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Selections from The Ins and Outs of Gay Sex


A note from The field of medicine is constantly evolving. As a result, parts of this article may be outdated. Please keep this in mind, and be sure to visit other parts of our site for more recent information!

The Ins and Outs of Gay Sex

From Chapter 4: Non-HIV Viral Sexually Transmitted Diseases

In the AIDS era, most guys are so worried about HIV that they forget about all the other viral sexually transmitted diseases. Although the list is long, the most common viral STDs include herpes, condyloma, and molluscum. (No, it's not something you'd order at a raw bar.) I have included hepatitis in this chapter because within the gay community, this disease is often spread through sexual contact.... [M]ost STDs are far more prevalent than AIDS and don't require ejaculation or even penetration to spread. Viral STDs are no exception, but it gets worse; the condom you so faithfully wear for penetration may not protect you. If your partner has been rubbing his penis against your butt or groin, he can easily pass a virus. You say it couldn't happen because you make him wear a condom even during foreplay. Don't forget about his scrotum, pubic hair, and base of his shaft, areas not covered by the condom. He can carry viruses there and give them to you. And once you catch one of these nasty viruses, you can have it for life.

This doesn't mean you are doomed to a life of pain and unsightly blisters. On the contrary, viral STDs are typified by recurring outbreaks between quiet periods. These viruses hide within your cells, safe from marauding antibodies, white blood cells, and medications.

A virus is the simplest biological form -- a segment of genetic material tightly wrapped inside a protein coat. Unable to reproduce on its own, a virus must invade a living cell to multiply. Once safe inside, the virus commandeers the cell's reproductive machinery and new viruses are made. When a virus is dormant in a cell, its genetic material is still present but idle until it receives some unknown biological stimulus to reproduce again. Then the cells are turned into factories making copies of the virus. New viruses break out of the cells (sometimes but not always destroying the cell in the process) and move to infect other cells -- in your body or in an unsuspecting partner!

Each viral outbreak sends your immune system into overdrive, churning out antibodies and T-cells that attack viruses. Men with AIDS may not have immune systems capable of producing enough T-cells to kill the virus. Fortunately, various medications such as acyclovir (Zovirax) help immune systems by preventing viral reproduction and are available by prescription.

Since there is no simple way to rid yourself of many of the viral STDs, what's a sexually active gay man to do? The answer is simple: Prevent infection in the first place. But prevention is a two-sided responsibility. You must recognize signs of infection in your partner (see below), and you also must recognize your own symptoms. It is much harder to transmit dormant virus, so the quicker you get treated, the less chance there is for you to pass the virus on to an unsuspecting partner.

From Chapter 10: Monogamy or Promiscuity

So you've asked some questions and you've decided that you want to have sex with the guy -- well, not so fast. Any good doctor will tell you that a history is only half of an evaluation; don't forget the physical exam. Surprised by this notion? Why shouldn't you examine any prospective partner before performing the most intimate of acts? When in some exotic new restaurant, you smell your food, look at it closely before tasting that first bite, don't you? So why shouldn't you do the same with a new partner before he winds up in your mouth?

I don't expect you to don a white coat and rubber gloves, but at least give him the once-over with the lights on! Don't make it a clinical examination, make it a hot sexual experience, and keep your eyes open. Be aware of any sores on his penis, and if you see one, ask about it. Don't be embarrassed; you have a right to know what you're exposing yourself to. And don't forget to look in his pubic hair and scrotum, other harbingers of STDs that aren't covered even if he wears a condom. Tiny clustered open sores or blisters can mean herpes, and you might catch it just from jerking off. A larger open wound certainly can be from an overzealous previous conquest, but it may be from syphilis, not teeth. When a partner has penile sores, it's best to limit contact (hands without cuts are usually okay) until you know for sure. Be careful that you don't touch your penis when touching his. Small bumps, especially on the undersurface of his penis, can be hair follicles. Warts tend to be flatter and have broader bases, while follicles look like the goose bumps you get when you're cold. Hair follicles are usually the same color as surrounding skin whereas warts may be either lighter or darker.

If your date seems to have an inordinate amount of pre-cum or if his testicles are tender when you gently rub them, think about the possibility of urethritis, prostatitis, or epididymitis. These are also contagious, but you'll probably be okay if you limit the session to masturbation. Again, don't forget to wash your hands before touching your own body.

I've talked about masturbation quite a bit as being relatively low risk. It is, especially if the masturbation involves two naked guys touching only their own dicks. Even if you do him and he does you, and you both wash your hands after it's all over, you're probably pretty safe and it can be very hot. The minute it goes beyond that with your penis rubbing against his, docking, or rubbing between butt cheeks, your risk rises significantly. And once body cavities are entered, risks climb further. Now I'm not telling you "Don't suck his cock" or "Don't let him suck yours." Just use your brain. If he's got a lot of pre-cum and you're worried or if he's got some sore that might be from his zipper, put a condom over it and you'll probably be fine.

An anus -- whether his or yours -- is the area most at risk for STDS. If you don't know the guy, it may be best to stay away. In any case, the same applies to his anus as it did to his penis -- keep the lights on, your eyes open, and look first.

Don't expect the skin around his anus to be as smooth as what you see on guys in porn magazine or movies. Skin tags or external hemorrhoids are present in about half of all Americans and are easily confused with warts. While hemorrhoids generally arise from the anal opening and extend outward as a continuous piece of flesh, warts are often scattered around the opening. If it's fleshy and more than half an inch from the opening and doesn't look like a pimple, consider it a wart until proven otherwise. If you are worried about catching something from his anus, stay away. If you can't stay away, or even if you are sure that he's clean, always wear a condom. Even if you're just rubbing on the outside and penetration is the farthest thing from your mind, wear a condom. I can't say it enough: Rubbing without penetration or ejaculation is often enough to transmit most STDS. Although a condom is your best protection, it still doesn't cover a man's pubic hair, the base of his shaft, or scrotum, all potential sites for men to carry or catch many STDS.

