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Q & A

Welcome to the Q&A’s page, where you will find questions asked by visitors to M2M and answers given by Dr Dick. You may find some of these Q&A’s useful, so read on.

General (7)

Dr Dick’s response:

Having a ‘pornstar’ as a partner is the stuff of many a gay man’s fantasy! Perhaps try the following:

  • Purchase yourself a butt-plug. Preferably one that is large. The design of the butt-plug is such that your anus gradually widens the deeper you insert the butt-plug into your anus. In this way you should become accustomed to ‘large’ objects. Try 6 reps a day for at least two weeks. You can practice inserting it yourself or you can introduce it as a form of fore-play with your fiancé.
  • Try to reframe the sexual encounter. Gay men often put a lot of pressure on themselves and their sexual partners to perform anal sex. This is because anal sex has become synonymous with gay sex. Most gay men see anal sex as the only valid form of ‘real sex’ between men and therefore place a great deal of pressure on themselves and their sexual partners, directly and indirectly. So perhaps a suggestion could be to remove your focus off anal sex for a short period and agree instead to focus on other, equally exciting ways to experience desire and pleasure with one another. I am reminded here of a case I heard about where a guy had a particular fetish for being f*cked in the arm pit. It may sound bizarre for many but at least he was able to find alternative ways to experience pleasure. Thigh sex, which is very popular amongst straight adolescents, is another option. Be creative and have fun while you’re at it.
  • It will only work if you really want it to. This may be a bit of an unsettling idea, but we need to explore all the alternatives. There is the idea that he can’t enter you because you are feeling conflicted about something: perhaps anxiety, perhaps fear, or perhaps anger. Try and think (and hold back the laughter for just a moment) what his ‘huge’ penis may represent or mean for you? How does it make you feel? Now, how would you feel having it inside you? What could that mean? What are you achieving by not having him enter you? Does he use protection? These questions might sound strange but might be helpful to consider. Those in the know maintain that if you really want it (him inside you) then it will.

Dr Dick’s response: It seems that your current difficulty might be caused by psychological factors. However, always clarify possible biological factors with a medical doctor. Sometimes, being nervous, tired or not sufficiently horny, you may find that you lose your erection while engaging in foreplay or once one starts anal sex. This may happen to a person who is just starting as a top or even to someone with lots of sexual experience. If this happens, take a deep breath, remove all pressure to perform, and consider continuing foreplay / other sexual play a bit more before attempting anal sex again. Experts believe that psychological factors such as stress, anxiety, guilt, depression, low self-esteem, and fear of sexual failure cause 10 to 20% of inability to maintain an erection. I cannot say for certain that your difficulty is due to psychological factors as a full assessment needs to be done. I can however recommend that you visit a psychologist / counsellor to discuss your concerns and receive guidance. They can also provide you with guidance on sexual health and anal sex. Always remember to play safe and use condoms and water-based lubricant, especially during anal sex. Condoms, if used correctly and consistently, can reduce your risk of contracting HIV and STIs by up to 85% and offers protection during oral and anal sex. Using lube makes sex smoother (because it decreases friction) and gives you added protection. Regarding your sensitivity to hygiene issues, don’t be too concerned. Anal hygiene and hygiene in general is an important factor. You are welcome to read through the anal hygiene section on the men2men website.

Dr Dick’s response: First, let’s look at information regarding penis size to clarify your concern that your penis might be very small. The length of a non-erect penis usually measures between 8.5cm and 10.5cm (3-4 inches) from tip to base. The average length is about 9.5cm (3.75 inches). Many factors can cause a temporary shrinkage of two inches or more, for instance cold weather or going swimming, so you needn’t worry if you happen to fall short of the average figure. Interestingly, most penises are very much the same size when erect. A guy whose non-erect penis is smallish will usually achieve about a 100 % increase in length during sexual excitement. A guy whose non-erect penis is already quite large will probably manage about a 75 % increase. This means the great majority of penises measure between 15cm and 18cm (6-7 inches) when erect, with the average figure being about 16.5cm (6.5 inches). The average width of a flaccid penis is 3.1cm (1.25 inches) and 4cm (1.6 inches) when erect.

Medical articles and research shows that it is quite difficult to enlarge penis size. You could try a “penis pump” which is said to also enhance sexual performance, but conflicting debates exist whether it really increases penis size. User instructions need to be followed carefully as the penis pump might cause damage to the penis (burst blood veins).

