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

The Ins and Outs of Gay Sex The Body recently met with Dr. Stephen Goldstone, author of a new book, The Ins and Outs of Gay Sex, a medical handbook for gay men. Dr. Goldstone specializes in ano/rectal disorders and, in his medical practice, he sees a large number of gay men. Throughout his years in practice he has noticed too many men taking risks, so he uses the time he has with every patient to teach about safe sexual practice and sexually transmitted diseases. Some patients are shocked by his frank discussions of topics usually kept "in the closet" by most doctors. But when he noticed how many in his New York practice were ignorant about basic facts concerning sexually transmitted diseases, he decided to write a book. It's an eye-opening, astonishingly detailed book covering a wide spectrum of gay medical concerns -- including his recommendation concerning anal pap smears. In his book he answers all types of interesting questions, such as:

How do you put a condom on over penile jewelery? (Condoms must be a little larger -- avoid ultra sheer styles which break easily.)
If you are itching like crazy and think you have crabs, can you delouse yourself at home with over-the-counter medications? (Yes.)
Can a doctor tell from a simple exam that you've had anal sex? (No.)
Can sexually transmitted diseases be spread without penetration? (Yes.)

What made you want to write a book about gay sex?

Each day in my office I meet men with questions they have carried around for too long, either because they were afraid to ask or because no physician could answer them. I searched bookstores for a book to recommend but found none that dealt with gay sexual practices from a medical standpoint. Plenty of books detail "how to" but I wanted to write a "what if" to answer my patients questions. My hope is that this book will fill a void in the gay community.

Do you find most of your patients knowledgeable about sexually transmitted diseases?

Unfortunately not. Most don't realize how many other STDs (sexually transmitted diseases) are lurking out there besides HIV, how easy they are to catch and how impossible some of them are to cure.

What do you think blocks gay men from having safer sex?

Drugs are the biggest barrier to safe sex. Your high keeps you from focusing on safety and instead you only think about getting off. Gay men have also been listening to healthcare workers and activists preach safe sex for over a decade, and like background music, they are no longer hearing the warnings.

Why do you think that barebacking -- or having unprotected sex -- is on the rise among gay men?

I think that some gay men are tiring of safe sex practices -- especially now that men are living long productive lives because of improved HIV treatment. It lulls them into a false sense of security with the idea that even if they catch the virus, it won't kill them. Young people also have not witnessed so many of their peers dying from AIDS as my generation did.

What STDs do you see most frequently in your office?

HIV, herpes and venereal warts.

What do you think is the biggest mistake gay men make concerning their sexual health?

They ignore their risks for catching STDs and then put off seeking treatment for fear that it will lead to instant outing.

Do you think that using antibacterial soap immediately after sex will help stop the transmission of STDs?

Antibacterial soaps can kill many infections while the bacteria or virus is still on your skin and hasn't had time to invade your body. Wash up quickly and thoroughly after sex.

Do you think a sexually active gay man should see a gay doctor? If so, what's the best way to go about finding a good doctor?

Your doctor does not have to be gay, but he or she must be gay friendly. You have to feel comfortable talking about any issues that might impact on your health -- especially your sexual practices. If you can't talk openly about your sexuality, then find another doctor. Ask friends for a recommendation. If their experiences were good, chances are yours will be too. Gay switchboards also often maintain a physical listing as does the Gay and Lesbian Medical Association (based in San Francisco).

What question do your patients most frequently ask you?

How did I catch this when I used condoms?

How can you have safe sex if you are allergic to latex condoms?

That's a real problem. Try different brands because you may find ones that are less irritating than others. Also be sure that your problem is an allergy and not just irritation from poor fit or too much friction. In addition, the real problem is sometimes an allergy to the spermicide (Nonoxynol-9) contained in most spermicidal lubricants. Before you give up latex condoms, try using a latex condom with a water-based lubricant that doesn't contain any spermicide. If you still think you have an allergy to latex, try Avanti condoms made of plastic. They are very thin, and can be used with oil-based lubes. But be really careful with the Avanti condoms -- they tend to slip off and may have a higher breakage rate than latex condoms.

What's the safest way to give oral sex?

Put a condom on your partner's penis.

Why is anal cancer on the rise?

Human papilloma virus infections, which cause anal cancer, are increasing and men with HIV are at greatest risk. With better HIV treatment these men are living longer and the cancers have time to develop.

I hear that you recommend pap smears for HIV negative and HIV positive gay men. Could you explain what this is?

Pap smear is a small dacron swab that is inserted into a man's anus and twirled around. It doesn't hurt. The swab is then smeared on a slide and sent to a lab so the anal cells can be studied for signs of cancer. It is important because more than 90% of HIV positive men are carrying the human papillomavirus which causes cervical cancer in women and anal cancer in men. If you can catch it before it becomes a full blown cancer with a pap smear then the treatment is simple.

Is hepatitis prevalant among gay men? If so, do you recommend all gay men get vaccinated?

Hepatitis is very prevalent amongst gay men and all should be vaccinated against both hepatitis A and hepatitis B.

We are pleased to feature an excerpt from Dr. Goldstone's new book, The Ins and Outs of Gay Sex. You also may take a look at the listing.