right messages to your penis. Regular crystal use also puts stress on parts of your nervous system that regulate normal blood flow between muscles and the tissues of the penis. Finally, crystal shrinks your blood vessels, making the problem even worse. Using more crystal will NOT fix the problem!

SELF-MEDICATING = DANGER

Boner-uppers like Viagra aren't the answer to fixing crystal dick either. Viagra is designed to treat specific health conditions that you may NOT have--so you should never take Viagra without a prescription. It's also very dangerous to mix boner-uppers with poppers. The strain on your heart could cause a heart attack. The combination can be fatal!!! Click here to read more: Crystal, Poppers & Boner-Uppers

WHAT CAN YOU DO?

The best solution for you may be to lay off crystal for a while. Most men see their erections return once they take a sizeable break from speed or seriously cut down their use. It's hard (pardon the pun) to say how long it will take for your dick to rise again. The recovery time varies, but the results are usually positive. Unless you have other health issues, this type of impotence is usually not permanent once crystal is out of the picture.

For some guys, it's not an option to quit crystal. You might be able to cut back though.

If cutting down or taking a break from speed doesn't help, then definitely talk with your doctor. Otherwise your little soldier should be saluting in no time!

Sincerely,

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

Hep C Positive

Dear Dr. Dick,

I was part of a study where they tested my blood for all kinds of stuff. They told me I was HIV positive. I knew this already (for six years). The woman also told me I have hepatitis C. HIV was bad enough--now this. She gave me some information but I lost it. She also told me some stuff but I wasn't too clear-headed at the time. I'm worried. What's going to happen to me? I hear a lot of different things from a couple of friends who have hepatitis C and HIV. Is there anything I can do to help keep healthier? I'm not going to stop shooting meth--at least for now--but I might in the future. I know shooters mostly get hepatitis C from sharing dirty works.

Since I switched to IV speed four years ago, I've been real careful--except for one accident, I never used anything that belonged to anybody else. It happened once when I was too geeked and mixed a hit with my ex-lover's dirty rinse water. I also used his old cotton and spoon. He was HIV positive but so am I. Did I get hepatitis C through just this one time?!! Maybe I got it through sex but I've been pretty careful on that score. I need some direction and advice.

Thank you,

-Anonymous

Dear Anonymous,

Everybody slips up once in awhile--so don't be hard on yourself. What's done is done. It sounds like other than that you've been faithfully practicing harm reduction.

About 80% of HIV-positive people who inject drugs also have HCV--and having both infections can make HCV progress faster in the body. Make an appointment to see your doctor so you can get your questions answered and discuss your health. You'll feel a lot better when you know what's going in on your body, and can talk about treatment and care.

In the mean time, let me give you some info about the hepatitis C virus (HCV). Hepatitis simply means inflammation of the liver. HCV is a contagious liver disease (just like hepatitis A and B). It is spread mostly through contact with the blood of a person who has HCV. Common symptoms of HCV are tiredness, mild fever, nausea, loss of appetite, stomach cramps or side pain, dark yellow or brown pee, pale or white bowel movements, and jaundice (yellow eyes and skin). Unlike A and B, there is NO vaccine for HCV.

HCV infection can be acute or chronic. Acute HCV is a short-term infection that shows up within the first six months of getting HCV. 70-80% of individuals with acute hepatitis C don't have symptoms--so many don't know they're infected. About 15-25% of people will clear the acute HCV infection from their systems.

For the other 75-85% of folks infected with HCV, the acute infection leads to chronic HCV infection--meaning the virus stays in their system. Chronic HCV can lead to more serious health problems, such as scarring of the liver (cirrhosis), and liver cancer. That's why going to your doctor regularly is important if you have HCV.

A lot of injectors get HCV. Why?? Hepatitis C can live on a surface or in a used needle anywhere from 16 hours, to four days. So, any object that has blood in it (like a cooker), or any surface that blood may have been on (like a counter top you use to prep your injections) can be a risk. While bleach can kill HIV, it is unknown if it kills HCV. That's why even if you bleach a syringe, you still run the risk of spreading or getting HCV.

It is possible to get HCV through sex. A small percentage of HCV is transmitted through sex--and it happens more among guys who have both HIV and HCV. If you have HIV and HCV, you should use condoms to prevent spreading HCV (or getting another strain from a partner). There are many strains of hepatitis C, so don't think that you're immune just because you already have the virus.