Dr Dick’s response: No, the fact that you enjoy looking at naked men and that you have had sexual experiences with men previously does not necessarily mean that you are gay or bisexual. I would like to normalise your possible anxiety in this regard by telling you that you are not alone. Research has shown that there are many men who are in heterosexual relationships who has / has had sexual experiences with other men. Literature distinguishes the following:

a) Sex: Whether a person is a male bodied or female bodied person (biological traits)
b) Gender: Traditional masculine and feminine roles which were constructed by society (masculinity vs. femininity)
c) Sexual orientation: Whether a person is heterosexual, homosexual (lesbian or gay) or bisexual. It is much more than just a sexual attraction. Sexual orientation also includes various other levels of attraction, including amongst others, emotional, spiritual, psychological, intellectual etc. Sexual orientation refers to “who you want to build a life with”.
d) Sexual play: Refers to sexual experiences of an individual – not dependant on the person’s sexual orientation. This means that a heterosexual man might enjoy sexual experiences with other men for whichever reason – this does not mean that he is gay or bisexual. A heterosexual woman might also engage in sexual activity with other women from time to time – this does not imply that she is lesbian or bisexual. Your sexual orientation does not determine who you have sex with. People have sex for various reasons.

It is difficult to give you a direct answer. Sexual orientation is a wonderful journey of discovery for an individual. It might be beneficial to approach a sensitised and affirmative mental health professional who can provide guidance while you discover your own sexual orientation. Also remember to always “play safe” by using condoms and water-based lubrication and other barrier methods to reduce the risk of STI transmission.

Dr Dick’s response: You are still young and developing your identity as a young male. As humans, we cannot always predict and control whom we get attracted to or who we find attractive. Attraction is not linked to our sexual orientation. Some straight men might find other men attractive even though they are not gay. Some straight women might find another woman attractive even though she is not lesbian. There is nothing wrong with finding your straight friends attractive and fantasising about them – you are appreciating their beauty. The most important thing is to have mutual respect for each other and not to invade each other’s privacy and personal boundaries. Sometimes it remains only a fantasy and no other action will follow and we have to respect that.

Dr Dick’s response: I believe that one has to be “ready” before disclosing something that is of such importance. When it still feels as if the words get stuck in one’s throat, it probably means that one is not “ready” yet to disclose. Why it is important to be ready, is because one projects one’s own feelings onto the person that one discloses to, and that person then reacts to the disclosure with those exact same feelings. For example: should you go to your parents to tell them, but you go with fear and shame, they will pick up on your fear and shame, and may react with that same fear and shame. But when you are ready to disclose with confidence, they will pick up on your confidence, and chances are that they will react then with that same confidence. I hope this makes sense…

Suggestion: Why don’t you wait just a little longer before telling your parents, and first work on your own fear and finding the courage to do so? In the meantime, take a deep breath and relax about the whole issue. After all, you know that you are going to tell your parents at some stage. It just doesn’t have to be today, or even tomorrow. Lift the pressure to tell them now from your shoulders, and you will see that things will start to appear a bit more clearly.

Dr Dick’s response: The fact that you are seeking help indicates that you have intuitively felt that something needs to be done. It appears your biggest enemy at this stage is isolation. And the driver of that isolation is fear. I guess the question is: How long will you allow fear to dominate and dictate your life? When is enough enough?

Your first responsibility in life is towards yourself. You need to take control of and responsibility for your life, your decisions, and your actions. As long as you live in fear, you project that fear, and people respond to that fear by making you feel inferior or rejecting you. It makes sense: what you think of and about yourself, other people will also think of and about you. You need to become your own best friend first and be happy within yourself. Only then will people respond positively to you. You need to make some decisions that will be good for you, and take action. Nothing will happen if you do nothing, and happiness will not find you if you hide from everything and everyone.

You need to take that step to get out of the house as well, not to find a partner, but to start enjoying life and making friends. I know everyone looks for that special someone, but we all need friends first. And when we are happy with whom we are, our happiness will attract that special person. I know all of this is easier said than done, but nobody can do these things for you. Only you can do it – and you can!

Questions you can consider:
• Who is Jason (strengths and weaknesses)?
• What makes you happy?
• What are your interests? Anything you can pursue as something to do with your time, something that will make you feel happier…
• What do you want in life (not just a life-partner)? Do you want it badly enough to do something about it?
• What are the steps needed to get what you want?

