Anal Pleasure and Health: A Guide for Men, Women and Couples (42 page)

• Step 5: Learn to have natural bowel movements free of all straining-a major cause of hemorrhoids, fissures, and other anal health problems (see Chapter 7).

• Step 6 Apply something soothing to irritated anal tissues. The marketing of preparations for hemorrhoids is a multimillion-dollar industry, which indicates just how widespread the problem is. Some preparations simply soothe the area by keeping it moist. Others contain mild anesthetics to temporally reduce the pain. Still others claim to help reduce swelling, but their effectiveness is limited. Witch hazel or aloe vera usually work very well without the chemical additives. It's also a good idea to use moistened pads, available at all pharmacies, for gentle cleanup after bowel movements.

• Step 7: To help reduce overall stress, set aside at least two fifteenminute periods each day to practice deep, slow breathing combined with any other relaxation technique(s) you've found useful in the past, such as mindful meditation or progressive relaxation. If you haven't yet tried any relaxation techniques, now is a good time to begin.* Moderate exercise is also an effective stress-reducer. But avoid weight lifting or other activities that involve straining, because this puts pressure on your anal and pelvic muscles. Developing a simple but regular stretching routine is one of the best things you can do for yourself.**

• Optional Step: It's very helpful (once you get used to the idea) if you can find a massage or physical therapist with special training and experience with pelvic floor touch and release. This will involve receiving touch around, on, or even inside the anus. Intimate touch like this will progress very slowly, with plenty of explanations and discussion about your feelings and preferences. The therapist will use a latex glove and lubrication for this touch. If you'd rather skip the anal massage, receiving regular massages can also be quite calming. One additional note about massage: the idea that "deep tissue" styles of massage are more effective than gentle touches may be completely wrong for you. Many people say that lighter, even sensuous, touches relax them profoundly, while deep touch makes them tense up.

FINDING A PHYSICIAN OR ALTERNATIVE PRACTITIONER

AN IMPORTANT aspect of maintaining anal health is finding a competent, nonjudgmental physician and/or alternative practitioner with whom you can freely discuss questions about anal health with a minimum of embarrassment (a little is inevitable, of course, especially at first). If you're conducting some of the experiments recommended in this book, or plan to in the future, it will be an asset to let your physician in on your activities so that he or she can collaborate with you as a health advisor.

I've just described an ideal situation that, unfortunately, is relatively rare in the real world. For one thing, doctors often are judgmental about anal sexuality. Many of my clients with anal health problems report being questioned in accusatory or condescending tones. More frequently, judgments are implied rather than openly stated. Unfortunately, when you need medical attention for an anal health concern, you may have to settle for the basics: someone competent who won't scold you.

Of course, another big problem is that under today's "managed care," an oxymoron if there ever was one, doctors are so pressed for time that they can't focus on much of anything except your immediate symptoms and getting you out the door. If you're covered by one of these HMO, assembly line health plans, consider consulting an out-of-network physician with special expertise and paying for his or her services yourself Be sure to make it clear when you make an appointment that you'll be paying yourself because you want extra time.

Americans are increasingly using alternative healing practices, including mindful meditation, acupuncture, yoga, stress reduction, and body-oriented therapies. As a result, most medical centers now offer some or all of these approaches as adjuncts to traditional medicine. Generally speaking, alternative practitioners take a greater interest in the whole person, not just malfunctioning or diseased body parts. Usually, they'll will want to hear about your life circumstances, overall stress and emotional state-in other words, to understand your problem within a larger context. This can be especially important when there's no clear-cut medical explanation for your symptoms.

If you need advice or treatment for an STD, most cities and counties maintain clinics specializing in these diseases. Employees usually have a supportive, yet nonchalant, attitude-they've seen and heard it all-and follow strict policies to protect your privacy (you can even use a phony name). And none of the test results will wind up in your medical record, which isn't as private as you would wish. Your local Planned Parenthood may also be a good resource.

Those who are coping with HIV have the best chance of finding competent care at a university medical center or teaching hospital. Most urban areas, and even smaller communities, have clinics and private medical practices with extensive experience treating HIV and AIDS. You may want to explore one or more of the HIV and health-related websites listed in the References and Resources section following this appendix.

When it comes to finding a supportive primary physician or specialist, asking friends about their experiences with particular physicians can be a good start. Depending on the friendship, however, it may be difficult to describe your needs honestly. With or without a recommendation, I suggest an assertive approach. Whenever you consult with a new physician or other practitioneror if you haven't yet raised the subject with your current one-ask directly about his or her attitudes toward anal sexuality. Try not to be intimidated, but even if you are, ask anyway. Listen very carefully; if he or she dodges your question, squirms uncomfortably, or looks at you like you're an idiot, find someone else.

Many, but by no means all, doctors will relax their professional aloofness a bit if you make it clear that you expect to be treated like an intelligent person who is capable of understanding and actively participating in any treatment efforts. The best doctors already appreciate the value of informed and involved patients, so you won't have to convince them.

Most primary care physicians are trained in internal medicine and are quite capable of conducting a basic analrectal examination, or even treating some or all of the diseases I've just discussed. If you need a referral to a specialist, use the same assertive approach when you first meet with this person. The most likely type of specialist you'll see for analrectal problems is a gastroenterologist.

