x Seex x S Se A safer sex guide for men who have sex with men Contents 4 TH SEXUAL HEAL s) ted Infection it m s n ra T y ll STI’s (Sexua ORAL SEX SUCKING or CONDOMS TH SERVICES SEXUAL HEAL Phone: 0191 233 1333 www.mesmacnortheast.com [email protected] www.facebook.com/MesmacNorthEast www.twitter.com/TeamMesmac 13 34 40 46 SEXUAL HEALTH SEXUAL HEALTH (For men who have sex with men) Introduction In this booklet we cover the sexual health concerns of gay and bisexual men and men who have sex with other men. MESMAC North East can offer information and advice on your sexual health in person, over the phone, through our website or from this booklet. If you don’t find the information you are looking for please contact us on the phone number at the back of this booklet. Information in this booklet includes: • Sexual health Sex and You! A lot of people question their sexuality at some point in their lives, for most it’s when we are teenagers but for others it can be at anytime during their lives. Sometimes people can be in a straight relationship and something might not feel right or something may even happen to make them question their sexuality. For that reason when talking about sex in this booklet we will cover some sex with women as well as sex with men. Having a healthy sex life involves knowing what risks there are from STI’s to unplanned pregnancy to even the type of sex you have. Sex means different things to different people, to some it’s not that important but, to others it can be a compulsion. • STI’s (Sexually Transmitted Infections) • Safer sucking and oral sex • Condom usage • Sexual health services 4 5 Knowing what sex you enjoy and the best ways to enjoy it are very important, not just for your body but also for your mind. Sexual frustration can be quite damaging so it’s important not to push it aside or to try to ignore it. Talk about it either with your partner, a trusted friend, your doctor, a sexual health advisor or a MESMAC worker. There are different ‘strategies’ people use when thinking about safer sex, from always carrying a condom to abstaining from sex altogether. Whether single, with a partner, having multiple sex partners or abstaining, it’s always a good idea to have a safer sex plan. Think about it, talk to partners and negotiate what is going to work best for you. 6 The type of plan you might want to think about: • Contact info for the nearest sexual health service. • Where to get condoms and lubricant (lube). • Where in a gay sauna the condoms and lube are located. • Your nearest family planning clinic. • Where to go for sexual health advice. Always be aware that the affects of drugs and alcohol can seriously effect your judgment and can make safer sex difficult to achieve. 7 Whatever your situation try to enjoy a healthy sex life A Loving Relationship For most people, having a regular partner and love in our life is important. Finding and maintaining a healthy relationship however takes work and commitment. If you are having difficulty with relationships, whether you have a partner or can’t seem to find the relationship you want, it’s worth thinking about whether there are things you can improve upon to find what you want. • Are you going to places to meet people such as groups, bars, clubs and saunas? • Are you trying to mix with people as much as possible? Talking is the best way of getting to know someone! • Do you have any off-putting habits or bad personal hygiene? • Are you making the most of your appearance? Looking good through clothes and hairstyle can boost your confidence when it comes to attracting possible partners. 8 to know t n a t r o p im ’s Most of all it r. Don’t o f g in k o lo u're what it is yo nd a le ib s s o p the im set yourself time. a t a p e t s e n take things o 9 HIV Positive Men There can be a range of issues about your health and the anxiety about it can affect you keeping up a fulfilling sex life. There’s nothing wrong with having lots of sex, or no sex at all. You don’t have to give up things that give you pleasure and you may decide to weigh up the pleasure and the risks involved. How safe, secure and happy you feel about the sex you’re having can have a big affect on your general well being. Safer sex information for HIV+ gay and bisexual men is available on our website: www.mesmacnortheast.com rong with w g in h t o n There’s at all. x e s o n r o , f sex having lots o p things u e iv g o t e v You don’t ha pleasure u o y e iv g t a th 10 Unfortunately, it’s almost certain that you’ll face some prejudice and discrimination. Sometimes it can come from unexpected and unwelcome sources, and that includes other gay or bisexual men who are HIV negative or who haven’t been tested. There’s still a lot of ignorance, and people can make some very strange, illogical and hurtful assumptions about you. HIV is a very personal subject. Having the chance to discuss your concerns may increase your own confidence so that you can make your own informed decisions and take control. MESMAC continually works towards challenging the prejudice and discrimination against HIV+ people. It’s hardly surprising if you’re worried and confused about being HIV+. 11 STI's MESMAC can offer you help with this, and also the opportunity to talk about concerns you may have about things like disclosure of your status, relationships, abuse, legal issues, illness, HIV drug side affects, harassment, housing and discrimination. MESMAC can put you in touch with other support groups and specialist HIV workers throughout the North East. We provide HIV+ gay and bisexual men with the opportunity to access the following services: • Individual support in a safe, friendly and confidential setting. • A social group for HIV+ men. • The latest up-to-date information on a wide range of issues, from housing to medical treatments. • Relevant and practical down-to-earth advice on sexual health for positive men. • A reference library with books, journals and articles on HIV/AIDS from Britain, The USA and other countries, as well as free sexual health magazines. • FREE condoms and lubricant. 