Remember: baby steps! It doesn’t happen all at once. Most of the time it takes a while before we see results. You need to do the work.

Living Positively (3)

Dr Dick’s response:

Being a discordant couple does not mean that the relationship is doomed. There are a lot of very happy and ‘safe’ discordant couples out there. I usually tell people to find creative ways to keep each other fulfilled and safe. Oral sex is considered a low risk activity, but there is some risk nonetheless because of

  • the presence of pre-cum (which has been found to contain small traces of HIV);
  • the possibility of microscopic tears in your mouth (on your gums, between your teeth, under your tongue, at the back of your throat, or on the inside of your cheeks – which can act as an invitation for the infection to enter into your body); and
  • the unpredictability of reaching orgasm (he may just cum without warning giving you little time to withdraw his penis from your mouth).

The decision is yours, but I would suggest using flavoured condoms or flavoured dental dams – which can be a lot of fun. Obviously anal intercourse carries a higher degree of risk. If your partner is a top and you a bottom, be sure that condoms are used correctly and consistently and that a water-based lube is used in order to minimise friction and breakage. And if he were to cut himself somehow I would suggest that without making too much of a fuss, minimise direct contact with that area or his blood. Keep gloves, disinfectant, plasters, bandages etc nearby just for in case. It is all about learning the facts, allaying your anxiety, and enjoying each other.

Dr Dick’s response: There are a few ways in which you can stay healthy. These include regular exercise, healthy eating and following a protein-rich diet and supplementing your daily nutrition by taking a multi-vitamin. Try to avoid social habits such as drinking alcohol, smoking and using other substances.

Dr Dick’s response: It is very important to take your medication at the same time intervals every day. One can be creative in finding ways to remind you to take your medication. Some of these include: setting reminders on your phone and setting your alarm clock, keeping sticky notes where you can see them (but not necessarily others) and creating a routine for yourself.

Sexual Health and Safety (9)

Dr Dick’s response

The main function of the rectum is to act as a passageway for faeces. Faeces are not normally stored in the rectum unless you are about to have a bowel movement. However, small amounts may remain in the rectum in between movements. There is also the risk of transmitting Hepatitis B if in contact with an infected partner.

If you are wanting to douche (squirt water in the anus using an enema bottle) then be sure to use a vinegar mixture (half a teaspoon of vinegar with 500ml luke warm water) and not a betadine douche. The betadine douche has been found to disrupt the mucosal barrier of the rectum and thus increase the risk of HIV infection. Be sure not to douche too frequently and also be sure to lie on your side when douching as this will reduce the likelihood of any injury. It is also through injury that one’s risk of HIV transmission increases.

Other helpful tips include:

  • Ensure that you use condoms correctly and consistently with plenty of water-based lube when engaging in anal intercourse;
  • When rimming be sure to use either a dental dam/ non-microwavable cling wrap/ a cut open condom;
  • Purchase and use sterile wet wipes to use at the point of anal play;
  • Before and after anal intercourse be sure to clean the insertive partner’s penis and the receptive partner’s anus thoroughly (not vigorously); and
  • Rimming should be avoided if you have a cut or sore in your mouth or gums.

Dr Dick’s response
To answer your question I need to tackle this from different sides:

