1. Your Gay Arse: from top to bottom

Your sexual health is very important. Gay, bisexual and MSM need to stay on top of their health and protect themselves throughout their lives. There are a number of precautions you can take to prevent contracting a sexually transmitted infection, and if you are concerned you can easily take tests to find out your status.

All sexually active gay and bisexual men should be tested regularly for STDs, including HIV, Syphilis, Hepatitis B, Hepatitis C, Chlamydia, and Gonorrhoea.

If you have had sex with someone you don’t know well, or have casual sex with multiple partners, you should be screened more often for STDs and may benefit from getting tested for HIV more frequently.

It is important to have an open conversation with your doctor about getting vaccinations for Hepatitis A and B, and HPV – there are a number of vaccines that can help to protect your health.

You can do many things to protect your sexual health. For example, you can learn about how STIs are spread and how you can reduce your chances of getting an STI. Have open and honest conversations with your partners about your risk of being infected with an STI. You can also talk to your doctor about PrEP, which may be appropriate if you have many partners.


2. These are such a pain in the arse: Fissures, warts and rectal STIs

1. Fissures

An anal fissure is a small cut or tear in the thin moist tissue that lines the anus, and in the case of men who have sex with men, is most often caused by anal penetration. An anal fissure can also occur when you pass hard or large stools during a bowel movement. The condition generally causes severe pain and bleeding, and you can also experience spasms in the ring of muscle at the end of your anus (anal sphincter). The fissure can be deep enough to expose the muscle tissue underneath.
Symptoms of an anal fissure can include:

  • A visible crack or tear in the skin around the anus
  • Pain, sometimes severe, during bowel movements that may last several hours
  • Pain after bowel movements that can last up to several hours
  • Bright red blood on the stool or toilet paper after a bowel movement
  • Burning or itching in the anal area
  • A small lump or skin tag on the skin near the anal fissure

Anal intercourse puts you at a much higher risk of developing fissures. Repetitive injury to the area can prevent the anal fissure from healing, and if the condition last longer than eight weeks it may need further treatment.

An unhealed fissure may require medications or surgery to reduce the pain and to repair or remove the fissure. Otherwise, the most common treatments include dietary fibre and stool softeners, as well as applying topical pain relievers to the affected area. Taking a sitz bath to relax the anal muscles, relieve irritation, and increase blood flow to the anorectal area can also help.
Once you have experienced an anal fissure, you may be prone to getting them more often.

A doctor can usually diagnose an anal fissure by examining the area around the anus. They may sometimes need to perform a rectal exam to confirm the diagnosis, and will use an instrument called an anoscope to make it easier to see the tear. An anoscope is a thin tube that allows doctors to inspect the anal canal.


2. Anal Warts

Anal warts are caused by the human papilloma virus (HPV), one of the most common sexually transmitted infections (STI). The warts primarily affect the area inside and around the anus, but may also develop on the skin of the genital area. Anal warts first appear as small bumps or growths, and generally don’t cause discomfort or pain – they may itch or bleed as they grow larger though. They often develop a cauliflower-like appearance as they grow, or when several warts are clustered together.

HPV spreads from one person to another by direct contact with the mouth, anus, penis, or vagina of a person with HPV, even if warts are not visible. Sexual intercourse is not necessary to spread the infection as it can be transmitted by skin-to-skin contact.

You are at greater risk of contracting anal warts if you have unprotected anal sex with multiple partners.

A doctor can diagnose anal warts by visual examination. An anoscope may be used internally to look for warts inside the anus. Topical prescription treatments may be used for anal warts that are located outside the anus. Other medications or cryotherapy (freezing) to treat anal warts may be applied by your doctor.

3. Rectal STIs

Anal itching can be a symptom of a sexually transmitted infection, and is often an indication of anal herpes, gonorrhoea, anal warts, and pubic lice.
Anal herpes is caused by a virus known as the herpes simplex virus (HSV). Herpes can be spread by sexual contact with someone infected by the virus, especially if they have an active outbreak of herpes sores on their skin. Reddish sores and whitish blisters that appear when you’re having an outbreak can be itchy and ooze discharge or pus.