12 STI’s (Sexually Transmitted Infections) There are many different STI’s, in this section we cover the most common: • Chlamydia • LGV • Genital Herpes • NSU (Non-Specific Urethritis) • Genital Warts • Scabies • Gonorrhoea • Hepatitis A/B/C • Pubic Lice (or crabs) • Syphilis • HIV Cock and Balls Pubic Area (Pubic Hair) Shaft Blood Vessels Spermatic Cord (Arteries and Nerves) Epididymis (Where the cum travels from ) Penis (Cock) Scrotum (Ball Sack) Prepuse Testicles (Foreskin) Glans (Knob) (Balls) Where the sperm (cum) is made At times we will mention sex with women as well as men for the bisexual men and men in relationships with women who read this booklet. 13 CHLAMYDIA Chlamydia is a STI caused by small bacteria that live inside human cells. It is the most common STI in people under 25. Left untreated, Chlamydia can permanently damage the sexual organs leading to infertility in women and in men. Symptoms Chlamydia is called the ‘silent’ disease as around 50% of men and 70-80% of women do not experience any noticeable symptoms. Because of this lots of people do not know they have got it. Symptoms in men may include pain when pissing, a discharge from the cock or pain or discomfort in the balls. In women there may be pain when having sex, bleeding between periods or after sex. Treatment Chlamydia can be easily diagnosed through a ‘pee in a pot’ test or having a swab taken from inside the tip of your knob, once diagnosed it can be treated with antibiotics. Under 25s can get a free, confidential chlamydia test through the National Chlamydia Screening Programme or check the local website: www.checkyourbits.org People over 25 can visit their GP or a local Sexual Health Service to arrange a test. 14 GENITAL HERPES Genital herpes is an infection of the genital skin (below the waist and between the legs) that is caused by the herpes simplex virus (HSV). HSV lives in nerve endings and is the same as cold sores on the face. HSV can be easily passed from person to person by close, direct skin to skin contact. Genital herpes is passed on by having sex with some one who already has it. Genital herpes is a long-term (chronic) condition. Symptoms At least 80% of people who carry the virus don’t know that they’ve been infected because there are often few or no symptoms to begin with. Other people may develop symptoms very soon after getting the infection. These usually start as an area of small blisters that may be itchy and then burst leaving the area sore and uncomfortable. Sometimes it can be impossible to pee (more likely to occur in women) resulting in the need for a hospital admission. Even if someone with genital herpes doesn’t have any symptoms, it’s possible for them to pass the condition on to a sexual partner as the virus is present in the skin cells (that are shed) in the area where the infection has been. Treatment When herpes is first diagnosed, medication can be given to treat it along with painkillers if necessary. 15 Some people will only ever have one outbreak although the virus will still remain in their body, others may have further outbreaks. For others the virus starts up again, causing a further outbreak of herpes. The symptoms of genital herpes also tend not to happen as often and not be as bad each time someone has the condition. If an outbreak happens more than 6 times in 12 months you or if you prefer the sexual health service can talk to your GP about treating the virus with medication, usually over 6 months, in an attempt to reduce the amount of outbreaks. GENITAL WARTS Genital warts are the result of a viral skin infection that is caused by the human papilloma virus (HPV). Genital warts are usually painless and are not a serious threat to a person’s health. However, they can look unpleasant and make you feel unhappy or upset. Genital warts can be spread during sex, and by sharing sex toys. You do not need to have penetrative sex to pass the infection on because HPV is spread by skin-to-skin contact. Condoms do not provide complete protection because it is possible for the skin around your genital area (that is not covered by the condom) to become infected. HPV is most likely to be passed on to others when warts are present, although it is still possible to pass the virus on before the warts have developed and after they have disappeared. 16 Symptoms Genital warts are small fleshy growths, bumps or skin changes that appear on or around the genital or anal area. It can take up to a year for symptoms to develop after getting an infection, so if you are in a relationship and you get genital warts, it does not necessarily mean that your partner has been having sex with other people! Warts may grow in clusters and cause pain when you are having sex. Treatment Treatments for warts usually work well. Several treatments are available, such as using medicated creams and freezing the warts (cryotherapy). However it is important to know that many treatments can take up to three months before they work properly. GONORRHOEA Gonorrhoea is a STI caused by bacteria called Neisseria gonorrhoea or gonococcus. It used to be known as “the clap”. Gonorrhoea is easily passed between people through unprotected vaginal, oral or anal sex, and sharing vibrators or other sex toys, that have not been washed or covered with a new condom each time they are used. Anyone who has sex with another