You are more likely to spread HCV when you don't use condoms and lube, have multiple sex partners; engage in rough sex; or when you or a partner has HIV or another STD. You CAN avoid getting another strain of HCV by protecting yourself!

taking care of yourself when you have HIV and HEP c:

1) Visit your healthcare provider so they can monitor your liver health. Some people with HCV take medications to reduce the inflammation. These medications are effective, but can reduce how well HIV medications work. Seeing your provider so they can talk to you about treatment and care options is important.

2) Be kind to your liver! Try not to drink alcohol, as it will cause more damage to your liver.

3) Get immunized for hepatitis A, and B, unless you have already had these infections. Getting A and/or B could cause more damage to your liver.

4) Join an HCV support group. Be in a safe space with other folks who have HCV: HEP C Support Group.

5) As always, take care! Rest, a healthy diet, and exercise are important ways to keep your immune system up.

Ways to reduce your risk of spreading or contracting HCV:

1) Use condoms when you're getting some booty.

2) Do not share personal items that may have blood on them. Razors, tooth brushes, sex toys, and nail clippers should be kept to yourself.

3) Cover cuts and open sores with a bandage.

4) Use clean works, keep them to yourself, and don't share. Need clean works? Click here for the Seattle & King County Needle Exchange Schedule.

If you'd like to read more, I recommend visiting Hepatitis C Facts.

Take care.

Dr. Dick

Updated & Reposted 12/28/12

Too Big to Fit in Here

Dear Dr. Dick,

What's the deal with female condoms? My roommate told me he's used them before, and I was totally grossed out. They look awkward, and the thought of sticking a plastic ring up my butt is frightening to say the least. What's wrong with regular condoms? Please enlighten me in regards to this madness.

Sincerely,

A Seattle Skeptic

Dear A.S.S.,

Thank you for your great question! I understand just how you feel, but first of all, let's get PC here. Around here we call them "insertive condoms" because they are not just for the ladies anymore. Men have been using them anally for years, and you might be surprised how well "received" they are.

Insertive condoms are made of nitrile--a soft, smooth and flexible material that feels similar to latex. Just like "regular condoms," they are for one-time use only.

The "inner ring" (made of polyurethane) is used to easily insert the condom, and to hold the condom in place during sex. Both the "outer ring" (made of nitrile) and the end of the condom bag stay outside the anus, and actually provide some extra protection against sexually transmitted infections.

Insertive condoms may not be the most fashionable protection--but they can be a fabulous addition to your repertoire of protection. Here are the top benefits guys like:

top five reasons to use insertive condoms:

1) You can put one in hours or minutes in advance. Since crystal can make it hard to remember to use a condom, you'll already be covered when it's time to play.

2) No boner required! This means less pressure and more fun all around for you and your partner.

3) You get to be in charge of your health. It's no secret that it can be difficult to talk to a partner about protection. Saying, "I have an insertive condom in," or "I'm going to put a condom in," can help start a conversation. In addition, you won't have to rely on a partner to use protection. Remember: it's your health, and you have the right to use protection.

4) Variety is the spice of [sex] life. "Regular condoms" are no longer your only option.

5) Extra protection against HIV and other STIs. Since the outer ring and the end of the condom bag stay outside the anus and lie against the surrounding area, you get extra coverage from fluids, sores, and STIs.

THINGS TO KEEP IN MIND

1) Like with "regular condoms," you'll want to use lots of water or silicone based lube. Too much lube is almost enough.

2) You can put an insertive condom on your sex toy or partner (instead of inserting the condom directly) to mix things up. You can also ask your partner to put the condom in for you. Make it a part of foreplay.

3) You can take the inner ring out once the condom is inserted. Some guys find this more comfortable. (See instructions below).

4) Insertive condoms are 6.5 inches in length--the same as your standard male condom. They are one-size-fits-all (unless your partner is the Hulk).

How to use

It's recommended that you practice putting in an insertive condom a couple times before using one with a partner. Then you can make the choice if it's right for you. Here's how:

1) Open the package carefully by tearing the notch on the top right corner.

2) Squeeze the closed end of the condom including the inner ring, so it becomes long and narrow.

3) Gently insert the inner ring into the anus.

