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Authors: Debby Herbenick

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•
Start small.
If one or both of you is new to prostate stimulation, it may be easiest and most comfortable to start with something small such as a finger covered with a well-lubricated condom or a thin dildo that has a very wide base (so that it doesn't get sucked up inside the anus and rectum out of reach).

•
Go slowly at first.
Even with water-based lubricant, it can take time, patience, and a great deal of relaxation to insert something into a man's anus and rectum.

For more detailed information about anal play, including prostate play, check out my e-book
The Good in Bed Guide to Anal Pleasuring
(
www.goodinbed.com
).

70. What to do if . . . you get cuts or tears during sex

It's not unusual for women to occasionally notice very light pink blood stains on toilet paper when they pee sometime after sex or on their underwear within twenty-four hours after sex. This can be a sign of having experienced “microtears”—very small cuts or tears, possibly not even noticeable to the naked eye—inside the vagina or on the vulva itself. One
way to reduce the risk of getting cuts or tears during sex is to spend significant time in foreplay, giving the body enough time to warm up and produce sufficient amounts of vaginal lubrication. Remember: vaginal lubrication can help reduce friction and protect the vagina.

A second strategy is to start out slow during sex, as it gives you a chance to find your groove before adopting a faster pace. Some women also find that by choosing positions, such as woman on top, that allow them to assume greater control over how fast or slow or deep or shallow the penetration is, they can reduce the likelihood of vaginal cuts or tears. Finally, consider using a store-bought lubricant to decrease friction even more, making sex more comfortable and pleasurable. In our 2011 lubricant study, 22 percent of women said that they used lubricants during vaginal intercourse in order to reduce the risk of tearing. For anal sex, this figure was more than double, at 53 percent of women. If you continue to experience vaginal cuts or tears during masturbation or sex with a partner, even after trying these or other strategies, let your health care provider know. Some medical conditions or low-estrogen states (such as breastfeeding or menopause) can cause the vaginal tissue or vulvar skin to be thinner and more fragile, making women more vulnerable to tearing.

70. What to do if . . . a condom breaks or slips off during sex

If this happens before a man has ejaculated, it's probably not a big deal. Is it ideal? Of course not. However, if he hasn't yet ejaculated, the chances of pregnancy risk are extremely low. The chances of infection risk are increased the more your genitals touch each other, but you also can't go back and rewrite history to keep the condom on. The best you can do is make sure to get tested for STIs and try to do a better job keeping the condom on the next time. If the condom break or slip isn't noticed until after your partner has ejaculated, it's a bigger deal with more significant risks. If the condom was your one and only form of birth control, then you may be at risk of pregnancy. You might want to consider getting emergency contraception (EC, also known as the “morning-after pill”) to reduce your risk of pregnancy. EC is most effective when taken within three days of unprotected
sex. Again, follow up with STI testing. You will want to ask your health care provider how soon you can be tested for STIs such as chlamydia or gonorrhea, as it depends on the types of lab tests that a particular clinic uses. Some health care providers recommend coming in for testing several days after unprotected sex, whereas others advise waiting about two weeks for general STI testing and a month for an HIV test; although not everyone who has HIV will test positive one month after exposure, most HIV-positive individuals will.

The Condom You Might Never Have Heard Of

Many people in the US have never heard of the female condom—and if they have heard of it, they may never have seen one. They are rarely carried in drugstores or pharmacies. Those who do use them often order them online. However, female condoms are more widely available in countries outside the US, particularly as part of programs that work to empower women to take charge of their sexual and reproductive health and insist on condom use. In some ways, female condoms resemble pouches or baggies. The closed end is inserted into the vagina, which means that using them requires some degree of comfort touching one's genitals. The open end frames a woman's vaginal entrance so that her male partner can insert his penis into her vagina and only come into contact with the female condom (not her vagina itself). In this way, it serves as a barrier between his penis and her genitals. Even though the name of the female condom makes it sound as though it's used only by women, in fact some men who have sex with men use it during anal sex. Used in this way, the pouch end is inserted partly into the anus and rectum. To learn more about the female condom, check out
www.avert.org
or
www.plannedparenthood.org
.

71. What to do if . . . you run out of condoms but desperately want sex one more time and aren't on birth control

Many doctors, nurses, and health educators would tell you to control your desires, put your pants back on, and forget it: there is no safe way to have sex “just one time” if you're not on birth control. They're right: if you're looking to greatly reduce your risk of pregnancy and infections, condoms are the way to go. That said, I live in the real world and I know that millions of people have sex that puts them at risk, even when they know better. People take chances. If you find yourself in this situation, the best case scenario truly is to take a deep breath and try to resist. Do something else sexual that helps you to feel good and satisfies your desires but doesn't put you at risk. Straight couples (men and women together) are often focused on vaginal sex as if it were the only way to feel good sexually. Same-sex couples (gay men and lesbians) are often far more creative in bed because their sex lives don't revolve around penis-in-vagina sex. If you're in a heterosexual relationship, take a lesson and expand your idea of sex. It can be just as gratifying to masturbate each other or to masturbate in front of one another while kissing. Oral sex is another option; there is no pregnancy risk involved with oral sex, although there is still some risk of passing STI (however, it's a lower-risk activity than unprotected vaginal sex).