  • Learn about the shape of your rectum. The depth of anus is not that straight forward. It is not as simple as saying 15cm because the whole alimentary canal consists of (in a southerly direction) rectum, anal canal, and then the anus. The rectum is not straight, after the short anal canal, the rectum tilts (sometimes as much as 90 degrees) toward the front of the body. Then, after a few centimetres, it curves towards the front of the body again. A useful tip here is to learn about the shape of your rectum by gently inserting your finger or a soft object (make sure that it is a safe object, like a dildo with a flared base – having a flared base will help to ensure that the dildo does not slip completely inside your rectum should you lose your grip) into your anus, and then explore your rectum by probing in different angles. Concentrate on how this feels. By exploring yourself, you will gain firsthand knowledge about what feels ok and what is not. For example, depending on the direction of the penis in the anus, shorter or deeper penetrations may be acceptable. As such, penetrating deeply in a direction towards the back of the body or straight up might not be advisable, given the shape of the rectum.
  • It is all in the technique. Many gay men think that pleasure is derived from hard thrusts or deep penetrations. But this is not necessarily true. The anal region and rectum has an abundance of nerve endings, with the highest concentration at the opening of the anus (a pleasure point). Thereafter, the anus responds mostly to feelings of pressure or fullness. Putting pressure on the ventral wall (towards the front of the body), a few centimetres in, will stimulate the prostate gland (a walnut shaped gland situated behind the pubic bone). Try to locate this spot by gently inserting your finger into your anus and then point your finger towards the front of your body. If stimulated, it should intensify your pleasure when climaxing. Thus, most of your pleasure will be derived from the opening of the anus and the prostate gland, which does not require any full thrusts or deep penetration.
  • Know about the risks. The main function of the rectum is to act as a passageway for faeces. Faeces is not normally stored in the rectum unless you are about to have a bowel movement. However, small amounts may be remain in the rectum in between movements. It is for this reason that it is recommended that we use condoms during anal intercourse (to minimise the risk of getting Hepatitis B for example). In addition, the lining in the rectum is very thin, not very elasticated, and can rip very easily. It is therefore VERY IMPORTANT that you 1) always practise safer sex using condoms correctly and consistently, and 2) limit the amount of stress placed on the rectum by taking it easy, cutting your fingernails short, and using plenty of water-based lubrication. Reckless or rough anal sex may result in serious damage: a tear in the lining of the rectum or an anal fissure. After repeated damage, the risk of fecal incontinence becomes significant.

Dr Dick’s response: It is difficult to tell if someone you had sex with had any infections. You might have been exposed to infections if the condom broke. To be on the safe side and to put your mind at ease, I would recommend that you visit your doctor / clinic for a STI / HIV screening. Your sex partner should preferably do the same. PEP is also available. PEP stands for Post Exposure Prophylaxis and consists of a course of medication begun within 72 hours of the sexual encounter that will, in most cases, stop the virus in its tracks before it can take hold in the body. PEP does not provide protection against other sexually transmitted infections. Always use a condom-compatible lubricant with a condom when practicing penetrative sex. It will make penetration easier and lessen the risk of the condom breaking.

Dr Dick’s response: There could be various causes to the sensitivity you experience in your testicles. It would be best to consult with a doctor who could then refer you to a urologist. It is always important to seek medical advice for matters regarding testicular health.

Dr Dick’s response: It is not recommended that you use condoms with an oil-based lubricant as this can lead to the condom tearing or bursting. Instead, use water based lubrication with condoms. In this case, if the condom was intact and there were no leaks or breakages then your risk of contracting HIV is slim to none. HIV is only spread once bodily fluids are exchanged from one person to the other. Whether it is through blood, semen or vaginal fluids. If no ejaculation was passed on to you from your partner to you then there is nothing to worry about.

Dr Dick’s response: Basically everybody has a “tight” anus, since we are not born with an anus that’s “ready for action”. That means that one has to be “prepared” first before being penetrated, and especially so when it happens for the first time. The best way to be “prepared”, is when your partner uses his finger to first stimulate the anus to relax it a little and slowly begin to enter his finger into your anus.

Use a lot of water-based lube in the process. I would suggest that that could be enough for the very first time, and slowly work your way towards being penetrated by your partner’s penis the second or even third time you attempt being penetrated. It may be a little painful when being penetrated, especially the very first time.

The key is to take it very slowly. Enter the penis slowly and just a little (tip of the penis) at first, until you feel comfortable and then continue a little further. Should you feel too uncomfortable and it is too painful, rather stop, and try again another time. Be aware that a percentage of men have a condition that causes the anus not to be able to “open” up for penetration.

Haemorrhoids can be caused by penetration, but more damage can be done if you are not careful and you do not take it slowly. This, however, is usually because of rough sex where people are not taking it slowly and carefully. If your partner’s is very thick, you could rather try with a dildo first.

The saying goes: Age is but a number. If the age difference doesn’t bother the two of you, then it should be fine.

Dr Dick’s response: It is very difficult for me to tell you exactly what the problem is if I haven’t examined you. There are however some possible options that we could be dealing with here. The discharge might be due to a sexually transmitted infection (STI). Gonorrhoea, chlamydia and prostatitis can cause you to have a discharge anally. You will need antibiotics to treat all of the above infections if you have one of them as soon as possible.

