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.*

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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!

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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 

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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. 

xoxoxo
jill

*(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)

Guest Post: "Demystifying Cunnilingus" by The Barreness

Today we bring you a lesson in the art of pleasuring a female orally. Or, as it is more formally called, "cunnilingus." (Though it is Most Certainly Not called cunnilingus by anyone I know--even at the most formal of occasions. Cunnilingus is a displeasing word, made all the more displeasing by the prominent "ling" sound right there in the middle of the word, forcing anyone who says it aloud into making an involuntary suggestive flick of the tongue.)

Our instructor in the art of, well, you know, is a lively, sassy Brit, The Barreness, who writes the equally lively and sassy blog Hello, Sailor.  I urge you, using my highest possible words of urging, to check it out immediately. At the very least read Meet the Barreness, an intro to the Barreness worldview. But you're here for cunnilingus talk. Let us cede to the Barreness:

Greetings Chaps and Chapesses.
As you might have guessed, today's topic is an educational one, its necessity brought into rather glaring focus for me throughout the recent audition process.

As it turns out, despite machinations and unsubstantiated claims to the contrary, nearly every man I meet, infuriatingly  most men  lots of men are absolutely bloody clueless about how to give good head.