If you decide to throw caution to the wind and have vaginal or anal sex, even without a condom, at least ask him to pull out before he ejaculates. If you're not sure he's able to, then you might proceed with a few moments of intercourse and then, if you're on top, get off him (or have him pull out) and bring him to orgasm some other way, such as with your hands. If you can keep his semen out of your vagina, you will reduce your risk of infection and pregnancy. It's not the ideal situation but as far as the real world goes, it's better than nothing. And of course, make sure to follow up with appropriate STI and HIV testing.

Get Local

Find an HIV testing site near you by visiting
www.hivtest.org
. Local-area STI testing can be found through
www.findstdtest.org
, websites that are services of the US Centers for Disease Control and Prevention. You can learn more about HIV and STI by calling the CDC at 1-800-CDC-INFO.

Sex Smarts Quiz

1. Which toy should silicone lubricant not be used with?

a. A Silver Bullet vibrator made of hard plastic

b. A glass dildo

c. A vibrator made of medical-grade silicone

d. None of the above

2. Which of the following is the best advice when it comes to anal and vaginal toys?

a. Vibrators are best inserted in the vagina first and the anus second

b. It is safest to insert a vibrator in the anus first and the vagina second

c. Vaginal and anal toys shouldn't be mixed. Buy a separate one for each activity.

d. All of the above

3. Most women use vibrators to stimulate their

a. Clitoris

b. Mons

c. Vagina

d. Labia

Answers

1. c

2. c

3. a

Chapter 8
Sexploration: Giving Fantasies a Whirl

W
hat do Americans do in their private sex lives? How often do people have sex? And when they have sex, what exactly are they doing? These questions form the backdrop for many of the emails and letters I receive from readers of my sex advice columns. Given how much secrecy surrounds sex, it's no wonder that so many people would like to move sex conversations out of the dark and into the light.

Scientists have similar questions about sex too, though often for different reasons. We want to know what kinds of sexual behaviors people engage in, how often, and how they protect themselves from STI and pregnancy (if they do). After all, understanding human sexual behavior matters to our nation's health. If we can better understand what people do sexually, doctors, nurses, health educators, teachers, and parents can provide better—and more relevant—sexual health information to the people who need it.

Safer Sexploration

If you're having sex with someone you don't know well—whether it's someone you meet out at a bar or party or someone you connect with at a sex club—please consider making it as safe as possible. Use a condom. If you think using a condom with someone you don't know well is the obvious choice that anyone would make, think again. In our national sex survey, our research team found that teenagers were the best condom users of anyone. A total of 84 percent of young men and 89 percent of young women said that they used a condom the last time they had vaginal sex with a casual partner. That's great news, considering what a high STI risk group teenagers are in (not to mention unintended pregnancy).

Surprisingly, condom use wasn't nearly as common among
older adults who were having casual sex. Only 53 percent of men and 42 percent of women ages twenty-five to twenty-nine used a condom during vaginal sex with their most recent casual sex partner.
1
For those in their thirties, 58 percent of men and 31 percent of women whose most recent vaginal sex was with a casual partner said they used a condom. Adults in their forties were even less likely to use a condom with a casual partner: only 36 percent of men and 20 percent of women said they used one. Sex shouldn't be like Russian roulette. Keep condoms in your wallet and/or purse and insist on using them—especially if you don't know your partner's STI history, if you're not ready to become pregnant, or if you suspect your partner may have, or may have recently had, sex partners other than you.

H
OW
S
EX
H
AS
C
HANGED

I
n our National Survey of Sexual Health and Behavior, we discovered that one of the biggest recent changes to occur in Americans' sexual lives has to do with anal sex. In an earlier survey of sex in America that was conducted in the 1990s, it was found that as many as 20 to 25 percent of Americans in some age groups had had anal sex.
2
-
4
In our study, which was conducted close to twenty years later, we found that far more people had engaged in anal sex, which was reported by

• 10 percent of men and 20 percent of women ages eighteen to nineteen

• 24 percent of men and 40 percent of women ages twenty to twenty-four

• 45 percent of men and 46 percent of women ages twenty-five to twenty-nine

• 45 percent of men and 40 percent of women in their thirties

• 43 percent of men and 41 percent of women in their forties

• 40 percent of men and 35 percent of women in their fifties

• 27 percent of men and 30 percent of women in their sixties

• 14 percent of men and 21 percent of women ages seventy or older

Of course, many of these people may have only tried anal sex once or twice and others may have engaged in it more often. Regardless, this is a massive shift in sexual behavior and it's important. If we all kept believing, based on outdated scientific data, that only 20 percent or so of Americans had ever tried anal sex, we would be missing out on important opportunities to educate people about an increasingly common sexual behavior. This matters for reasons of health and pleasure.

If we fail to understand how common anal sex is, we're missing the boat on understanding more about HPV-related anal cancer (HPV can be transmitted during anal sex and has been linked to a number of cancers, including anal cancer). Other STIs including chlamydia and gonorrhea can also be transmitted during anal sex, and if doctors and their patients don't talk more openly about sex, including anal sex, that's a problem. If you have ever had anal sex, let your health care provider know so he or she can decide whether or not to offer you rectal STI testing (chlamydia and gonorrhea in the anus/rectum cannot be detected from vaginal testing, so separate testing is often recommended).

BOOK: Sex Made Easy
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