Anal Pleasure and Health: A Guide for Men, Women and Couples (36 page)

HONORING EROTIC PREFERENCES

JUST AS it's helpful to consider the conditions under which anal pleasure is desired, the relative importance of anal sex among all erotic activities is a highly personal matter to be decided by each individual. Of course, the "people pleasers" believe that they shouldn't have any preferences of their own. Instead, they want to be available for whatever their partner desires. Yet as much as some may deny it, virtually everyone has unmistakable preferences which, while certainly subject to change, tend to become more clearly defined with experience.

As each form of anal pleasure is embraced as an option, it must be integrated into a pre-existing set of preferences. Typically, but by no means always, this happens fairly naturally. New erotic possibilities sometimes turn out to feel very different than originally expected. For example, some people experience varying degrees of disappointment with anal stimulation even though they've enjoyed it on occasion. In spite of frequent discussions with my clients about their hopes, some don't become fully aware of how much their ideals and their actual desires differ until they've gathered a considerable body of experience.

Mary expressed her disappointment: "I guess I hoped anal sex would perk up my sex life with Frank. But it hasn't changed anything really. I still don't like the way he makes love to me." Jeremy voiced a different kind of expectation: "I was hoping anal sex would be the greatest sexual trip ever. It's okay sometimes, but I like oral sex much better-just like always. I'm so different from my friend Rob who thinks getting fucked is the ultimate turn-on."

Believe it or not, disappointments with anal stimulation often result from subtle vestiges of the anal taboo. Just as taboo pressures can give anal sexuality a highly negative emotional charge, they can also turn forbidden fantasies into larger-than-life expectations. Discovering that anal pleasure probably won't be the sole solution to a dull sex life, or a source of cosmic ecstasy, may understandably feel like a loss. A few people actually go through anger, depression, grief, and other feelings associated with grieving before they reach an acceptance of what anal sexuality is and is not for them. In the midst of this process, Andy expressed an important insight: "I think this whole thing [disappointment with anal sex] is one reason why I had so much trouble learning to do it in the first place. Somewhere inside I must have known it couldn't possibly live up to everything I'd imagined. I may have lost my tense ass, but I also lost a couple of dreams."

At first glance, feelings like these may seem unfortunate and sad. However, with a little support, most people are able to resolve them with minimal distress. Instead of clinging to larger-than-life expectations, they're able to allow desired forms of anal pleasure to find an enjoyable place within the larger context of their sexuality. It's uncommon for the ability to enjoy anal sex to change one's preferences dramatically. Of course, for some people, anal erotic activities quickly become their favorites. Others decide that they don't like some or any forms of anal stimulation much after all. But most people end up somewhere between the two extremes-happy to have discovered one more way to please themselves, appreciate their partners, and celebrate the many facets of their evolving eroticism.

At one time I was concerned that discussing the nitty-gritty details of anal health problems might frighten people and make anal exploration even more threatening and difficult than it already can be. However, I've repeatedly observed that matter-of-fact discussions about all aspects of anal pleasure, including the unpleasant ones, help demystify the entire subject and actually reduce fear-especially the irrational anxieties born of ignorance.

This appendix includes information about:

• HIV and AIDS (including guidelines for safer sex)

• other STDs involving the anus and rectum (chlamydia; gonorrhea; syphilis; herpes; HPV; hepatitis A, B, and C; and intestinal infections)

• common diseases of the anus and rectum (hemorrhoids, fissures, fistula, constipation, Irritable Bowel Syndrome (IBS), and Chronic Pelvic Pain Syndromes)

• guidelines for selfhealing

• getting professional help

Feel free to go directly to areas of greatest interest, but I suggest a quick read-through of the entire appendix. Obviously, it's not fun to read about all the things that might go wrong. Initially, you may even feel rather disturbed by it. But I predict that you'll come away with a greater appreciation of this complex area of the body-and what's necessary to protect and care for it.

Keep in mind that when you have a serious anal health problem, or you're not sure, none of the information here is a substitute for the expertise of a competent and sensitive physician. Nonetheless, basic knowledge about common medical problems can help you decide when to consult a professional, how to describe your problem as clearly as possible, and what questions to ask.