4) Place the index finger inside the condom and push the inner ring up as far as it will go. The outer ring should remain on the outside of the anus. Once the condom is inserted, you can reach in with your index finger and pull the inner ring out. Some guys find it's more comfortable to take the ring out.

5) Insert the penis or the sex toy in the bag of the condom, not to the side!

6) To remove the condom, twist the outer ring and gently pull the condom out. Wrap the condom in the package or in a tissue and throw it in the garbage. Do not put in the toilet.

I hope I've helped calm your insertive condom trepidation. Good luck!

Sincerely,

Dr. Dick

Abnormally Abstinent

Dear Dr. Dick,

I think there's something wrong with my sex drive. I like sex and don't have any trouble getting hard, but I just don't get horny when I get high. As soon as my friends shoot up, they pop instant hard-ons. They spend days partying at the bath house or on chat lines. But I don't have any desire to have sex when I'm tweaked. Most of the time I'd rather stay home and do projects or work on my writing. Could it be a psychological problem? What's wrong with me?

Abnormally Abstinent

Dear Abnormally Abstinent,

Thanks for asking one of the most common and perplexing questions for men everywhere: "am I sexually normal?" Every man wants to think he's got it all together in the sex department. But in private, most guys are quite anxious. Issues like arousal, performance, and body image can be big worries. Then when crystal is involved, our ideas about what is "normal" sex get tossed right out the window. Before we look at this issue of sexual desire and speed together, let's talk about male sex drive in general.

First of all, there is no "normal" male sex drive. We as men, and gay men at that, feel a lot of pressure to be "hot, hard, and ready" all the time. Advertising, porn, and magazines tell us we're supposed to be obsessed with sex: Maintaining erections. Giving good head. Fucking all the time. "That's just what gay men do." These expectations are cultural stereotypes. But they're really not true for a lot of gay men. Some guys want a lot of sex. Some guys don't. Neither side is right or wrong. It's really an individual preference.

According to most sexperts (and I'm NOT talking about Dr. Laura), you should judge your sexual interest and activity by what feels healthy or "comfortable" for you. If your sex life feels good to you AND it's not causing harm to yourself, your partner, or your life in general, then whatever you're doing is OK. Lots of sex is fine. But so is a little sex or none at all.

Your need or desire for sex may increase and decrease on a natural cycle. One month you could care less about sex. The next month you may be hornier than a goat! This is normal. And it's true for gay men, straight men, and women as well. Also, there are many outside factors that can affect your sex drive. Illness, medications (especially some HIV meds and antidepressants), stress, emotions, and environment can all dampen your libido. Aging brings about changes as well. Your testosterone levels naturally decrease as you get older.

If you think you might have a physical problem, talk to your doctor. Together you can talk about your symptoms and their causes. You may also want to check your testosterone levels, especially if you have HIV. The tests are simple and can be very helpful.

Now let's talk about speed. Contrary to what many people think, there are no secret chemicals in crystal that make it a "sex drug." Rather, crystal is a powerful stimulant that floods your brain with chemicals. These chemicals may make you focus intently and exaggerate your feelings of pleasure. They may also increase your sense of stamina. This change in brain chemistry may enhance your dancing, artistic creativity, sex, or any other activity you enjoy. But, depending on dose and time, crystal may interfere with these and other desired functions. While crystal can intensify sex, it does not automatically trigger sexual desire.

Most of the sexual desire men experience on speed is learned or "expected" behavior. Here's how it works. At first, you don't know what sex on crystal is like. Then during your next high someone engages you in a sexual situation and you quickly find out! At this point your brain makes a connection between getting high and having sex. This response is "learned behavior." Now your brain expects that when you get high, you want to have sex. This is expectation. A lot of guys have such intense expectation with crystal and sex that the events get reversed. Just thinking about sex makes some men want to get high.

Of course, your brain can make connections between crystal and unpleasant sex as well. For some, crystal sex is empty and isolating. Some men talk about feelings of shame about what they did or who they did while high. They might feel guilty about not using condoms or not disclosing their HIV status. For others, the connection between crystal and sex may not exist. Some men use their high to focus on other activities like writing, drawing, painting, or cleaning their house.

