The Ins and Outs of Gay Sex (22 page)

Get tested.


Anytime blood is taken or you sign a medical consent, know what it’s for.


Do not hide your HIV status from any healthcare provider or sexual partner when more than masturbation is planned.
Be mindful of whom else you tell.


Consult with a specialist regarding treatment as soon as you learn you’re HIV positive.


Take your medications religiously.


HIV medications are not an alternative to preventing infection.


Keep informed.

A
lthough in his late twenties, he still had boyish good looks and the not-quite-full beard of adulthood.
He had come to me for condyloma years before, unfortunately caught after one of his earliest homosexual experiences.
I nursed him through his surgery and then his difficult coming out.
I knew when he moved out of his house and I knew when he quit working with his father to pursue his own dreams.
I picked his chart up and smiled.
I enjoyed taking care of Chad.

“How’s it going?”
I asked when I entered the exam room.

“Terrible,” he blurted out.
“My penis is too small.
Can you send me to one of those doctors to make it bigger?”

Although I couldn’t remember exactly what he looked like, I certainly didn’t think of him as small.
“Let me see,” I said, pointing to his pants.
Definitely not small.
“You’re normal, Chad.
Not huge, just normal.”

“This is not normal.
Certainly not compared to those guys in the movies.
No one will go out with me.”

“You can’t have a relationship because guys think your penis is too small?”

“Absolutely!”

I couldn’t believe this.
“Has any guy told you that?”

“They don’t have to.
So either send me to someone or I’ll go on my own.”

Can men really think with their dicks?
Who said all men are created equal?
(Certainly not a gay man.
) Does size matter?
Just a few of the questions all men—straight or gay—ponder through the ages.
We all have one, and for most of us it is our favorite toy.
But what do we really know about it, and for that matter, how much do we really need to know, other than when we play with it, we are rewarded?

Your penis is an organ just like any other, but somehow you never think of it in those terms—as, say, your liver or kidneys.
And your penis does not act alone.
The male genital system is extremely complicated, and all parts must work in sync for you to achieve the ultimate:
an orgasm.

Men love talking about their penises in often boastful (and probably exaggerated) terms, but when something does go wrong, it’s frightening—often too frightening to mention it even to their doctor.
Whenever a patient hems and haws, unable to ask a question, I know it has to do with his penis.
The problem can be worse for gay men because we assume that any genital problem results from a sexual act, and merely mentioning it leads to forced outing.
Not true.
I hope these pages will clear up any misconceptions and lead to a better understanding of your body.

Your genitals belong to the genitourinary system, which has two main functions:
production and excretion of liquid waste (urine) and procreation.
(See
Figure 6.
1
.
) The fact that procreation is a pleasurable experience is a bonus—especially when so few of us desire to procreate.
For most gay men, the issues of reproduction are not paramount, and they will not be addressed in this book.

Figure 6.
1:
Normal Male Anatomy

It’s probably best to start with the penis, because everything else seems oddly secondary.
We’ve all heard that size doesn’t matter, yet somehow hearing it isn’t enough.
All men are not created equal, and if we listen to what we hear on gay sex phone lines, we’d expect the average length to be eight to ten inches with the girth of a small tree.
In actuality, the average length of an erect penis is approximately six inches with a diameter of 1.
5 inches.
Soft, the normal range is much greater, with average being from three to six inches, and it’s impossible to predict erect size from flaccid.
Your penis’s main functions are to conduct urine from your body and to transport semen into a woman’s vagina, making size of little significance.
And yes, it
can be too big.
The misconception that virility relates to size has screwed up so many heads and caused us to spend far too much money trying to attain the unattainable.
Basically, what you have at twenty is all you’re going to have.

Your penis contains three tubes of spongy erectile tissue (two on the top and one on the bottom) that fill with blood (engorge) to produce your erection.
Your urethra carries urine from your bladder and runs along the undersurface of your penis.
The head is referred to as the glans, and in uncircumcised men it’s covered by foreskin.
Nerves provide pleasurable sensations and concentrate along the top.
A bridge of skin between the base of your glans and shaft is called the frenulum.
Thin skin in this area brings nerves close to the surface, heightening sensation—particularly in uncircumcised men, where foreskin protects the frenulum.
Circumcision is reported to decrease penile sensation because exposed skin on the glans toughens.
Skin at the edge of the glans and frenulum is not perfectly smooth; little bumps (white or dark) are normal and should not be mistaken for warts or other STDs.
Hair, if present at all, is found only on the base of the shaft.