person can get gonorrhoea, however it is more common with people 17 who change partners more often and people who do not use a condom when having sex. Symptoms Typical symptoms are a yellow/green discharge from the cock or vagina, pain when pissing and sometimes a burning sensation and itching. Some people get no symptoms at all when they have Gonorrhoea. Treatment Gonorrhoea can be easily diagnosed through a ‘pee in a pot’ test or swab and is treated with antibiotics. You are likely to be asked to come back for repeat tests after your treatment to check that the infection has gone. If you don’t get treatment, it may lead to more serious long-term health problems and infertility. Successful treatment for gonorrhoea does not stop you from catching it again in the future. HEPATITIS A, B and C You get Hepatitis when there is inflammation (swelling ) of the liver, often caused by a virus. caught by putting something in your mouth that has been contaminated with shit containing the virus, so can commonly be transmitted through rimming (licking the bum hole for pleasure) for example. Hepatitis B Caused by the Hepatitis B virus, it’s present in body fluids such as blood, saliva, semen and vaginal fluid. It can be passed from person to person through unprotected sex or by sharing needles or drug injecting equipment, for example. Hepatitis B is not very common in the UK: about one in 1,000 people are thought to have the virus, MSM (Men who have Sex with Men) are more at risk of this virus through unprotected sex. Hepatitis C Caused by the Hepatitis C virus, it’s present in the blood and, to a much lesser extent, the saliva and semen or vaginal fluid of an infected person. It is particularly concentrated in the blood, so it is usually caught through blood-to-blood contact. The most common way you can become infected is by sharing contaminated needles or drug taking equipment. Symptoms The three main types of hepatitis are described here: Hepatitis A Caused by the Hepatitis A virus, it’s the most common type of viral hepatitis. It is more common in countries with poor cleanliness and sanitation (sewage and rubbish). Hepatitis A is 18 There are often no symptoms for Hepatitis A, B, or C, which is why it is important to get checked regularly. Symptoms, if you get any, can include feeling tired, aches, nausea, being sick, pissing darker pee than usual and being jaundiced (yellowish skin tone). Blood tests are needed to confirm if you have an infection, which type it is and whether the infection 19 has cleared itself or needs further investigation. Treatment Hep A: In certain parts of the UK sexual health services will offer all MSM vaccination against Hepatitis A, if there have been a lot of people infected locally. Hep B: A course of vaccinations, which can prevent getting the virus, is recommended for all MSM and is available from sexual health services. Hep C: There is currently no vaccine to prevent Hepatitis C. If you show signs of Hepatitis you are most likely to be referred to a Liver Unit at a hospital where more tests will take place and you may be offered drugs that fight the virus, these can clear the infection for about half of those who are infected. HIV The Human Immunodeficiency Virus (HIV) is a virus that attacks the body’s immune system. A healthy immune system provides a natural defence against disease and infection. HIV infects special cells, called CD4 cells, which are found in the blood and are responsible for fighting infection. After becoming infected, the CD4 cells are destroyed by HIV. Although the body will attempt to produce more CD4 cells, their numbers will 20 eventually go down and the immune system will stop working. This leaves a person who is infected with HIV with a high risk of developing a serious infection or disease, such as cancer because the immune system is no longer able to prevent it happening. How is HIV spread? HIV is spread through the exchange of bodily fluids. This most commonly happens during sex, including oral, vaginal and anal sex. HIV can also be passed on through sharing needles. There is no cure for HIV and no vaccine to stop you from becoming infected. However, since the 1990s, treatments have been developed that help most people with HIV to stay well and live relatively normal lives. The sooner you know you have HIV the better as treatment can keep you healthy. What is AIDS? Acquired Immune Deficiency Syndrome (AIDS) describes the later stages of HIV, when the immune system has stopped working and the person develops a life-threatening condition, such as pneumonia (infection of the lungs). The term ‘AIDS’ was first used by doctors when the exact nature of the HIV virus was not fully understood. It is not used as much because it is too general to describe the many different conditions that can affect somebody with HIV. Specialists now prefer to use the terms advanced or late-stage HIV infection. 21 Symptoms The first stage of HIV is known as primary HIV infection. In people who are infected with HIV, 60% will develop associated symptoms, usually two to six weeks after they are first infected with HIV. Symptoms of primary HIV infection may include: Fever, sore throat, tiredness, joint pain, muscle pain, swollen glands (lymph nodes), or a blotchy rash on the chest. These early symptoms are often very mild, so it is easy to mistake them for something else, like a cold or glandular fever. After this HIV will often not cause any other symptoms for many years. This is known as asymptomatic HIV infection. During this time, the virus is still reproducing and damaging your immune system. Late-stage HIV infection Left untreated, HIV will lower the number of CD4 cells in your body to a dangerously low level, and your immune system will stop working. On average it takes 10 years for the virus to damage the immune system in this way. A damaged immune system will result in you developing a serious infection. Possible symptoms of a serious infection caused by a damaged immune system include: feeling tired all the time, night sweats, unexplained weight loss, diarrhoea that won’t go away, blurred vision, white spots on your tongue or mouth, dry cough, shortness of breath, a fever of above 37C (100F) that lasts a number of weeks, or swollen glands that last for more than three months. 