Crystal can be a sexual drug if a man wants it to be. But the sexual effects of crystal are not the same for everybody. Sexual response will depend on how much, how often and how long a person has used. Your environment has a lot to do with it as well. If you get high in a bath house, chances are you will be aroused! If you are high at the QFC, you may just get caught up in reading the food labels for several hours.

It's your high and you can have sex if you want to. There's nothing wrong with you if you don't have a screaming urge to head to the bath house. But if you do get horny, remember that crystal may also lessen your resolve to fuck safely. So plan for safety before you get high. Have those condoms and lube ready before you enjoy!

Sincerely,

Dr. Dick

Reposted & updated 12/14/2012

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 clenched....do they work? Help!

Sincerely,

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 heard one guy say he 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 https://www.supertracker.usda.gov, 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 ½ 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!

Sincerely,

Dr. Dick

What's a freak to do?

Dear Dr. Dick,

Halloween is my favorite holiday, but I always end up with too much candy in the bowl. Any advice for how to keep my tricking in-check?

Yours truly,

Joe McFreaky

Dear Mr. McFreaky,

You'd be surprised how many people write me at this time of year, concerned about too much tricking on Halloween. Below is a sure-fire list of ways to get your freak on while reducing fright on Halloween night.

ÿ Keep costumes to yourself. To avoid coochie critters and other fright-night cooties, keep your pants on and don't share!

ÿ Keep condoms and lube handy. Planning to get some booty? Go trick-or-treating at Seattle Counseling Service on Friday, October 26 from 3-5 p.m., for free condoms (many sensual varieties available) and lube.

ÿ Use the condoms and lube. Use a new condom every time you have sex. Remember, condoms may wear out before you do. Check them often during sex, when you change position, or withdraw. Worried you'll forget to use one? You can put an insertive condom in up to eight hours before sex. It could make a great addition to your costume!

*ALWAYS use LOTS of condom-safe lube (water-based or silicone-based) with condoms.

ÿ Stay hydrated! Shaking your ghoul thing will make you sweat buckets. Drink plenty of water before the fun begins. It's also important to drink lots of water if injecting is on your list of plans for Halloween night.

ÿ Be smart about glitter. Apply it generously, but avoid your dick! Glitter has no place on your delicate flower (unless of course you dress up as a giant flower).

ÿ Avoid biting. Wearing fangs? Avoid biting, and especially avoid drawing blood. You put yourself and your partner at risk for HIV and Hepatitis when playing Dracula.

ÿ Don't mix crystal, boner-uppers, and poppers! Your heart will shift into overdrive, causing changes in your heart rate and blood pressure. Read further.

ÿ Be a smart sexual being. Get tested often. How about Tuesday? Sign-up for Health Night at Seattle Counseling Service to get free, confidential testing for STIs, Hepatitis, and HIV. Health Night happens every Tuesday from 4-6 p.m. Call 206.323.1768 to sign up. Snacks provided.

Planning on bare backing?

ÿ Don't douche or use an enema before going out. You could damage the delicate skin around the anus, making it easier to get or spread HIV.

ÿ Pull out before cumming. You'll lower your chances of getting or spreading HIV and other STIs.

ÿ Avoid booty-bumping. Booty-bumping can damage your bowels and anus. It can increase your chance of getting HIV, and can also make anal sex painful. Ouch!

ÿ Use LOTS of lube. Lube will reduce friction and lower your chance of tearing the skin around the anus.

I hope this helps reduce the trickery. Happy fright night!

Dr. Dick

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 am considering barebacking with. That's cool if all parties involved are HIV negative right? Both of guys have posted the following statement in their online profiles: "HIV NEG as of November 20, 2008." [I'm guessing that you meant 2008??]

So here 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 a recent large study of gay/bi men, on average about 2% became infected each year; but among those guys who engaged in the highest risk behavior the rates of new infection reach levels as high as 8% yearly. 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. So, if you happen to encounter a guy who enjoys high risk behaviors, there could be an 8% chance that he's acquired HIV in the past year, and he may be not just pretty but also pretty infectious.

Knowing your own and your partner's HIV status is an important part of maintaining one's overall health. However, because one advertises their year-old HIV status in an online profile or in person does not necessarily mean it is accurate and frankly it's a big risk to take for HIV, the worst of all sexually transmitted diseases.

Additionally, someone is HIV negative can have another sexually transmitted infection (STI) present. Anal and/or oral sex without condoms can still spread infections such as syphilis and gonorrhea.