Most blood flow to a flaccid penis drains directly into its veins, leaving erectile tissue empty.
When blood fills erectile tissue, your penis swells, rising to an angle of 140 to 160 degrees.
Voilà,
you’ve got an erection.
The hardness you feel comes from blood-filled spongy cylinders.
As we all know, we cannot willfully cause an erection.
Nerves involuntarily relax muscles in your penile artery so more blood rushes in while veins constrict to keep blood from leaving.
A cock ring works because it acts like a tourniquet, helping to further constrict veins and keep blood in your penis.

Two testicles hang in your scrotal sac, which rises and falls to keep the temperature 2–4 degrees F below normal body temperature, the ideal climate for sperm production.
I have seen many frantic patients, their faces ashen because they’ve just noticed that their left testicle hangs lower than their right.
Relax, that’s normal, and there may even be a slight size difference between them as well.
During fetal life, testicles develop within the abdominal cavity, where they remain until approximately one month before birth.
Then they descend via the inguinal canal into the scrotum.
If this passageway does not close off completely, you have a hole and an inguinal hernia results.
Occasionally, one or both testicles fail to descend or only partially descend into the scrotum (resulting in an undescended testicle).
The testicle is often abnormal and may not function.
Surgery brings the testicle down and fixes it into the scrotum.
(See
Chapter 8
.
)

Testicular size varies greatly and does not correlate with general body proportions (big men don’t necessarily clang when they walk), nor does it correlate with virility or fertility.
(Big ones can still shoot blanks, while small ones can do fine!
) Most are about the size of a walnut.

Besides producing sperm, testicles also manufacture testosterone (the male hormone).
Testosterone produces secondary sex characteristics, including male hair patterns (facial hair, crab path from navel to pubis, and temporal baldness), deep voice, libido, and so on.
Only one testicle is necessary for adequate testosterone and sperm production, so if one is damaged or removed, most men do fine.
Fertility rarely affects testosterone, so even if you’re sterile, your testosterone level is usually normal.

Sperm production occurs in billions of tubes within your testicles.
From there, the sperm enter the epididymis, a comma-shape structure draped over the back of each testicle, which you can easily feel.
Your epididymis, though only a little more than an inch long, is actually a series of tubes that, if uncoiled, would stretch more than twenty feet!
When sperm first reach your epididymis, they are immobile
and incapable of fertilizing an egg.
By the time they reach the end of the epididymis, about ninety days later, and enter another tube called your vas deferens, sperm have fully matured into Olympic-caliber swimmers.
Your vas deferens has the diameter and consistency of a strand of al dente spaghetti and can be felt at the top of your scrotum.
(See
Figure 6.
1
.
)

The vas deferens transports sperm from your epididymis to your seminal vesicles and prostate.
It is cut during a vasectomy, an operation for male sterilization, so sperm cannot leave your testicle.
Your seminal vesicles and prostate contribute most of the fluid for your ejaculate; thus even infertile men with low sperm counts have normal-appearing ejaculations.
Seminal vesicles secrete fructose, a sugar to nourish your sperm on their journey (to the end of your condom), as well as an enzyme that clumps semen into nice globs that stick to your belly.
When you wake up in a messy puddle thirty minutes later, it’s because enzymes from your prostate liquefied your semen.
Is this just nature’s way of forcing you to reach for a towel?
No, biologically semen clumps and sticks to keep it from being pulled out of a vagina by a thrusting penis.
(Some men actually do that sort of thing.
) Semen liquefies when it’s safe for sperm to swim upstream.

Most men ejaculate a teaspoon of semen in three to seven waves.
Semen has been described as tasting sweet, salty, bitter, and everything in between.
One patient swore with the utmost authority that he knew if a relationship was on solid ground or headed for disaster just by how his lover’s semen tasted!
I have yet to find a medical study correlating taste with disease, emotional state, virility, fertility, or anything else.

Blood, when seen in ejaculate, makes most men apoplectic.
Although blood occasionally signifies an infection or prostate ailment, most often it’s nothing more than a tiny
blood vessel that burst from the pressure of your ejaculation.
If it doesn’t clear up in a day or two, see a urologist to be sure that nothing serious happened.

Foreskin covers the glans (head) of your penis.
It is actually a double-sided flap of skin that retracts off the head onto the shaft.
If your foreskin cannot be retracted, a condition known as phimosis, problems arise.
Foreskins vary greatly from only partially concealing the head to dangling an inch or more beyond it.
Even circumcised men can look very different depending on how much foreskin was removed.
I have seen patients who swear they were circumcised, but it looks like nothing was taken off.
Men can urinate without retracting their foreskins, but for sex, it is usually pulled back.