Wednesday, July 24, 2013

Dr. Andrea on the Safety of Oral Sex and the Comfort of Anal Sex. For other kinds of sex, you're just gonna have to wing it.

Doing this? You're on your own.
Welcome, possibly troubled Gentle Reader, to today's installment of Ask Dr. Andrea. For you new subscribers (thank you!!!), Dr. Andrea is the IBWMW Doctor-at-Large, which is a good thing because the blog is a bit of a hypochondriac.

Dr. Andrea is a total bad-ass--an osteopath at the Center for Sustainable Medicine, with specialties in women's/sexual health, nutrition and Ayurveda--and I can still scarcely believe this, she's still willing to take our questions.*


HPV is in the news as causing throat cancer in Hollywood stars. Is it a danger to a, say, 57-year-old het? And if they can immunize kids against it, can they immunize adults? Oh, and if they can, why aren’t they offering it? Cost? Liability? We’re already doomed?

Dr. Andrea: Throat cancer is a danger to anyone who's ever had oral sex, including having had a penis in his or her mouth (especially one without a condom on it.). The reason HPV (the kind that, say, likes living on penises) loves the back of the throat, is that there are tonsils there ( = lots of folds and crevices to hide in) and the back of the tongue also has lots of bumps and stuff stuck to it (bad breath bacteria, adenoid/tonsil-like blobs, etc. yum. :/ ) that make for a lovely spot for HVP to stick.

As for immunizing adults- sort of. The vaccine seems to work well for females up to age 25 and males up to age 21. The thing is, once you've been exposed to the viruses, the vaccine we have doesn't seem to do much so it's recommended to be given before the first sexual encounter for best prevention. I wouldn't say we're doomed exactly, but prevention does seem to be our best (only?) weapon at the moment. That and decreasing risk by having fewer number of partners (the risk tends to go up the more you've had), not also having HIV, and using protection (although condoms aren't 100% especially if the skin that has the virus in it is outside the condom). The good news is, despite throat malignancies in general being pretty terrible, spread seems to be slightly rarer with HPV types, and treatment seems to be working as well as it can be expected to, with the usual gnarly side effects, but still not as bad as possible. Sorry for a not Mary-Sunshine answer, but you did ask about throat cancer. :/ [see also: this NYT article]

We are exploring open arrangements. What STIs are men at risk for when performing oral sex on women? (I'm as open to precautions as anyone, but sorry, dental dams are like I'm having oral sex with a love doll. And that I can do at home, alone. I mean, if I did that kind of stuff. )

The simple answer is: all of them. I guess I'm not being very Mary-Sunshine on this one either.  The reality is that beyond monogamy, things get statistically way more risky. I would suggest choosing partners and weighing risks of this idea carefully, discussing it again with your main partner at regular intervals to make sure you're both ok with it, and have full testing done on everyone before you are physically intimate with each new partner. And of course, do a thorough visual inspection of each partner before intercourse. [IBWMW note: I am immaturely picturing one of those miner's caps with a halogen light for said visual inspection.] Complicated, yes, but this is the world we're in- it's not just HIV, HSV, gonorrhea and chlamydia, but even bugs like syphilis are making a huge world tour comeback. Be safe out there!


My husband and I are interested in trying anal sex, but our attempts so far have been much too painful even with copious amounts of lubricant. Fingers are fine, and a tapered dildo smaller than my husband's penis, but any attempts with his penis are excruciating. I've not found any advice that was specific enough to help, just generalities about 'relaxing.' Any ideas?

Honestly, for some people, anal sex is not pleasurable. But it sounds like you've done a great job of trying various versions of it, easing yourself into it, and being creative, so what is the motivation for this if it's not an workable progression that is fun for you both? If the smaller items are pleasurable for you, it could simply be a size issue, which could be worked on (using increasingly larger sizes for a few weeks) along with relaxing breathing exercises to remind your body you are safe and shut down the sympathetics that may be causing reflexive tightening. (p.s. that can work for mild cases of vaginismus or size differences also. Think SLOW- slowly increase dimensions, use very slow movements). Just take it easy as you don't want to stretch yourself permanently or tear anything- pain may be an indicator that that's about to happen.

Aside from general cleaning preparation and lubricant, generally that suffices if it is going to be a pleasure-inducing activity. That said, this next part isn't directed at you necessarily, but in general, the psychological aspects of anal sex can be more pronounced than with vaginal sex (especially for women, in my experience with patients), which can be related to, yes, 'relaxing,' but also deeper sorts of things like vulnerability in general, and letting go completely of control and security to trusting the other partner. My suspicion in this case is that this is a size issue, but looking at your motivations and desire to do it in the first place (when it's excruciatingly painful) might be helpful too- there are many many things to try other than anal sex if it's not doing it for you.

Let me know if you figure out a way to make it happen and it's great--I'd love to hear about that for future patients!

-Dr. Andrea 

Say 'thank you' to Dr. Andrea everybody!  And remember, send questions in a comment below, an email or using the (fully operational!) contact form in the right margin.

Btw, the anal sex question reminded me of a time Sandra and I were pervishly browsing the "sex" section at a book store and saw a book called something like "Anal Sex, Volume 2."  I wish we would have looked inside it because it was a HUGE book. They must have been doing lots of padding to come up with that much anal sex info, perhaps adding pages and pages of anal sex word searches or something.

Now, I am not an anal sex expert (though I am, as I like to brag, an Anal Bleaching Expert) but it seems to me that there is not *that* much to know about the topic. Surely not two volumes worth? Perhaps an anal sex pamphlet could've done the trick. Or, fuck, maybe even just an informative haiku. Which I have thoughtfully provided here. Clip n' save to consult in times of need. 

Anal Sex, A Haiku

Want some anal sex?
Here's what to know: Use lots of 
Lube and go real slow. 