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.

Best,

Dr. Dick

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?

Thanks
Magnum

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

Santa's Safe Sex List

'Tis the season!

Dear Loyal Readers,
Every issue, we get questions from simple to hard core. This time, I'd like to do a
"Santa's Safe Sex List" A short and easy way to remember how to stay warm & healthy
while being sexy & safe:

The obvious one is ABSTAIN from SEX. But, really?

If you are sexually active:

Get tested every 2-3 months for HIV & STDs (sexually transmi ed
diseases), including Hepatitis
Get vaccinated for Hepatitis A & B, if you already haven't been vaccinated
Always use a NEW CONDOM: regular, fl avored or Reality for every sex act
Always use water-based LUBE
Get to know your partner - TALK

If you shoot up drugs, always use a sterile rigand all new works; don't use rigs that others have used. Sterile rigs are available by exchanging used ones at any needle exchange site or from many local pharmacies (call 206-296-4649 for times and locations).

If you think you've been exposed to an STD and have symptoms, go to your doctor or the STD Clinic at Harborview Medical Center.

To make an STD Clinic appointment, call (206) 744-3590.

If you have time to cruise online, you have time to read up on HIV &
STD information online.

Here's a start:
http://kingcounty.gov/healthservices/health/communicable/hiv.aspx

Until 2009... Happy Holidays!

Jail Sex

Dear Dr. Dick,
I'm writing to you from my cell - long story, basically got caught with possession and accused of intent to sell.

Anyway - as you can imagine - I'm horny as hell with all the hunky men around me and the idea of having them in me - just blows my mind! Literally!

But, now that I haven't been using - I'm sorta getting clearer and feeling like I've put myself at risk with barebacking in jail.

What should I worry about? I try to read up on things - so far, no nasty drainage or sores from the guys I've fucked around with - I'm assuming I'm safe.

Mr. Jail House Rock

Dear MJHR,
Let's set aside the cliché first - "Don't ASSume" - it only makes an ASS of U & ME.

Risk for sexually transmitted diseases (STD), especially HIV is going to be high since rates of HIV among inmates are higher than outside. And I can assume you didn't use protection, as it's NOT very common to have condoms distributed in the jail system. Some prison officials argue that having condoms available only increases sexual activity and STD infections.

But, I'm an advocate of harm reduction - condoms, condoms, condoms! Get tested, get tested, get tested!

Luckily, HIV/STD testing is available within the King County Jail - take advantage of this free service. If you are infected, services are available to get it treated right away.

Sometimes people who are infected and are infectious may not show immediate symptoms. But, do you really need another thing to worry about?

Why not practice playing with yourself? Wash your hands good - and get a finger or two up in your asshole while jacking off.

Another safer option is to watch each other get off. Of course, ask around to avoid any issues with the wardens. You wouldn't want to stop in the moment of climax!

To some, having bareback sex is the ultimate fantasy - but is it really worth getting it and then some syphilis on your cock, chlamydia in your ass, gonorrhea in your mouth - and maybe hepatitis, too?

Be on your best behavior, and straighten your legal matters so you can actually get out of there - and enjoy sex where condoms, lube and cum towels are in abundance!

And if you're still itching for that "scene," rent a video or two - that's another safer option for that visual kink you might crave.

-Dr. Dick

Fisting and Crystal: Dr. Dick on sphincter safety

Dear Doc:
Last weekend I went to a Tina party which turned into a huge fisting fest. Everyone was pretty spun and fucking each other with anything they could find. I even saw one guy get double fisted. He looked too wacked to feel anything, but I wonder if this could cause any serious damage? Can a butthole really get that big?
Stunned and Amazed in West Seattle

Dear Stunned:
Once speed loosens up those butt muscles and inhibitions, it can be hard to curb your anal appetite! But your ass is not a Volkswagen. It only has so much room.

Your sphincter is pretty flexible and can stretch quite far on crystal. But fisting or massive penetration can easily overstretch your sphincter and other rectal surfaces. Although tears will probably heal, they may never quite get back to normal. Over time, this can lead to permanent damage, a loose sphincter, and lifelong problems with incontinence (inability to control stool).