3. Douching and Enemas: Understanding the ins and outs 

Rectal douching (or anal douching or enemas) involves rinsing the rectum to clean it in preparation for anal sex.

Douching is usually performed with plain water using an instrument of some sort to push the water into the rectum, and then expelling it to rinse out. While generally harmless, it should be noted that douching should not be performed too often – too frequent or improper anal douching can lead to constipation, irritation in the lining of the rectum (which can increase risk for HIV/STD), or damage to the rectal walls.

Over the counter douches designed for women should not be used in your rectum. Also do not put any chemicals like soap inside yourself. What you use and how often you do it matters.


4. Preparing the ‘hole’ thing for anal sex

When it comes to having mutual pleasurable and safe anal sex, it’s important to know how to be prepared. In addition to cleansing and douching (as above), the paraphernalia we use can play a big part. But did you know the absolute importance of using a water-based lubricant (and not an oil based one) in conjunction with latex condoms? In case not, this is vital for condom safety!

While we are on the subject of condoms, always wear a condom and use a water-based lubricant. Sex toys should be treated the same for that matter, and always washed thoroughly after use. The wisest decision is to use a fresh condom on sex toys every time they are used.

Fingering, rimming and fisting can all bring great pleasure, but usually with the aid of a lubricant. You should again use a water-based lubricant and avoid chemicals that can irritate and damage the anus, which in turn increases the risk of infections and tears/bleeding. Sores or lesions make it easier for STIs such as Hepatitis and HIV to enter the body. And if you’re living with HIV, your viral load is likely to increase because your immune system is weaker – this will make you more likely to pass on HIV if you have sex without a condom. So your choice of lubricant may be a lot more important than you think.


5. Avoiding Anal Cancer

5.1 What is Anal Cancer

Anal cancer is predominantly caused by chronic or persistent human papillomavirus (HPV) infection. HPV, which chiefly spreads through direct skin-to-skin contact, is the most common sexually transmitted infection across the globe.

According to research, oncogenic high-risk HPV can be detected in 80% to 90% of anal cancers, placing anal cancer second only to cervical cancer in the strength of its association with HPV infection. Anal HPV infection among gay men is common and if it remains undetected or not adequately treated, it may lead to anal cancer. Likewise, HPV infection is also responsible for causing cervical, vaginal, vulvar, and penile cancers.

Furthermore, according to research, age-specific anal pre-cancer management, including post-treatment HPV vaccination, can potentially lead to an 80 percent decrease in lifetime risk of anal cancer and anal cancer mortality among gay men.

 5.2 How to Avoid Anal Cancer

If anal cancer is typically preceded by persistent HPV infection that often leads to pre-cancer, what can be done about it? Vaccinate against HPV! The best form of prevention for anal cancer is the vaccination against HPV infection. HPV vaccination is recommended for males 13 to 27 years old. It’s important to know that vaccination at older ages is not as effective in lowering cancer risk. Speak to your doctor immediately to get an HPV vaccination.


6. Anoscopy & Anal Cytology

What is an Anascopy?

An anoscopy is like a pap smear for the anus to detect anal cancer. Using a small tubular instrument called an anoscope which is inserter a few inches into the anus a doctor can evaluate problems of the anal canal. An anoscopy can also be used to diagnose haemorrhoids and anal fissures which are tears in the lining of the anus. It is also used in the treatment of warts produced by HPV. Screening for anal cancer in gay men is inadequate, but the Queer Wellness Centre is aiming to turn that around with Africa’s first anoscopy and anal cytology unit.

What is Anal Cytology?

Anal cytology is a screening test that collects cells from the anal canal to determine if you have anal cancer or are at risk of getting it. Like the cervix, you can detect cancer at any early stage, when it’s still treatable, via a sampling of cells.

The Anascopy Procedure

The anal Pap test is quick and painless. Your doctor will insert a swab that looks like a long Q-tip into your anus to collect a sample of cells to be sent to a pathologist in a lab. The pathologist then views these cells under a microscope to determine if they are normal, dysplastic (precancerous) or cancerous. This is a highly effective screening tool for the anal canal.