I've spent time telling you what to look for in him, but don't forget to let him examine you. You're probably thinking that you know you're clean, but don't be so sure. While it certainly is difficult for us to examine our own anuses, it is something a partner can do easily. If he asks you about something, don't be offended. Answer him and remember he has just as much right to protect himself from STD's as you do. He may even be freer to allow your inspection of him if he knows you expect him to do the same to you. Remember, you're probably both afraid of catching something. The fact that he's also cautious makes him a less risky sexual partner.

So how do you make it a sexual experience and not a medical examination? Romantic music certainly helps, massage and other aromatic oils are nice, and so is a lot of kissing while you look. A shower scene is totally hot, and while you're washing his most intimate spots, check him out.

I'm sure you're aware of how your doctor's touch is different from a lover's, but you don't have to touch like a doctor to get similar information. Gently work your hands over his penis and through his pubic hair while looking for little nasties. Even if you see something worrisome, you probably won't catch what he's got from this brief contact if you follow it by thorough hand washing. You can always work on his thighs or lower abdomen (low-risk places that are often quite sensual) with your hands and mouth while conducting your STD inspection. Not only will you whip him into the desired frenzy, but chances are you'll be swept along as well. Don't rush. Take your time pleasuring him in low-risk kinds of ways while completing your survey. Your doctor's exam may take only minutes, but neither of you anticipate an orgasm by the end.

Gay men fear HIV transmission most often during sex, and rightfully so. But sometimes we don't fear it enough. Medical research documents the high frequency of men having unprotected sexual encounters -- including anal sex with ejaculation. What I've tried to do in this text is alert you to the myriad of other STDs as well. I've told you what warning signs to look for in a partner with regard to many other diseases but not HIV. The reason for this is simple. It is often impossible to tell that a prospective partner carries the virus. Sure, we've all seen men in end stages of AIDS, but thankfully that scenario is growing less common as medicine makes great strides in HIV treatment. Temporal wasting (sunken canyons on the sides of his head) and dark-purple blotches from Kaposi's sarcoma are now often the exception instead of the rule. In short, there is no way to tell if a prospective partner has HIV unless he tells you. Given that fact, the best alternative is to be safe. Fortunately, HIV is still fairly difficult to transmit without exchanging semen during anal or possibly oral sex or via shared needles. Using a condom and a little intelligence is often protection enough.

You've checked him out, he's clean, and you embark on a hot sexual experience. Make sure you use condoms. In a recent survey conducted in Philadelphia, almost half of the men who'd had unprotected anal sex did so because the sex was too exciting to bother with condoms. Almost another third gave their partner's refusal to wear one as a reason for unprotected anal sex. Poor excuses. Unroll the condom on him -- that can be hot too. If he refuses, tell him your life isn't worth the risk.

After you have sex, what should you do? Take off your condom and throw it away. Make sure he does the same. Immediately after you've come during anal sex, withdraw holding your condom tight. Any loss of erection loosens the seal and semen can spill out. And after he's ejaculated, don't let him rub his penis against your anus. He'll still discharge semen for a while, and if the head of his penis is against your anus, it can seep inside. This is especially true as more time passes after ejaculation because prostate enzymes work to liquefy his semen, making it far more runny than when it first shot out.

I know it is far more romantic to lie entwined with your partner in a postorgasmic embrace, but if you don't know what he's got, it is probably smarter to excuse yourself and wash off with an antibacterial soap. You have no reason to be embarrassed about trying to protect yourself from an STD, and many can be prevented just by a thorough and immediate washing. You'll do your partner a great service if you drag him along to the bathroom as well. Wash your hands, penis, scrotum, and anus well and don't forget any other area where his cum landed. Towel off and then climb back into bed for postcoital cuddling. You'll sleep a lot more soundly if you know you're clean instead of worrying while his semen drips down your thigh.

You say this guy you're climbing into bed with is a regular fuck buddy and you've got nothing to worry about with him. Wrong! Whether you get together for hot sex once a month or once a week or even once a day (then it's a relationship), you still don't know whom he's slept with in between. Unless you're in a monogamous relationship, there is no excuse for not staying vigilant. You never know when he's going to bring more to your bed than his erection.

What do you do if several days after the most fantastic sexual experience (or even one of your worst) you find yourself staring at a sore on your penis or a ton of pre-cum even when you're not aroused? See your doctor! Don't think it's nothing or try to rationalize it away. Chances are you caught something treatable, and the quicker you see your doctor, the quicker you'll be cured. And just as important, early treatment prevents you from transmitting the STD to someone else. Embarrassment and delay only aggravate your situation and complicates treatment.

From The Ins and Outs of Gay Sex, by Stephen E. Goldstone, M.D. Copyright © 1999 by Stephen E. Goldstone, M.D. Carried by permission of Random House, Inc. For on-line information about other Random House, Inc. books and authors, see Internet Web Site at

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Go to An Interview with Stephen E. Goldstone, M.D.

A note from The field of medicine is constantly evolving. As a result, parts of this article may be outdated. Please keep this in mind, and be sure to visit other parts of our site for more recent information!

This article was provided by Random House, Inc.. It is a part of the publication The Ins and Outs of Gay Sex.
See Also
Quiz: Are You at Risk for HIV?
Ten Common Fears About HIV Transmission
Is HIV the Only Incurable Sexually Transmitted Disease?
The HIV-STD Connection
More on Other STDs


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