Sugar Talk: Anal sex advice and a PrEP explainer

This week, let’s get right into some questions.

“My boyfriend wants to have anal sex. I’ve tried it with my past boyfriend and it really hurt. Is there a way to reduce the pain? I’d really like to give my boyfriend this experience.”

Anal sex should never, ever hurt. Pain is our body’s way of telling us that something isn’t right. It’s a warning system that prevents us from really hurting ourselves. So listen to your body and slow down. Getting to place where a body is ready to receive anal penetration can take time. To get ready for penetration, you need to relax. For penetration to be comfortable, those muscles need to relax. When the muscles in your anus are relaxed, penetration can be not just comfortable, but mind-glowingly delightful. Start out with analingus (rimming), massage with lube, or vibration around the outside of the anus. When you feel like you’re ready for a little penetration, tell your partner. Have your partner use a well lubricated finger or a small butt plug. The person receiving the penetration is the person in charge of how much, how fast, how deep. If something starts to hurt, slow down.

Don’t go into it thinking that you’re going to go from a little vibration outside the butt to full on anal intercourse in one session. This is something that may take days, weeks, or frankly never. Anal sex can be utterly fantastic. And no matter how educated and caring a partner is, some folks just don’t like it. That’s totally OK. You don’t have to like everything. One of the best things about giving or receiving anal sex is that it’s totally not gender dependent. Everyone has a butt. And anyone can celebrate their butt. In fact, the clitoris has more nerve endings than anywhere on the human body, followed by the anus, then the penis (new information is coming out that indicates it’s possible an uncircumcised penis may have almost as many nerve endings as the clitoris). So, if you have a penis, you should definitely experiment with exploring your butt. Enjoying anal sex is a process—it takes time. Be patient and enjoy the journey and if you’re looking for more info, check out these books: Tristan Taormino’s “Guide to Anal Sex for Women” (which has great advice for people of all genders) and Jack Morin’s “Anal Pleasure and Health.”

I’ve been hearing about PrEP. What the heck is that?

PrEP is AMAZING. It’s the first major breakthrough we’ve made in HIV prevention in decades. We’ve come a long way in our fight against HIV, the virus that causes AIDS. With ongoing treatment, many people are able to live long, healthy lives with HIV. Currently there are around ONE million people living with HIV in the United States. Unfortunately, in the past several years, we have seen an increase in HIV infections, especially among men who have sex with men, and even more among African-American men who have sex with men. While folks who have ongoing treatment can live healthy lives, treatment involves a decent amount of medication and following up with doctors. In Maryland, we have good systems in place to support folks living with HIV and it’s rare for someone to not be able to afford or access treatment. Unfortunately, that’s not true for people in many other states.

Previously, we had four main ways of preventing HIV: abstinence, condoms, needle exchange programs, and testing and treatment. All of those methods require people to change their behavior. Sometimes, people don’t want to change their behavior. Sometimes, for a million different reasons, they just can’t use a condom every time they have sex. And that is putting them at higher risk for HIV.

There are many reasons that people aren’t able to use condoms when they have sex. They may be in a relationships where they can’t ask their partner to use a condom. They may be too high when they have sex to remember to use a condom. They may love going to condom-free sex parties. They may be a sex worker who gets paid more to have sex without a condom, and they need that money. They may be an HIV negative person in a monogamous relationship with an HIV positive person who hates feeling like there’s a barrier between them and their partner.

Until PrEP, there wasn’t a good way for folks in these situations to protect themselves. But now, there’s PrEP, a pill that someone who is HIV negative takes every day (kind of like the birth control pill). If it’s taken every day, the risk of infection drops to less than one percent. If someone misses some pills, the effectiveness drops, but it’s still more effective than nothing.

Not everyone should take PrEP—it’s for folks who are at higher risk for HIV. Like any medication, it has side effects, and if you’re not at higher risk for HIV, it’s probably not worth the trouble.You can even stop and start PrEP. Are you planning a vacation that’s going to be a fuck fest? Start PrEP six weeks before you go, take it consistently until after you’re home, and stop taking it until your next vacation. You can get PrEP by asking your doctor. Depending on your doctor, you may need to do a little bit of education. If you want to avoid that, try going to a local LGBTQ clinic like Chase Brexton. If you have insurance, PrEP should be covered. It’s definitely covered on Medicaid. For the right person, PrEP can be an amazing option.

Thanks for your questions! I can’t wait to hear what you’re thinking about next.