Another issue is simple anatomy. Your rectum is a tube, but not a straight tube. It curves towards your navel and then your spine in a narrow S-shape. At the wrong angle, a fist (or dildo, thick toy, etc.) can hit the rectal wall with too much force. This could cause bleeding or tissue damage. Go too far up your ass and you can break through your colon wall. A ruptured bowel requires emergency surgery and can be fatal!

Fisting and crystal are a bad combo - plain and simple. Crystal numbs your pain receptors so you might not know when injury is about to occur. Or if it already has. And if sex is getting that out-of-control, your drug use may be too. It might be time to cut down or take a break.

Watch out for these injury warning signs:

Severe abdominal/groin pain
Bleeding from your ass
Fever (especially over 101 degrees)
Painful gas or bowel movements

If any of these symptoms last over two days or get worse, see a doctor or go to the ER immediately. No matter how embarrassed you may be - get checked out!

Your rectum may be a pleasure palace, but it also has a day job - managing your stool. So strong, intact sphincters are nice to have around!
Until next time, Dick

Dr. Dick on Blow Jobs: Before you lick, check the dick

Hey Doc!

Gratefully,

I. Lovedick

Well, every guy needs a hobby now doesn't he? And you're right, the issue of safety and blow jobs can be downright confusing. So let's try to make it simple.

Hepatitis is also a risk. But you can eliminate or reduce this risk by getting vaccinated for hep A and B. Even though it's not very common, it is possible to get hepatitis C through sex.

There have been reported cases of HIV transmission through oral sex. However, the number of cases is small compared to the whopping number of blow jobs that happen every day!

The experts agree on two points:

ÿ You are less likely to get HIV from oral sex than anal sex,

and

ÿ HIV risk is virtually zero if you use a condom when you give head

Your risks for any STI or HIV increase if:

ÿ You have open sores or cuts in your mouth. These are the express lanes for infection! And since crystal is famous for causing gum problems and loose teeth, your mouth could be in serious trouble!

ÿ You have just brushed or flossed. Scratches or tiny cuts in your gums can easily invite infection.

ÿ You take cum in your mouth. Therefore, a lot of guys agree on this before the action begins. And many men prefer to "let it fly" anyway so it could be a win-win for you both!

So here's my free advice to lovers of dick everywhere:

ÿ Have an honest conversation about your STI statuses. For example, you might say "I was negative for chlamydia, gonorrhea, etc...when I got tested last month."

ÿ Check your own mouth. Don't brush or floss before or just after giving head. Crystal users - take EXTRA steps to avoid gum disease and tooth decay!

ÿ Check your partner's dick, especially under any foreskins. If you see anything unusual, play it safer. Use a condom or pass on giving head.

ÿ Don't take cum in your mouth.

ÿ When in doubt, use a condom. The flavored ones (and lubes) can be deliciously tasty. So why not give them a try?!

ÿ Get vaccinated against hepatitis A and B

Well, fellatio fans, I hope this clears up the confusion.

Until next time

Dr. Dick

Dr. Dick on Crystal Dick: The hard facts.

Dear Dr. Dick,
I never thought it would happen to me, but I think I've got a bad case of crystal dick. No matter what I do, I can't get it up anymore. I've heard about this happening with other guys who shoot crystal, but I've been partying for years and never had a problem before. I tried Viagra, but that didn't really help. Is this a permanent thing? What can I do?
- One Panicked Penis

Dear Panicked Penis,
Ah, good ol' crystal dick! Speed's little practical joke isn't so amusing when it happens to you, is it? Not all crystal users will develop erection problems, but it does happen more often with long-term or high-dose users. And you guessed it - that usually means injectors. Erection problems are one of the real downsides of shooting crystal, but you do have some sex-saving options!

There are many things that can affect your ability to get hard. Your testosterone or hormone levels may be low, especially if you have HIV or AIDS. Levels can also be low if you are taking certain medications or have other health problems and psychological factors. And, erection problems become more common as we get older. A good health care provider can help sort it all out. But back to crystal - it is the factor we're most concerned about here.

Crystal causes severe changes in dopamine and serotonin. Over time, your brain can have trouble sending the right messages to your penis. Regular crystal use also puts constant stress on parts of your nervous system that regulate normal blood flow between muscles and the tissues of the penis. Finally, crystal shrinks blood vessels, making the problem even worse.

