As a versatile gentleman, I enjoy being on the bottom as much as I do being on top. Anal sex can be exhilarating, the perfect concoction of pain and pleasure and along with that pleasure comes the responsibility of maintaining optimal anal health.
We all know about HIV, Gonorrhea, Syphilis, Herpes and several other common STDs, but what about those other infections that homosexual men are more prone to catching?
The anus (opening of the anal canal) functions as eliminator of waste, sexual organ, and intake orifice for treatment (e.g., suppository, enema). It is necessary to care for the anus, anal canal, and rectum if they are involved in sexual activity. Sexually transmitted diseases can be transmitted through anal sex and can affect the anus itself. And anal cancer is associated with STDs in men and women. Damage to the internal and external skin and tissue of the anus jeopardizes health, causes pain, and impairs function.
Recently, infection with a strain of potentially deadly bacteria (called methicillin-resistant Staphylococcus aureus or MRSA) has been reported in men who have sex with men (MSM). These bacteria can cause life-threatening infections that are resistant to antibiotic treatment. Some forms of MRSA live in the anal area and can be passed between sexual partners.
The anus is an orifice, the opening of the anal canal. Just behind it, in the anal canal, lie an exterior sphincter and an interior sphincter. A sphincter is a circular muscle that constricts and expands. Anal sphincters constrict to retain feces and expand to allow it and flatus (gas) to pass during defecation. The anal canal is the first 2 inches of skin after the anus; it is closed while at rest and open during defecation and penetration. It leads to the rectum, the cavity that runs vertically from the end of the colon to the anal canal. The rectum is approximately 5 inches long and 1 1/2 inches wide. It stores feces prior to defecation.
The abundance of nerve endings in the anal region and rectum makes anal sex pleasurable for many women and men. Some men get pleasure from anal penetration that stimulates the prostate gland, which lies between the rectum and the rest of the male reproductive organs.
Anal sexual behaviors include the following:
- Anal stimulation and insertion using the fingers
- Anal stimulation using sex toys (e.g., vibrators, dildos, etc.)
- Oral-to-anal sex, or "rimming"
- Penis-to-anus penetration
- Pleasurable use of enema (introduction of fluid into the rectum)
Anal health should be of great importance to all gay men who take on the role of the bottom. Here are some common medical conditions they should be aware of:
ANAL FISSURE
An anal fissure is a small tear in the skin and tissue of the anus. It can bleed, itch, and become extremely sore, making bowel movement, sitting, and sex painful. Anal sex without lubrication, a hard bowel movement, and inflammation of anal tissue can cause a fissure. Some heal within a couple of weeks, especially if therapeutic cream, warm baths, and stool softeners are used. Others require surgical removal of the tear, which is exacerbated by sphincter movement, and the underlying scar tissue. People with fissures are advised to avoid anal sex. The bleeding that occurs with a tear increases the risk for STDs.
HEMORRHOIDS
Hemorrhoids are lumps that may appear outside the anus or inside the anal canal. They are inflamed enlarged veins that rarely require surgery. Hemorrhoids may be painful or itchy and may also bleed. Risk factors for hemorrhoids include strenuous or frequent bowel movements. Anal sex does not cause hemorrhoids but may exacerbate them. Eating a high fiber diet, taking lukewarm baths (Sitz bath), and using witch hazel to wipe after bowel movements may help.
ANAL CANCER
The risk for anal cancer is a concern for men and women who have anal sex. It can produce malignant tumors inside and outside the anal canal. Many people with early anal cancer have no symptoms. The major risk factor for anal cancer is infection with HPV. Many LGBT practitioners are advising routine anal Pap smears to detect the early changes that might indicate a risk of developing anal cancer. There are no long term studies, but some providers advise that any male with a history of having anal sex should be screened. Also women with cervical dysplasia should be screened. About twice as many HIV-positive men as uninfected men develop anal cancer, so this group is particularly at risk. Although anal cancer accounts for less than 5% of all digestive and intestinal tract cancers, the rate of incidence is rising.