22 AIDS-related illnesses, such as tuberculosis, pneumonia and some cancers, may appear. Many of these, though serious, can be treated to some extent and some are likely to improve if you start treatment and your CD4 cell levels increase. Monitoring If you are diagnosed with HIV, you will be offered an appointment to a HIV or Sexual Health Service. You will also be offered counselling. You will need to have regular blood tests to check how the HIV is affecting your body. As part of the blood testing two main things are checked: Your CD4 count - which is the number of CD4 cells in your blood. Your viral load - which is the amount of HIV in your blood. These tests allow the staff at the HIV service to see how far the disease has progressed, and whether you might develop an infection. Treatment If the level of CD4 cells fall below a certain level (currently 350) you will be advised to start medication called HAART. This holds back the growth process of the HIV and allows CD4 levels to increase. Once HAART is started it should not be stopped without discussing it with your doctor because the disease can then come back quickly and the medication may not work again. 23 LGV Outlook There is no cure or vaccine for HIV and researchers believe it will be many years before either is found. However, special medicines that are used in what is known as Highly Active Antiretroviral Therapy (HAART) have been really successful in slowing down HIV and helping people to live longer. Researchers are confident that improvements in therapy will mean that a person with HIV will live as long as somebody who does not. PEP – POST EXPOSURE PROPHYLAXIS PEP may stop someone from getting HIV as long as the treatment is started within 72 hours (3 days) of having unsafe sex or condom failure. The sooner it is started the better the chance of HIV being prevented. PEP means taking anti-HIV drugs for 4 weeks and can have side effects. PEP is not a cure for HIV and is not guaranteed to prevent HIV from taking hold once the virus has entered the body. PEP is available from Sexual Health Services and most Accident & Emergency centres across the North East. You might only get the first 5 days of medication from A & E, so you would need to go to a sexual health clinic to get the further medication needed. Call MESMAC North East if you would like more information. 24 LGV stands for ‘lymphogranuloma venereum’. It’s a serious STI caused by a type of chlamydia bacteria. In 2004 the first cases were noticed in gay and bisexual men and is now seen more in MSM. Symptoms A few people have had LGV without noticing but most get symptoms within a few weeks. Most gay and bisexual men get infected with LGV inside their bum. This can cause painful swelling (proctitis). Going to the toilet might become difficult and painful, and you may get an abscess or ulcer. Some people feel ill, get a fever and might lose weight. If you get LGV in your cock you might also get a discharge or pain when you piss and the glands in your groin can swell. You don’t often get LGV in the mouth or throat. There may be a small, painless sore where the bacteria got into your bum or penis but most people don’t get or notice a sore. Untreated LGV can cause lasting damage for example: the inside of your bum can be so seriously damaged that you might need surgery and your penis and scrotum can swell massively with blocked fluid. 25 The Unusual Suspects Anyone can catch a sexually transmitted infection! Syphilis am Chl ydia Herpes HIV Crabs 26 27 Treatment As long as it’s treated quickly LGV can be cured in three weeks of starting antibiotics and leaves no lasting damage. Because of the bleeding and skin damage LGV causes it makes it easier to pick up or pass on HIV, hepatitis C, syphilis and other STI’s, so It’s likely you will be tested for these when attending a sexual health service. NON-SPECIFIC URETHRITIS (NSU) Non-specific urethritis (NSU) is a condition where the tube that pee passes through becomes inflamed, usually due to infection. The term “non-specific urethritis” is used when the cause is not yet known (Gonorrhoea is an STI that can also cause urethritis and tends to be more serious than NSU). NSU can have a number of possible causes, but it is thought that chlamydia is responsible for 75% of all cases. Symptoms Symptoms tend to range from mild to a stinging sensation in the piss tube and this can usually pass within a few months, this needs to be checked out. Treatment You should always have any unusual stinging sensations checked out with your GP or sexual health service because of possible causes, and treatment will be required to prevent the spread of infection. Antibiotics are usually used to treat cases of NSU. 28 Untreated NSU can lead to swelling of the small tubes in the balls (epididymitis). PUBIC LICE Pubic lice (phthirus pubis), also known as ‘crabs’, are tiny bloodsucking insects. They live in coarse human body hair, most commonly pubic hair, and cause itching and red spots. The lice can also be found in the eyelashes or eyebrows, hair on the abdomen or back, and facial hair, such as beards or moustaches if left untreated. Adult