HIV AND AIDS

FOR QUITE some time, the most deadly sexually transmitted disease (STD) has been AIDS (Acquired Immunodeficiency Syndrome), caused by HIV (Human Immunodeficiency Virus). The first ominous cases appeared in the U.S. in 1981 when a few otherwise healthy gay men in NewYork and California developed life-threatening illnesses from micro-organisms that would pose no threat to people with normal immune systems. Soon, similar cases were also identified among intravenous drug users, as well as some recipients of blood transfusions and other blood products.

Research efforts were slow to get off the ground in the early years. In 1983, however, French and American scientists discovered a retrovirus-now called HIV-that has now been established as the primary cause of AIDS. Epidemiologists suspect that there were isolated cases of HIV infection in the U.S. and Europe as early as the 1960s. Analysis of stored blood samples from central Africa has identified HIV infections as early as the late 1950s. No one knows exactly how HIV originated, but the most plausible hypothesis is that a similar virus found in certain monkeys was transmitted to humans and gradually evolved into HIV. Since HIV, like all viruses, mutates over time, it has grown more virulent.

The Centers for Disease Control and Prevention (CDC) estimates that by the end of 2006, 1.1 million Americans were living with HIV, with over 20% of these undiagnosed. Almost 563,000 Americans have died of AIDS since the beginning of the epidemic through 2007. Of cases reported in the US during 2007, 75% were among males and 25% among females. The majority of cases occurred among men who have sex with men (53% of all diagnoses and 71% of diagnosed men). Among females, however, 83% of the cases involved high-risk heterosexual sex. The number of newly diagnosed cases has remained relatively stable for many years, but deaths are gradually dropping, thanks to better treatments, especially new types of antivirals that began to appear in the mid-1990s.*

The World Health Organization (WHO) estimates that approximately 33 million people worldwide were living with HIV/AIDS in 2007. About 2 million of these people are children. Approximately 22 million live in sub-Saharan Africa, by far the most highly impacted region of the world.**
Currently, Russia and parts of Asia are experiencing an explosion of new infections.

HIV is passed from one person to another when tiny amounts of virusinfected body fluids-especially blood and semen, but also vaginal fluid-gain access to the recipient's bloodstream. This can happen in a number of ways:

• having unprotected anal or vaginal intercourse (and occasionally other sex acts)

• sharing contaminated needles for injecting drugs

• during childbirth and breast feeding

• from accidental punctures with contaminated needles by health workers

Once inside the bloodstream, HIV infects and destroys two types of cells which are crucial for proper immune function: CD4 T-cells and macrophages. Shortly after infection, a person may have flu-like symptoms, most commonly fever, joint pain, and night sweats. These symptoms go away, but the virus continues replicating silently. From this point, the course of the infection is quite variable, but it may take ten or more years for T-cell counts to fall from a normal level of approximately 1,000 per micoliter of blood to fewer than 200, the point at which a person receives an AIDS diagnosis and becomes vulnerable to a host of opportunistic infections, including many types of parasites, certain cancers, yeast, fungal, viral, and bacterial infections. Opportunistic infections may affect the lungs, skin, gastrointestinal tract, lymph nodes, eyes, and brain. Another important way to monitor the progression of HIV infection, besides T-cell counts, is to look at the "viral load"-the amount of virus in the blood. In general, the more virus there is, the faster the progression of the disease.

Most infected people produce detectable antibodies to HIV within weeks or months after infection-six months is usually the maximum time needed. As treatments for managing HIV infections become increasingly effective, the benefits of getting tested are clear: earlier interventions produce better results.

Sadly, the search for a cure remains an elusive dream. Consequently, focused efforts at prevention are still our best hope for containing the epidemic. There are disturbing signs that that some people, especially younger ones, are growing weary of the safer sex practices that have made such a dramatic difference, especially among gay men. Others cling to the belief that because of the new treatments, safer sex is no longer that important. No self-affirming person should succumb to such a belief.