In December 2010, the U.S. Food and Drug Administration (FDA) approved the Gardasil vaccine to reduce the risk for precancerous anal lesions and anal cancer associated with some types of HPV. The vaccine, which also is approved to help prevent cervical cancer and other cancers of the female reproductive tract and genital warts, can reduce anal cancer risk in males and females between the ages of 9 and 26.
PROSTATITIS
Just when you thought you’d heard enough about the prostate... In all seriousness, this condition really is a pain in the ass. “Prostatitis is a bacterial infection of your prostate gland [that] can be either chronic or acute. Chronic prostatitis causes a dull pressure or pain in your rectum or pelvis, or a burning sensation when you urinate or cum. Acute prostatitis is much less subtle. What begins as dull pressure quickly turns into severe pain with chills, high fever, and an enlarged prostate that can block your urine from coming out.” Prostatitis develops when bacteria enter your urethra and pass through to your prostate. A particular risk occurs when two partners share toys that have been inserted into the urethra. Prostatitis can also develop if you ignore a urinary tract infection or urethritis. Early detection means you can most likely be treated with a one-month regimen of antibiotics. More advanced prostatitis may require hospitalization and intravenous treatment.
PERIRECTAL ABSCESS
A perirectal abscess is a bacterial infection that most often begins in the small glands inside your anus. Pain worsens as the infection grows and spreads to areas around your rectum. A cavity filled with pus develops and the skin over it becomes red and swollen. The infection can become so severe that you develop a high fever and other signs of infection.” Most often this is caused by bacteria from a stool getting trapped inside your anal glands, and in rare instances it can be caused by injuries during sex. If caught early, it can be treated with antibiotics and warm soaks; but, if it grows too large, surgery may be required to remove all the pus.
MOLLUSCUM
Molluscum contagiosum is a contagious skin infection caused by a virus. When the molluscum virus lands on your skin during sex or even through close non-sexual contact, it begins to reproduce. Within one to three months, a pin-sized pimple with a crater center appears. You can usually see a white cheesy center under the crater.” The anus is one of the most common points of infection, but it is also found frequently on the inner thighs, groin, genitals, and lower abdomen. People living with HIV may also be at risk for the infection to spread all over the body. Sometimes the infection goes away on its own, but while it persists, it can spread to other parts of the body and other people. There is no known medication to treat molluscum; the most common treatments include burning, freezing, or scraping the lesions. The best way to prevent molluscum is to thoroughly examine your partner before having sex.
GENITAL WARTS (HPV)
According Gayhealth.com, over one half of all men who have sex with men have human papillomavirus, or HPV, the virus that causes genital warts. This number is even higher in HIV-positive men. 90 percent of guys with HIV also have HPV. In fact, HPV is one of the most commonly transmitted sexually transmitted infections (STIs). HPV is spread by direct contact with the skin of someone who is infected, meaning insertive sex is not necessary for transmission. Since the virus can live in the skin on your scrotum, anus, and penis, a condom can’t always protect you from HPV. Your health-care provider will be able to tell by looking deep into your hole whether or not you’ve been infected. Treatment for anal warts can range from topical creams to surgery. There is no way to kill the virus that causes warts. If you’re carrying it and are prone to outbreaks, treatment is a necessary but temporary solution; you’ll most likely see them again. Untreated warts can grow bigger and bigger until they bleed and hurt like crazy. They can even cause anal cancer if left untreated. No matter how bad it is, or how many times it comes back, remember you’re not alone. HPV is very common and very treatable as long as you stay in touch with your health care provider and follow his or her treatment advice.