The other option is that because of the anal sex, your rectum might have stretched a bit too much and did not fully recover. This caused your anal and rectal muscles to not contract properly and faecal matter could leak out and cause the slimy discharge. Unfortunately, whatever the reason behind your condition, you are going to have to bite the bullet and consult with a health care professional.

You may want to contact OUT’s gay-friendly clinic if you are in the Pretoria / Gauteng area (click here). Or you may want to have a look at other gay-friendly clinics around South Africa, which you can find here.

Dr Dick’s response: It is very natural for some guys to have premature ejaculation when they start having sex. It will get better with time. Have a look at this article and see if it will help: http://www.everydayhealth.com/sexual-health/dr-laura-berman-tips-to-help-stop-premature-ejaculation.aspx

Dr Dick’s response: It usually takes about four weeks after the fissure has healed before you can have anal sex again. Because the anal wall has been torn once, you may have a weak spot in that area for a while until the soft tissue has been completely healed and strengthened. I would suggest that you don’t engage in any form of anal activities for at least four weeks from today. Give it time to heal properly. And then take it gently. If the problem persists, consult with your general practitioner.

You may want to contact OUT’s gay-friendly clinic if you are in the Pretoria / Gauteng area (click here). Or you may want to have a look at other gay-friendly clinics around South Africa, which you can find here.

STI's and HIV/AIDS (6)

Dr Dick’s response: There is some risk to masturbating your friend. Be aware of any open wounds on your hands, fingers and penis – HIV can be found in bodily fluids including semen (sperm) and can be transmitted through wounds, sores, and openings. An idea is for you and your friend to have a regular HIV test (every 3 to 6 months) and a STI screening to make sure that both of you are safe and enjoy masturbating together without being worried.

Dr Dick’s response: The highest risk for transmission is penetrative anal sex without a condom with ejaculation. Even though he did not ejaculate, there might still be some risk as HIV is transmitted through bodily fluids such as blood and semen. You might have exposed yourself to other sexually transmitted infections. I would recommend you visit your nearest health facility for an HIV and STI screening.

Dr Dick’s response: If you choose not to use a condom, minimise your risk in the following ways:

  • If you are concerned that you might have been exposed to HIV, PEP (Post Exposure Prophylaxis) is an option (PEP is a course of anti-retro-viral medication that is taken within 72 hours after you were potentially exposed to the HI virus to reduce your risk of HIV infection). PEP does have side-effects and is not fool proof form of HIV prevention.
  • Remember to use lots of water-based lubrication.
  • If the penetrative partner is positive pull out before ejaculating – this may help reduce the risk of infecting the receptive partner – and consider less rough sex to limit tearing inside the receptive partner. If the receptive partner is positive s/he could ensure s/he is well lubricated, asks the penetrative partner to go slowly at first to minimise tearing or breaks in skin, and limits the duration (time) and intensity (roughness) of the sex.
  • A lower number of sex partners might reduce your risk.
  • Try to limit your use of drugs and alcohol during sex so that you are more in control.
  • If you engage in very high risk sexual activities and you are HIV negative, speak to your doctor about the appropriateness of PrEP (Pre-exposure prophylaxis in the form of an ARV).

Dr Dick’s response: HIV is spread through body fluids, mainly semen, vaginal secretions and blood. Your risk of contracting HIV from any of those fluids is a possibility if they are present during oral sex. Note that even though oral sex is low risk for HIV transmission (in the absence of semen, vaginal secretions and blood), other sexually transmitted infections (STIs) could be transmitted. Condoms remain a method of prevention.

Dr Dick’s response: I assume that you mean both you and your partner are HIV negative. As long as both of you remain HIV negative, and you both remain monogamous (neither one of you cheats and has sex with anyone else, except with each other), you cannot become HIV positive. However, the safest option will be for both of you to get tested every three to six months, as we do not have any guarantees that our partners will always be faithful.

Dr Dick’s response: It is very difficult to tell you exactly what the problem could be if I haven’t examined you. I would suggest that you consult with another doctor to get a second opinion. There are numerous things that could be causing the pain you are experiencing. A full STI screening would have to be done and we have to rule out that you don’t have any urethral defect or most importantly a problem with your sperm duct. An infection could also cause you to have that sharp pain when you ejaculate. The best possible doctor for you to consult with regarding this matter would be an urologist.

You may want to contact OUT’s gay-friendly clinic if you are in the Pretoria / Gauteng area (click here). Or you may want to have a look at other gay-friendly clinics around South Africa, which you can find here.

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