pubic lice are about 2mm long and are grey-brown in colour. They are caught through close contact with someone who has them. The most common way is during sex. There is not enough evidence to say whether pubic lice can be passed through items such as bedding or towels, although some experts think that it might be possible. Only humans get pubic lice, you can get them at any age but they are seen most in young adults. Symptoms Pubic lice can cause itching to the infested area and lay egg sacks at the base of pubic hair which have a silver or shiny appearance. Treatment Pubic lice can usually be successfully treated with insecticide medicines available over-the-counter in most chemists, or from a GP or sexual health service. You should tell any current sexual partners 29 and any partners from the past three months as they may need to be treated. If pubic lice are caught through sex, it is best that tests for STI’s also be done. SCABIES Scabies is a skin condition caused by tiny insects called Sarcoptes scabiei, which burrow into the skin. It can be spread through prolonged skin-to-skin contact (such as sleeping) with someone who is infected and sexual contact with someone. Scabies can also be passed on through sharing clothing, towels and bedding with someone who is infected. However, this is less likely than getting the infection through skin-to-skin contact. They feed using their mouthparts and front legs to dig into the outer layer of the skin. They eat tissue and fluids as they burrow. As they feed within the skin layer, they burrow at a rate of about 0.5mm a day. The females lay two to three eggs a day inside the burrow. After three to four days, the baby insects (larvae) hatch from the eggs and travel to the surface of the skin where they lie in shallow pockets before becoming adult insects. Scabies like warm places on the skin, such as skin folds, between the fingers, under fingernails or around the buttock or breast creases. They can also hide under watchstraps or bracelets, and in the skin on the finger under rings. Crusted scabies is when there are insects that have had lots of babies that 30 have spread; this can affect older people and those with a lowered immune system (the body’s natural defence against illness and infection). Symptoms Scabies is not usually a serious condition, but the itching can be unpleasant and leave you feeling low or depressed. Visible signs can be small ‘silver’ threads that you may see that run across the skin. It can take up to eight weeks before you have any symptoms. Treatment Itching that is caused by scabies can usually be effectively treated using specialist skin creams, some of these need to be re-applied over 24 hours and may need to be put on the body again a few days later. The itching can persist for several days after treatment. Scabies can lead to another skin infection if the skin becomes irritated and inflamed through excessive itching and scratching. If this happens you need to see a GP or visit a sexual health clinic. SYPHILIS Syphilis is a bacterial infection that is usually passed on through sex. Three stages of disease Syphilis may not always be seen in its three stages, not everyone will have symptoms and if syphilis is up the bum changes may not be noticed. Stage 1 (primary syphilis). Symptoms of syphilis 31 can be painful and highly infectious, they can range from one to lots of look-alike sores on the genitals or sometimes on the mouth/tongue/cheek/gums. If somebody else comes into close contact with the sore, for example during sex such as oral sex or anal sex, they can also become infected. The sore lasts two to six weeks before disappearing. Stage 2 (secondary syphilis). Secondary symptoms, such as a rash on the palms of the hands/ soles of the feet, then develop. These symptoms may disappear within a few weeks, after which you experience a hidden (latent) phase with no symptoms, which can last for years. Due to being in the body untreated for years, syphilis can then progress to its third, most dangerous stage. Stage 3 (tertiary syphilis). At this stage, it can cause serious damage to the body. two years after becoming infected), syphilis cannot be passed onto others but you can still get symptoms. Treatment If found early, syphilis can be easily treated with antibiotics, usually penicillin injections. If it is not treated, syphilis can progress to a more dangerous form of the disease and cause serious conditions such as stroke, paralysis, blindness or even death. Some STI's have no symptoms - it is important to have regular check ups. Symptoms The first and second stages are when you can most easily pass it to infect other people. Symptoms can include: swelling in your lymph glands (small organs found throughout the body, such as in the neck, groin or armpit), a non-itchy skin rash appearing anywhere on the body, but commonly on the palms of the hands or soles of the feet, tiredness and headaches. Less common symptoms include: fever, weight loss, patchy hair loss and joint pains. In the middle (latent) phase (and usually around 32 33 SUCKING or ORAL SEX Many of us aren’t sure about the risks involved in oral sex. In this section we try and explain some of the risks involved and the STI’s that you can catch through sucking. HIV and Oral Sex The bottom line is: • Sucking is not totally safe from HIV infection. • The latest evidence suggests that there is a small risk, because there are a number of cases each year where infection could only have occurred through oral sex. • Compared to sucking, unprotected penetrative sex with men or women is definitely still the most risky kind of sex. Can HIV enter my blood through the mouth or throat? The linings of the mouth and