FISTULA
Oh my God, run! It’s Dracula’s kinky cousin and he’s carrying Crisco and a glove! Whoops, made you look. Seriously: “A fistula-in-ano is a small, abnormal tube that connects the inside of your rectum with the outside skin. Occasionally you can have more than one opening. It is often infected and pus and blood can drain out. The drainage is often minimal and you may only notice a stain in your underwear.” Most often you notice this as a pimple, although sometimes it can be accompanied by some pain and swelling. Bursting the pimple can relieve the condition until it starts over again. The fistula is caused by an infection in the glands of your anus, often when a piece of stool gets caught in the glands. “If the infection doesn't go away on its own, it can burrow through the tissues around your anus until it bursts through the outer skin. If the infection is very severe or if it doesn't burst through the skin you can end up with a peri-rectal abscess.” In the short term, you can treat the condition by soaking in a warm bath to loosen up the head and facilitate drainage; in the long run, surgery is needed to clear out the infection and allow the tissue to heal. For those of you prone to vanity, relax. Even though surgery may create a sizeable wound, it usually heals without scarring.
MAINTAINING ANAL HEALTH
Lubrication, cleanliness, and condoms reduce the chance of tearing and minimize the risk of transmitting disease during anal sex. The anus does not produce lubrication; it must be applied. Anal skin and tissue is likely to tear when it is dry, so lubrication is important before penetration. Lubricant should be water based or "condom or latex friendly," not oil based. Oil based lubricants destroy latex condoms.
Washing the anal region before and after anal sex reduces the amount of bacteria that could be spread from partner to partner, but may also remove some of the natural protection the body has to infection. Condoms can help prevent the spread of STDs when worn prior to any contact. Oral-to-anal contact is safest when using a dental dam, a flat, sheet like condom that provides a barrier between the mouth or fingers and the anus.
Overuse of enemas can destroy the normal, healthy balance of bacteria in the lower intestine.
Lubricants that contain nonoxonyl-9 (N9) spermicide should be avoided. Recent data suggests that N9 may actually increase the risk for transmission of HIV.
A healthy diet can also play a crucial role in maintaining anal health.
Broccoli is the number one vegetable for disease and cancer prevention. Raw broccoli contains two of the most powerful anti-cancerous agents in nature, diinodylmethane and sulforaphane. The combined action of these two chemicals can effectively suppress tumor growth in even the more aggressive types of cancers. Lightly cooked broccoli is also beneficial to your colon health. One cup of lightly cooked broccoli can give you more than 150% of your recommended daily intake (RDI) of vitamin C and 20% RDI of dietary fiber. It is also an excellent source of vitamins A, E and K as well as folate, which are all critical to your digestive functions and immunity.
Sweet potatoes are very effective for relieving constipation and irritable bowels, and they are considered a superfood for colon cancer prevention. Sweet potatoes are a rich source of complex carbohydrates, dietary fiber and antioxidant vitamins and minerals like beta carotene, vitamin C and E, pantothenic acid and manganese. High intake of these nutrients can speed up the movement of your bowels, reduce your colon’s exposure to toxins, and thus lower the likelihood of intestinal cell mutation. In addition, sweet potatoes also contain significantly amount of phytosterols, which is another key defense against colon cancer.
Eating yogurt each day is the best thing you can do for your intestinal health. The probiotic bacteria in yogurt balances your resident flora, and prevents the colonization of potential pathogens. Yogurt also accelerates your bowel movement, and those that contain extra fiber are especially notable for promoting fast waste elimination. Yogurt is also the best source for easily absorbable calcium and vitamin D. Deficiency of these two nutrients can elevate your risk of colon cancer. The byproducts of yogurt digestion increase your colon acidity and create an inhibitory shield against polyps and tumor formation.
Tuna contains tremendous amount of selenium. A 3-ounce tuna fillet gives you nearly 60% RDI of selenium. Eating tuna also supplies you with significant amounts of essential omega-3 and omega-6 fatty acids. These good fats are not only important for your heart health, they are also important to cancer prevention.
It's your anus. Take care of it!
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