We don't know why some men get crystal dick and others don't. But we do know that using more crystal will NOT fix the problem! Viagra isn't the answer either. Viagra is designed to treat specific health conditions that you may not have. So you should never take Viagra without a prescription. As a recreational drug, Viagra is a bad idea. And it's very dangerous to take it with poppers. (See AmphetaZINE #18 and #25 for details).

The best solution for you may be to lay off crystal for a while. Most men see their erections return once they take a substantial break from speed or seriously cut down their use. It's hard (pardon the pun) to say how long it will take for your dick to "bounce back." The recovery time varies, but the results are usually positive. Unless you have other health issues, this type of impotence is usually not permanent once crystal is out of the picture.

If cutting down or taking a break from speed doesn't help, then definitely talk with your doctor. Otherwise your little soldier should be saluting in no time!

Licking Booty

Dear Dr. Dick,
I like licking booty . . . I can do it for hours. I was recently vaccinated for hepatitis A - so I don't have to worry about getting that. Since I had been vaccinated, I thought I could lick to my heart's content. That was, until my best friend told me about some kind of stomach bug he caught that made him very sick. From what he and his doc could figure, he probably caught the bug from letting his tongue go wild one weekend at a local sex club. So, what's the poop on this?
Loves To Lick Ass

Dear LTLA,
Rimming is a sexual activity that many gay and bi men enjoy doing. The good news is that rimming carries a very low risk for HIV transmission - just make sure to keep your mouth healthy with regular brushing, flossing and trips to your dentist. And to hear that you've been vaccinated for hepatitis A - if only all gay men would get the vaccine we could prevent many unneeded illnesses. [Please see issue 19 for more on hepatitis. -ed.]

Now the not so good news about licking booty. Sadly, if you rim without some kind of protective barrier, you are very much at risk for a variety of other bugs that can make you very sick. And if you have HIV or have a weakened immune system from something else, these little bugs can really wreck your health. You probably already know about gonorrhea - you can get it in your butt and in your throat. But there are other harmful bugs - bacteria and parasites - that you should be concerned about, too. You may have heard of some of these . . . Shigella, Giardia, Cryptosporidia, Salmonella. Salmonella received a lot of press a few years ago when a child got it from a fast food restaurant.

Some people who have healthy immune systems will clear parasites or harmful bacteria without any treatment. But if you are HIV positive or weaken your immune system with drug use, you might not be so lucky.

So, how do you know if you have one of these bugs? Well, as you might have guessed, not everyone who has caught one will have noticeable symptoms. You might just have a few days of mild and brief diarrhea. You might just lose your appetite. If you do have symptoms, some that are more likely to show up include gas, abdominal cramps, watery or bloody diarrhea, nausea, vomiting, or fever.
How do you enjoy your pastime and avoid these evil critters? Again, the answer is pretty simple. Make sure the butt you're lovin' is clean. The two of you can enjoy a nice warm soapy shower first. If no shower is available, use a dam or piece of cling wrap, or stick to fingering. Be sure to wash your hands after any sort of butt play, especially before you eat that late night snack. If you are sucking dick that has recently been up somebody's ass, it can be a risk for these things as well.

Even if you don't rim, you can still get exposed to one of these bugs. Imagine you finger your partner or you touch something that has shit on it - like removing the condom after you screw. Let's say you grab a cigarette to relax . . . did you touch the tip of the cigarette or stick your finger in your mouth?

Remember: if you ever have diarrhea for more than three days, see a doctor right away. If you've got the runs and feel dizzy or lightheaded or have rectal bleeding, don't wait the 3 days - see your doc immediately. Don't take anti-diarrheals like Pepto Bismol or Imodium unless your doc tells you it's okay. These medications don't help with parasites and some harmful bacteria. In fact, over-the-counter diarrheals just make some conditions last longer. Your doc might put you on some other medication to help you get rid of the bugs. But even with medication, sometimes it takes a while to completely clear them from your body. Also, you want to keep your body hydrated. Talk to your doc about the best way to do this. Drinking fruit juice with a pinch of salt and some honey or sugar can sometimes help. And finally, you may have to take a break from your drug use. Recreational drugs can make your health worse and prevent you from making a full and quick recovery.

So, ask potential partners if they've had diarrhea recently. Wash any body part that might have come in contact with shit, before it goes in a mouth. Use a latex barrier if you aren't sure. And always wash your hands before you eat - after all cleanliness is next to godliness.

