Category Archives: Douche

Has anal sex gone out of vogue? What does this mean for HIV prevention?

Note: Since posting this article I was able to look at the full text of the study, which does ask participants questions about condom use at last encounter.  Roughly about 33% of respondents state that they used a condom at some point during their last sexual encounter, with almost half of those that have had intercourse stating a condom was used.  However, the article does not go onto the provide more specific analysis on condom use, since it is difficult to extrapolate generalities regarding condom use, based on information about singular encounters

So the Advocate recently reported the findings of a large-scale survey on sexual behaviors.  Apparently, only 37.2% of over 24,000 gay and bisexually identified men indicated that their last sexual encounter consisted of anal sex.   The most practiced activities were kissing (almost 75%) and mutual masturbation (73%).

The survey, entitled  ‘The Gay and Bisexual Men’s National Sex Survey’ was sponsored by Manhunt,  its sexual health affiliate Manhunt Cares (see my past post here about them) and  its research partners,  present the findings in a cutesy interactive graphical form which can be accessed from clicking on the picture on the left (i.e. I found out that 80.8 % of surveyed men have eaten cum at some point in their lives!) The abstract of the study, which appears in the Journal of Sexual Medicine can be found here.

Now before we give up our lube and condoms and other devices we find makes our anal sex experience more comfortable, there a few things to keep in mind.  For some reason, the majority of respondents in this latest conducted by researchers from Indiana University and George Mason University were Caucasian males.  Perhaps results would be changed if there was some diversity in the subject pool.  Also, one should note that the respondents were “self identified” gay or bisexual.  Perhaps if behaviors of non-identified men who have sex with men, (i.e. heterosexual identifying men) were recorded the results would also show a higher indication of anal sex.  However, I like the point that one of the commentators made:   Anal sex does require a lot of effort (much like vaginal penile sex as well) and perhaps people don’t want to go through such effort simply to get off.

First, usually the receptive bottom has to be sure that they have maintained proper ass hygiene – for some folks this means just a thorough cleaning in the shower, however for others this means anal douching (see my past insightful entry on this issue).  Then, both inserter and receptive partner both need to be properly lubricated.  Any condom needs to be applied, towels need to be made readily available to absorb the lube and any other pre and post-fucking products,  and finally one may fuck.  For some individuals this ceremonial ritual just may not be worth it.  I am not one of these people, but I can see the non appeal.  Additionally this survey stated that 40% of men surveyed said that their sexual encounter was with someone who they were in some way committed to.  For many couples anal sex is a special sex act, that does not have to be performed during every sexual encounter.  In my opinion, I seem to see anal sex as the final act in the play of random hooking up (especially bar sex) but I personally tend to think couples in a relationship have generally been with each other so long they have other ways of turning each other on and understand that anal sex is not a necessity.

I don’t think this study can necessarily tell us too much about HIV prevention strategies, or where they should be aimed.  As some may know, receptive anal intercourse without a condom is the most risky sexual activity one can perform in terms of HIV acquisition.  And although we know that only 40% of these Caucasian gay identified men admit to having anal sex, we don’t know anything about condom use (I couldn’t find anything about condom use at last anal sex in any of these graphics).  So, it can be assumed that a portion of those having anal sex (or oral sex) are having unprotected sex.  Additionally, we can assume that many of these surveyed men did either not know their own or their partners HIV status (which is likely given that 60% of the sex acts were recorded to be with people whom the respondent was not intimately partnered with.) So this our crusade most likely should continue.  Even if anal sex is supposedly  not the most common sex act, it is the most risky, and deserved to still receive, in my opinion, the bulk of prevention attention directed toward MSM.  However, additionally since oral sex almost seems to be universally practiced, individuals should also understand the risks of such behavior, especially with an individual one does not know, including herpes and other sexually transmitted infections.

So in my opinion, while interesting, and while it sheds light on the sexually behavior of a self selected group of gay and bisexual individuals, this survey does little to give us insight into HIV prevention. But I guess that was not its intention.  However, I would expect that a survey carried out by Manhunt and partners would include information on condom use. (see note above: it does).

To douche or not to douche?

So I’m sure that anal douching is not a topic that we frequently discuss over dinner or coffee.  However, as some MSM know, anal douching is a part of some MSM’s sexual rituals.  For those that don’t know, anal douching involves cleansing the bowels usually with a stream of water introduced through a hose of some nature or a pump type device put up the anus as pictured to the left.  Many receptive partners douche in an attempt to become clean for their partner, however some also douche simply in order to cleanse their bowels.

So how does this relate to HIV?  There is currently no robust body of quantitative body of  research focused on HIV and anal douching.   Some have said that frequent repeated douching is a “risky behavior” and  may increase anal tears among MSM, thus contributing to increase spread of HIV (However, whether douche or no douche, of course, I would recommend to use condoms, which minimize this risk from douching).   A new qualitative study (the full text is not available without a fee)  shows that attitudes toward anal douching differ among HIV positive and negative individuals,  but does not discuss anal douching’s potential role in HIV transmission.  It does state that HIV positive men report douching more frequently than those who are HIV negative: In the sample 91% (10/12) of the HIV positive men douched and 50% (6/12) HIV- men douched. Obviously this sample is too small to draw any conclusions from.

For a humorous take on anal douching watch Hedda Lettuce’s Clip below.  Although there is no reference to HIV transmission and prevention it is funny nonetheless (or perhaps slightly offensive but I think funny).