throat are very thick, and they don’t absorb much, even if they’re damaged. They also contain few cells that are vulnerable to HIV infection. Fluids stay in contact with these linings for a very short time because you swallow frequently. This suggests it’s unlikely that infected blood or cum could be absorbed through the mouth or throat. However there may be an increased risk if your gums are damaged, if you have cuts or sores in your mouth, or if you’ve got an inflamed throat caused by a cold, flu, or a sexually transmitted infection (STI) like gonorrhoea. So should I let someone cum in my mouth? The decision is yours! The risk of HIV infection can be reduced if you avoid getting cum in your mouth. Why? HIV is found in cum and pre cum, and the risk of HIV infection through sucking may be significantly increased when the amount of HIV in the cum of a man who is HIV positive is especially high. It’s thought this happens at two particular times: • During the period just after he’s become infected with HIV 34 35 • If he starts to develop HIV related illnesses (which could be years later) Most people who’ve just been infected probably aren’t aware of the fact, so they won’t realise there may be risk of passing on HIV through their cum. If he does cum in my mouth, should I swallow? Swallowing cum takes it away from any damaged tissue in the mouth and acids in the stomach probably kill HIV. However, if you do swallow cum it will also make contact with any inflamed tissue in your throat. If you decide to spit, the cum is in contact with gums and ulcers longer. There is no evidence to suggest either way is safest. The best way of reducing the risk of infection is by avoiding getting cum in your mouth. Does saliva kill HIV? Not exactly, but evidence suggests it contains an enzyme which makes it harder for HIV to infect vulnerable white blood cells. Saliva itself can’t pass on HIV. 36 Can pre-cum pass on HIV? Pre-cum (the clear, slippery liquid which appears before ejaculation) can certainly contain HIV, though some experts think it doesn’t contain enough HIV to be infectious (and some men don’t produce very much of it). This suggests that, although pre-cum might pass on HIV, it is particularly unlikely. Can I get HIV from being sucked? This is highly unlikely. What about the risk of other STI’s? Other STI’s though generally less serious than HIV are often more easily picked up through sucking. They include Gonorrhoea, NSU (NonSpecific Urethritis), Chlamydia, Syphilis, Hepatitis B and Herpes. Condoms when used correctly are the only way to protect yourself from these STI’s. See the STI’s section for more information on these and other infections. 37 If you think you may have picked up an infection, or just want a routine check up, visit your local sexual health service for a free & confidential examination, see the Sexual Health Service section for more information. Making sucking safer Only you can choose how safe you want to be, and only you can decide what precautions you’re willing to take. Here are some suggestions: • You may decide that the risks of oral sex are low enough for you to continue your regular behaviour. • You may prefer not to have oral sex because you do not wish to take even a low risk of HIV transmission. • Stop sucking him before he cums. Some men will tell you when they’re about to cum, others will groan louder, others will take their dick out of your mouth anyway. Some will shoot their load without warning, so be careful! • Don’t suck if you’ve got cuts, sores, or inflammation in your mouth or throat. It’s also best not to suck if you’ve just brushed your teeth (because your gums might be bleeding). 38 Current evidence suggests it’s best to wait 1 hour after brushing your teeth. • Lick the shaft of his penis or suck his balls instead of putting the end of his penis in your mouth (especially if you’re worried about precum). • You may decide to reduce the number of partners whom you have oral sex with. • You may decide only to have insertive oral sex (being sucked), as this is safer than receptive oral sex (sucking). • Take regular sexual health screening. This will show if you have any STI’s which may increase the risk of you transmitting HIV to a negative partner, and reduce the risk of you contracting HIV if you are HIV negative. • You can cover the dick, which is being sucked with a flavoured condom. Using a condom for sucking is the best way to minimise any risk (unless you choose not to suck at all). Women can also carefully split a condom or use a dental dam to cover the vagina. Split condoms or dams can also be used when rimming (anal stimulation using the tongue). 39 CONDOMS Why use condoms when having sex? Condoms are still the most effective barrier to HIV and other STI’s during anal or vaginal sex. Condoms help prevent the transmission of most sexually transmitted infections (STI’s), for example HIV, Gonorrhoea, Syphilis, Herpes and Chlamydia. Sensation and safety when using condoms. Nobody has ever suggested that condoms are perfect, or that sex feels the same if you use them. Lots of men think that condoms are uncomfortable, can ruin the sensation or even interrupt the fun, but lots of men don’t find using condoms a problem at all. You may have heard about condoms splitting or not being strong enough, there is some truth in this. Condoms are not 100% safe. However, the main reason that condoms fail is because they are used wrongly, for example oil based lube is used, tearing them when opening the packet or they are put on incorrectly. Some brands you may be familiar with are: Pasante Regular, Boys Own Regular, Mates Natural, ID Skins and Durex have a large range of condoms. There are many different types of condoms