*(Note: This is NOT a substitute for individual medical advice or care. So if Dr. Andrea tells you to stick a rusty tin can up your butt or something, check with your doctor first. Go on, check with them. I dare you.)

(photo courtesy of my beloved Lady Cheeky)


cegluna said...

Lovely haiku.
Dr. Andrea was both informative and entertaining. More please :)

Anonymous said...

So doesn't brushing your teeth and the pre-sex shower (with plenty of soap) eliminate all of those oral sex issues?

Zannie Q. said...

The haiku was spot on. Keep up the good work, people!

Zannie Q. said...

The haiku was spot on. Keep up the good work, people!

Highly sexual woman said...

I recommend a nice glass of wine before anal. Hell, make it two. Also, it has been my experience that while it may take a little coaxing to get a fully erect penis past the "Gate of Sphincter", once inside it can be heavenly. Just like losing your vaginal virginity, the first time with full penetration anal entry can be more painful than subsequent experiences. If all else fails, just wash up and partake in a wee bit 'o anilingus. If that is painful, you're doing it wrong and if it doesn't feel good, you're doing it wrong.

My recommendations in order:
1) cunnilingus
2) glass of wine
3) anilingus
4) another glass of wine
5) more anilingus
6) anal sex (and have a tube of lube handy as back up)

in bed with married women said...

If my HIGHLY EDUCATIONAL haiku didn't answer every one of your questions, this also came in via Facebook from "M":

"With anal sex if you push down and then pull up like you are doing kegels it helps. I suggest you get a butt plug that is a little bigger than you are comfortable with and push past the painful part... know that the pain will stop. He is probably stoping a nano second before because he doesn't want to hurt you...whereas a younger relationship the guy is wanting the anal sex a little more than his willingness to stop the pain so he pushes past that uncomfortable moment..."

in bed with married women said...

cegluna--I know, I love dr. andrea and she is soooo generous with her time.

Zannie Q.--thanks and also thanks. do think of me next time you're taking up the butt.

Highly sexual woman--you are fabulous. if there is anal sex in my future, i will think of you during. thank you, my dear.

Spiffy McBang said...

Hmm. With regards to HPV in the throat, she mentioned tonsils. I wonder, would a lack of tonsils reduce the risk of something getting, er, caught? I also wonder, do HPV vaccines lose effectiveness at certain ages because of the fact people will have most likely been exposed to it, or would even someone who has managed to avoid it receive less of an effect?

If the good doctor does follow-ups, that is.

Anonymous said...

Speaking as woman who has had both good & bad experiences with anal, there are a couple of important details I would add for making it work... The woman needs to be fully stimulated before & during!! Start with cunni (and wine, like the previous commenter mentioned) and then when the time comes (preferably after the woman does) for the man to work on his very slow & gentle entry, the woman should use her own hands to continue her own stimulation. Once you are past the entry point it can become pretty freakin awesome imho.

Anonymous said...

Try anal with the recipient on top, controlling the depth of penetration. Also, bearing down (like you're trying to squeeze one out) at the crucial moment may get you past the hump.

mjs said...

Anal all need to take a different approach.

1. at least 30 minutes of massage of hips, butt and upper thighs. Circles, long strokes, not just hands but forearms. Use compression and alternating bilateral stimulation (left, right,left, right)

2. massage the exterior of the anus wand the gluteal cleft as well as the butt with lots of lubricant. Anal massage involves using gentle pressure at aperture, running side of palm up and down the cleft and turning the outstretched palm into a fist and let the pressure of the fist press on the anal area. Imagine the anus is a clock face and make tiny soft circles at 12, 1, 2, 3 etc with perhaps some intermittent deeper pressure at 12,3,6,9 for instance.

you still have not even entered the anus.

you can take the movement of twiddling your thumbs and "twiddle" the thumbs over/onto the anus.

I can go on. but suffice to say that you can touch other body parts too and use your breath to create other types of stimulus during the massage.

3. after this you can approach entering the anus. slowly use some of the same massage techniques but use them gently and slowly on the interior.

4. After all this exterior and interior massage the anus should be in a totally different state and more receptive to toys and body parts.

drandrea said...

anonymous: sorry but no, brushing your teeth and showering doesn't rid you of viruses or bacteria or stop the viruses from shedding and awaiting pickup by an unsuspecting partner. it ~might~ lower the odds marginally due to exfoliation if you do it afterwards, but there's no evidence that any of that helps at all. think of it this way- soap doesn't wash off syphilis or herpes or warts, right? so... notsomuch.

spiffy: there ~might~ be a ~slightly~ lower risk if you've had your tonsils out, but there are still little crevices and such in the back of your throat and tongue regardless... so i wouldn't count on that being helpful. and the vaccine question- most of the data is statistical, over large populations, so i don't think there's been a study done on older patients that hadn't been exposed ever (and unless they've been entirely abstinent (truthfully abstinent) we'd never be entirely sure) mostly because there aren't very many of those to make it worthwhile for the vaccine companies to bother... :/ they tend to focus on the highest risk groups and the most likely to aim at prevention (so, kids), so they're pretty sure the vaccine doesn't help if you've been exposed and are older, but there isn't much data yet on long term efficacy of the vaccine as it just came out a few years ago, but a booster likely wouldn't work if you were exposed already anyway unless they find a new way to make the vaccine work... eh, messy answer, maybe ask me again in 5 years?? sorry, i got enmeshed in the science corner of my brain ;)

Jean said...

Dr. Andrea is amazing :) The HPV issue does seem to be rising... I guess all we can do is be safe with our partners, those of us old folks over 25 *cough,cough*

I applaud you, Anal Bleaching Expert. And for writing a haiku :) Your blog is always entertaining and informative -- a favorite of mine.