You might want to consider the fact that many gay and gay-friendly physicians who see lots of gay male patients are likely to have more practice and comfort with anal sexuality. Most of these physicians welcome all kinds of patients regardless of their gender or sexual orientation. Obviously, these openly gay physicians are much easier to find in urban areas.

Investigating alternative treatments can be a bit more complicated. Whereas Western doctors will vary in their assessments and treatment ideas, they generally choose among well-established treatment options supported by at least some medical research. Alternative practitioners draw on healing traditions, professional experience, and intuition, and they may also be more inclined towards experimentation. Their methods are less likely to be scientifically tested, although this is changing as alternative treatments skyrocket in popularity.

The greater flexibility of alternative healing methods is, in short, both a strength and a weakness. Wise consumers become informed about a variety of options, ask plenty of questions about a particular method, inquire about its rationale and outcomes in other cases, understand the possible risks and sideeffects, and make sure a plan is in place for evaluating effectiveness. Come to think of it, this is undoubtedly the best approach to any healing endeavor.

Presented in three separate sections: (1) Books & Articles, (2) DVDs, and (3) websites. Books of special interest, and all DVDs and websites, include brief descriptions.

BOOKS & ARTICLES

Addington, D. (1998). A Hand in the Bush: The Fine Art of Vaginal Fisting. San Francisco: Greenery Press.

Anderson, B. and J. Anderson (2000). Stretching. Bolinas, CA: Shelter Publications.

Often incorrectly seen merely as a preparation for "real" exercise, this invaluable guide places streching right where it belongs-at the heart of any healthpromotion plan.

Barbach, Lonnie (2000). For Yourself.• The Fulfillment of Female Sexuality. New York: Signet.

This updated classic offers a self-awarenss approach for women seeking to become orgasmic, or to expand their enjoyment.

Bergner, D. (2009). "What Do Women Want?" New York Times Magazine, January 25, 2009.

A fascinating report on women sexologists exploring the many mysteries of female desire and arousal.

Blumstein, P. and P. Schwartz (1983). American Couples. New York: Pocket Books.

Brame, W. D. and G. G. Brame (1996). Different Loving: The Worlds of Sexual Dominance and Submission. New York: Villard.

An excellent introduction to the many ways in which people enjoy playing with power in their erotic lives.

Brough, T. (2006). First Hand: An Erotic Guide to Fisting. Las Vegas: Nazca Plains Corp.

Califia, Patrick (2002, 2"d Ed.). Sensuous Magic: A Guide to S/M for Adventurous Couples. San Francisco: Cleis Press.

A gentle guide for couples wishing to expand thir sexual boundaries.

CDC (2007). Sexually Transmitted Disease Surveillance, 2006. Atlanta: US Department of Health and Human Services. (www.cdc.gov/hiv/ topics/surveillance).

CDC (2008). Male Latex Condoms and Sexually Transmitted Diseases: Fact Sheet for Public Health Personnel. (www.cdc.gov).

CDC (2009). HIV/AIDS Surveillance Report, 2007 Atlanta: US Department of Health and Human Services. (www.cdc.gov/hiv/ topics/surveillance).

Chalker, R. (2000). The Clitoral Truth: The Secret World at Your Fingertips. New York: Seven Stories Press.

This little gem of a book explains and shows the full scope of the sprawling, internal "clitoral body"and how it relates to other pelvic organs and muscles.

Clark, Donald (2009, 5th Ed.). Loving Someone Gay. Maple Shade, NJ: Lethe Press.

Another updated classic, this remains one of the best guides ever written for gays and lesbians and those who care about them.

Connolly, P. H. (2006). "Psychological Functioning of Bondage/ Domination/Sado-Masochism (BDSM) Practitioners." Journal of Psychology &Human Sexuality, 18 (1):79-120.

Davis, M., et al (2008, 6th Ed.). Relaxation and Stress Reduction Workbook. Oakland, CA: New Harbinger.

Anyone who's ever considered finding a relaxation method right for them should look no futher than this concise guide to just about every option available.

Dodson, Betty (1996). Sex for One: The joy of Sefioving. Three Rivers Press.

Sometimes called the `grandmother of women's masturbation," Betty Dodson has been guiding women to new heights ofpleasure for as long as I can remember.

Drew, W. L., et al (1990). "Evaluation of the Virus Permeability of a New Condom for Women." Sexually Transmitted Diseases, 17 (2):110-12.

Easton, Dossie and J. Hardy (2009, 2°d Ed.). The Ethical Slut: A Practical Guide to Polyamory, Open Relationships & Other Adventures. Berkeley, CA: Celestial Arts.

Those considering alternatives to monogamy will find plenty of options, and philosophies to go along with them, between these pages.

Ebel, C. and A. Wald (2007). Managing Herpes: Living and Loving With HSV. American Social Health Association (www.ashastd.org// herpes).

Ehrenpreis, E. D. (2003). Anal and Rectal Diseases Explained. London: Remedica.

Feigen, G. M. (1954). "Proctologic Disorders of Sex Deviates." California Medicine, 81:79-83.

Freud, S. (1900). "The Interpretation of Dreams." In James Strachey, Ed. Standard Edition of the Complete Psychological Works of Sigmund Freud, Vol. 4. London: Hogarth Press.

----- (1905). "Three Essays on the Theory of Sexuality." Complete Works, Vol. 7

(1913). "Totem and Taboo." Complete Works, Vol. 13.