for sale including Ribbed, Extra, Trim and Large, you may want to look for a condom that’s more suited to your needs, experiment and find the best type for you. We recommend that you use regular condoms for anal sex (as long as they carry the Kite or CE mark shown above) but some people feel the need to use Extra or Strong condoms (slightly thicker), this is entirely up to you. Regular condoms are widely available in gay bars, clubs and saunas throughout the North East. They are also available to 13-25 year olds at C Card outlets. There are also ranges of flavoured condoms available, these are recommended for use when having oral sex. Which condoms are best? It is best to look for condoms that carry a Kite mark or CE mark. 40 41 Keep it wrapped up! One of the best ways you can improve your safer sex life is by spending a little time to get it right. Research suggests that when people have negative experiences with condoms it’s because they have been used wrongly. The following is a step-by-step guide to getting the most out of your condom. • Store your condoms in a cool place away from extreme temperatures as this can cause damage to the condom. • Open the packet carefully to prevent damaging the condom (don’t rip it open with your teeth) • Only put the condom on when your dick is hard, place the condom over the end of your dick with the roll on the outside. If you have a foreskin pull it back before covering the head of your dick with the condom. • Use only 1 condom at a time, it’s unsafe to use one condom on top of another as this cases friction in the rubber making it easier to split. • Don’t put lube on your dick before putting the condom on as this could cause the condom to slip off inside your partner. • Squeeze the tip of the condom between your thumb and finger to expel the air. • Holding the condom in place, carefully roll it down to the base of your dick. It might sound ridiculous but don’t try to cover your balls. Smooth the condom to get rid of any air bubbles. 42 • Spread plenty of water-based lube over the condom on your dick and on your partner’s anus or vagina. DON’T use Vaseline, massage oil or moisturiser – these make the condom weaker so they are more likely to split. • While you’re having sex check occasionally that the condom is still in place, and use more lube if necessary. • If your dick goes soft during sex, the condom might slip off so put your fingers round the base and this will help it stay put. If the condom does split or slip off during sex, then withdraw as soon as you find out. • After cumming withdraw your dick before it goes limp (this can prevent leakage). Hold onto the base to make sure it doesn’t slip off. • Dispose of the condom carefully in the bin NOT down the toilet as it could contain air and would be difficult to flush away. • Always wash your hands with soap and warm water to remove any bacteria! 43 Practice makes perfect If you’re not very good with condoms or feel clumsy when putting them on, why not try practicing with them yourself? By making condoms a part of your sex play you will get used to them and might even find the condoms a turn on themselves. Take your time and follow the instructions step-by-step so you know what you are doing. You could also practice putting condoms on your partner, it’s another way of getting used to it and it can also be part of your foreplay. You should also use condoms on sex toys, not only does it keep them cleaner but it helps with the spread of STI’s, these should be changed regularly. What is lube? Lube (or lubricant) is available in small sachets, usually alongside condoms in the various venues mentioned earlier. It can also be bought in small bottles with a pump dispenser. Lube is made up of water-based ingredients and is put directly into the bum hole to make it easier for penetration to take place. Sometimes people use condoms for anal sex without any lube on them; apart from being painful this can also create other problems. The condom is more likely to rip, tear or slip off because of the increased friction. Having sex without lube greatly increases the chance of tears or cuts to the lining of the anus as well as tearing the condom. 44 The most important thing to remember is DON’T USE ANY OIL BASED LUBRICANTS WITH CONDOMS, they weaken the condom within minutes and it may well split while having sex. If you’re about to have sex and you realise you have no water based lube, you should still never be tempted to use oil based or anything that has oil in it - it will make the condom useless. If there’s no other alternative you can use spit but it’s not ideal because it dries out quickly. There are many brands of water-based lube available. Some people like different types of lube because of the colour, consistency and sensation so just experiment until you find the one you’re happy with. DON’T USE DO USE Water-based lubes like: Baby oil ID Glide Butter KY Margarine Boys Own Lube Vaseline TLC Vegetable oil EXS Lube Moisturiser Body lotion Lard 45 SEXUAL HEALTH SERVICES The best place to go if you think you’ve got a sexually transmitted infection, or if you want a sexual health check-up, is your local sexual health service. Sexual health clinics are completely confidential, so information isn’t accessible to your partner(s) or family for example. However, if you’ve been referred to the clinic by your GP or a hospital in writing, they’ll be kept informed about your diagnosis and treatment. If confidentiality is particularly important to you, go straight to the clinic without seeing your GP. Sexual health clinics see lots of gay and bisexual men and other men who have sex with men; for example, around 10% of the men attending New Croft Sexual Health Clinic in Newcastle are gay or bisexual. It will help the staff if you’re honest about the kinds of sex you’ve been having, because they’ll be able to do the right tests and treat you more promptly. Many gay and bisexual men and other men who have sex with men outinely have check-ups, some every 3 months, even if they feel perfectly well. Others like to go if they’re starting a new relationship. This way you’re reassured that you’re free from any infections and that you’re not passing anything on to your partner(s). 