Stay safe,
Dr. Dick

Abnormally Abstinent: Am I sexually normal?

Dear Dr. Dick:
I think there's something wrong with my sex drive. I like sex and don't have any trouble getting hard, but I just don't get horny when I get high. As soon as my friends shoot up, they pop instant hard-ons. They spend days partying at the bath house or on chat lines. But I don't have any desire to have sex when I'm tweaked. Most of the time I'd rather stay home and do projects or work on my writing. Could it be a psychological problem? What's wrong with me?
Abnormally Abstinent

Dear Abnormally Abstinent,
Thanks for asking one of the most common and perplexing questions for men everywhere - Am I sexually normal? Every man wants to think he's got it all together in the sex department. But in private, most guys are quite anxious. Issues like arousal, performance, and body image can be big worries. Then when crystal's involved, our ideas about what is "normal" sex get tossed right out the window. Before we look at this issue of sexual desire and speed together, let's talk about male sex drive in general.

First of all, there is no "normal" male sex drive. We as men, and gay men at that, feel a lot of pressure to be "hot, hard and ready" all the time. Advertising, porn videos and magazines tell us we're supposed to be obsessed with sex. Maintaining erections. Giving good head. Fucking all the time. "That's just what gay men do." These expectations are cultural stereotypes. But they're really not true for a lot of gay men. Some guys want a lot of sex. Some guys don't. Neither side is right or wrong. It's really an individual preference.

According to most sex experts (and I'm NOT talking about Dr. Laura), you should judge your sexual interest and activity by what feels healthy or "comfortable" for you. If your sex life feels good to you AND it's not causing harm to yourself, your partner or your life in general, then whatever you're doing is OK. Lots of sex is fine. But so is a little sex or none at all.

Your need or desire for sex may increase and decrease on a natural cycle. One month you could care less about sex. The next month you may be hornier than a goat! This is normal. And it's true for gay men, straight men, and women as well. Also, there are many outside factors that can affect your sex drive. Illness, medications (especially some HIV meds and antidepressants), stress, emotions and environment can all dampen your libido. Aging brings about changes as well. Your testosterone levels naturally decrease as you get older.

Butt Licker: Health hazards from rimming (licking butt)

Hey Doc,

I'm a dedicated ass-licker who just got over a hellish case of hepatitis A. I suspect the hep germ came from my favorite pastime--not bad salad dressing. After two weeks of pure misery, I want to make sure this never happens to me again. I'm not going to quit rimming so what can I do? Also, could I get anal warts on my tongue? For that matter, anything else a devoted rimmer needs to know?

Butt-Licker

Dear Butt-Licker,

As you now know, no matter how lovely and mouth-watering the butt in question, it crawls with germs - thousands or millions of them. Most of these germs help balance the gut-to-butt environment. They keep it from dripping, stinking, or hurting. However, some germs, such as E-coli, salmonella, shigella, amoeba, giardia, and cryptosporidiosis (just to name a few), can make you very sick when they get into your body. As you found out, viruses such as hepatitis A are also spread through rimming. However, now that you've gotten that particular bug you should be protected against more hepatitis A in the future.

One of the best ways to protect yourself when rimming is to use a dam (also called a "dental dam"). You get full visuals and heat while he (or she?) gets the full feel of your big hot tongue. A dam is a thin, smooth, and flexible sheet of latex or polyurethane. You can get them flavored or unflavored, colored or clear. Some guys however just prefer to use good old household saran wrap (plastic wrap)--just make sure it's not the microwaveable or colored variety (these have tiny pores in them). A double layer adds extra protection... just to make sure you don't tear through it. Squirting a dab of water-based or silicone-based lube on the butt-side will help it stay in place. You can also "pin" it in place with some deep tongue penetration.

Genital warts (from butts, dicks or pussies) can be found in or around the mouth, on tongues, lips, gums, etc. But they are not common unless you have HIV infection. And even with HIV, they are pretty rare. In my 10 years of working with STD's, I have only seen "oral warts" in about five people. Each of these folks was also dealing with HIV. It appears that a weak immune system can allow genital warts to grow in places like the mouth. As always, people with HIV or other immune system problems need to be especially careful.

Dr. Dick

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