46 WHAT HAPPENS AT THE CLINIC? At Sexual Health clinics you often have to make an appointment but lots now have drop in sessions. Procedures vary a little from one clinic to another, but you’ll be asked to give a name (though you don’t have to), and you’ll be given a clinic identification number. You’ll then be asked to wait till you’re called (either by your name or by the number you’ve been given). If you ask for a check-up, or you have something wrong with you but don’t know what it is, the doctor is likely to do the following: • Examine your cock, balls, arse, and general groin area to look for scabies (little mites which burrow under the skin) or crabs (pubic lice), and to see if there are any warts, sores, or moist discharges. • Ask you to pass urine into 2 glasses; they’re looking for signs of infection in your urethra (the tube you pass water through). • Use a small cotton bud or plastic ‘loop’ to take a swab of the end of your urethra if you have any symptoms • Look up your arse for warts or evidence of infection; the doctor might use an instrument called a proctoscope to help them do this, this may be uncomfortable but does not hurt. • Take a swab from your throat with a cotton bud. 47 You will be offered a blood test for Hepatitis B and C, and vaccination if you need it. You’ll be asked if you want a test for HIV, the virus that can cause AIDS. This is optional and you can refuse the test. If you decide to take the test, the doctor or nurse will go through a pre test discussion with you, this has to happen on every occasion a HIV test is done. If it’s your first attendance or if you are seen as high risk or anxious you’ll be offered the opportunity to speak to a Health Adviser who’ll make sure you know about the advantages and disadvantages of having an HIV test before you make your choice. AFTER THE CHECK UP If there is anything the doctor or nurse is able to identify on the day you can start treatment immediately. All medication prescribed by sexual health clinics are free of charge. Your results are usually available over the phone and by text. While waiting for your results you should avoid having sex that could put others at risk but you can still have safer sex. Ask the doctor or Health Adviser if you aren’t sure what’s risky. Sexual health clinics should treat gay and bisexual men with the same courtesy as anyone else, and you should never be made to feel guilty for having sex, or for being gay or bisexual. If you feel that you’ve been badly treated, ask to make a formal 48 complaint. Alternatively MESMAC or other local gay men’s services can take up the complaint on your behalf. 1 HOUR HIV TESTING A FREE and CONFIDENTIAL 1 hour HIV testing service is available through MESMAC North East. The test is a simple finger prick test with a pre and post test discussion and results within the hour. There are also other 1 hour test services available in the North East and it is worth checking on line if you can or by calling us for the most up to date information on the number at the back of this booklet. r Test u o H 1 le o h w "I found the rtable". o f m o c d n a y process eas e feel m e d a m f f a t "The s afe" at ease and s 49 SEXUAL HEALTH AND HIV SERVICES IN THE NORTH-EAST If you have difficulty contacting any of the services, please contact MESMAC for the latest up to date information. Newcastle: New Croft Centre, Market Street East. NE1 6ND Call: 0191 229 2999 Durham: University Hospital of North Durham, North Road. DH1 5TW Call: 0191 333 2660 or 0191 333 26601 Darlington: Darlington Memorial Hospital, Hollyhurst Road. DL3 6HX Call: 01325 743203 or 01325 743616 Bishop Auckland: Sexual Health Services, Bensham Hospital. NE8 4YL Call: 0800 42 20 200 Bishop Auckland General Hospital, Escomb Road. DL14 6AB Call: 01388 455700 or 01388 603180 North Tyneside: Middlesbrough: Gateshead: One to One Centre, Brenkley Avenue, Shiremoor. NE27 0PR Call: 0191 297 0441 North Ormesby Health Village, 11a Trinity Mews. TS3 6AL Call: 01642 459583 or 0333 000 0014 option 3 Northumberland: Redcar: Carlton Street Clinic, 27-29 Carlton Street, Blyth. NE24 2DT Call: 01670 543131 South Tyneside: Department of Urinary Medicine Stanhope Parade Health Centre, Gordon Street, South Shields. NE33 4JP Call: 0191 2832525 Sunderland: Sunderland Royal Hospital, Kayll Rd. SR4 7TP Call: 0191 569 9021 / 0191 569 9022 50 Redcar Primary Care Hospital, West Dyke Road. TS10 4NW Call: 01642 511156 or 0333 000 0014 option 3 Hartlepool: One Life, Park Road. TS24 7PW Call: 01429 285719 or 0333 000 0014 option 3 Stockton: Lawson Street Health Centre. Lawson Street. TS18 1HU Call: 01642 704314 or 0333 000 0014 option 3 51 This leaflet and others are available in other languages as well as in large print, Braille and on tape for people with visual impairment Phone: 0191 233 1333 Email: [email protected] Website: www.mesmacnortheast.com www.facebook.com/MesmacNorthEast www.twitter.com/TeamMesmac MESMAC would like to thank the New Croft Centre Newcastle for their assistance in developing this booklet. MESMAC North East is funded by Public Health from across the North East June 2012 Design by differentia.co.uk.
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