Let me just launch into this a bit by telling you how I got into thisarea. Everyone assumes (and it's fine with me that they do) that I musthave gotten into this line of research out of my own personal, passionateinterest in anal sexuality. That's really not how it happened; it was atotal accident. Two things came together at the same time for me in the70's. One is that I had a horrible case of hemorrhoids; they were recommendingsurgery and I couldn't sit down without a pillow (you know, one of thosedoughnut-shaped deals). But also, right around the same time the sexualrevolution was full-blown, especially in San Francisco where I'm from.People were coming to me saying, "Well look, I'm hearing more and moreabout anal sex, it's supposed to be great but it's not great for me; I'meither scared of it or it hurts like hell. Help!"
I was doing sex therapy then, and so I ran off to the libraryto see what had been done. Of course, nothing had been done on it at all.It started out pretty informally; I said to those people, "Well, you know,nothing much has been done in this area, but why don't we work togetherand through your experimentation and suggestions we'll find out what'shelpful in getting you to the place you want to be." In the meantime, Istarted poring over anatomy books (which wasn't my habit before then) totry to figure out what's going on back there. As it turned out I was alsoworking on my Ph.D. I was very reluctant to define a new sexual dysfunction(isn't that the last thing we need?), but this was a concern people hadthat maybe sex therapists could do something about, or people could bedoing something about themselves if they knew how to approach it.
I wanted to devise a step-by-step, sex therapy-oriented processwith an experiential part which then becomes a catalyst for discussion.I ended up working on this for many years: gathering data and analyzingit and everything. I did what I used to call "Anal Awareness and RelaxationWorkshops" in San Francisco. They were extremely popular, particularlyamongst gay and bi men, but then as word got around and I did a fair amountof speaking, women started to come to me as well. I never had an opportunity,unfortunately, to do a group of women, but I did work with women individuallyand with their partners a lot. Not as much as the men, although the proportionhas changed in recent times. It's getting closer in terms of the proportionof women to men who present with the kind of concerns we'll be talkingabout today.
After I finished my doctorate I rewrote my dissertation as a bookcalledAnalPleasure and Health, which came out in 1981. It did very well becausethere was a hunger for information - but nobody wanted to talk about it.I did get on a few radio programs, but that was about it; I was never ableto do any TV. So it was pretty much just "thrown out there," and it hadto be word of mouth. But it's interesting, because up until just last Decemberit remained the only serious book on the subject in the world. So if anybody,especially with the advent of the web, wanted to search about anal sexthey would find their way to my book. Also, in 1981 at an AASECT meetingin San Francisco I presented on the research at that time. I have not presentedat either SSSS or AASECT since then, until this year, and to my knowledgeno one else has presented on this topic either. This is an area that sexologistsare interested in learning about but not researching, at least not at thispoint. Or so it appears.
In my original study, 143 people completed those anal awarenessand relaxation workshops. There were 114 men, 21 to 62, with a median ageof 30. At that time I worked with only 29 women, ranging in age from 25to 44, with a median of 32. Most of the women saw me with their partners.In the years since then it's really branched out and gradually more andmore physicians have been referring people to me, until now I really seemore people who are dealing with anal tension because they have anal medicalproblems rather than anal sexuality problems. But I'm still very activein both areas.
That's how I got into it, and I do have to mention that a thirdedition of my book just came out last Spring. I completely rewrote thewhole thing; the basic approach is the same, but it's totally updated.I really enjoyed doing it. My other book which will come up briefly inour discussion, TheErotic Mind, came out in 1995 and is about the psychology of desireand arousal.
We have to start with a discussion of the anal taboo; this isthe headline: when you think anal, think taboo. Freud made a distinction,a crucial one, between taboos and moral prescriptions, which give reasonsfor why you shouldn't do this or that bad behavior. Taboos have no justification.None is given; they just are. The anal taboo is passed along through ourearly training in life: that it's just disgusting back there, we shouldtune it out as much as possible, not be aware of it, and God forbid notmess with it or enjoy it. The anal taboo encourages us to tune out theanal area, making it a sort of numb part of our bodies that we're justnot familiar with and vaguely uncomfortable with. This has major effectson our sexuality. As Masters and Johnson showed, of course, and I guessanyone who paid attention knew before, the anal musculature is totallyinvolved in the orgasmic contractions, which you can feel in your anus.They're exactly the same: the same rate and everything. I'm amazed evento this day in my graduate level sexuality classes how many of the studentsdon't know that all orgasms are to some degree anal orgasms; you can'tseparate them. That's because the musculature in the pelvic region is allintertwined. The anal sphincter muscles are directly connected to the pelvicfloor muscle, which goes throughout the pelvis. I'll get into a littlebit of that when we get to anatomy and physiology.
So what does it mean when we have this taboo against a whole partof our anatomy that's intricately involved in sex? One thing is that itreduces our pleasure even if we're not interested in anal sex, becauseone of the ways we tune it out - to obey the taboo - is to constrict it.We hold tight and that may lead to pain and problems for us. I think thiscan blunt or certainly limit the potential of our orgasmic responses. Ithink feeling about an area of the body so closely related in proximity- and in so many other ways - with the genitals has got to carry over.The "badness" rubs off, and I think it affects our sexuality that way,and it most certainly affects the sexuality of people who would like tobe able to enjoy anal stimulation of whatever form, but can't because they'retoo emotionally/psychologically uncomfortable, or can't because of analmuscular tension that makes it just hurt and feel bad rather than pleasurable.
The anal taboo also has major effects on our health. Again, becausewe tune out and we tend to constrict, that means that there's all kindsof people, millions upon millions, walking around with very tight asses.They're probably not that aware of it until some problem crops up downthe road. But if you look at the statistics, hemorrhoids (which are oneof the top reasons people go to doctors and one of the most widespreadand uncomfortable medical problems in the whole country) can really befairly easily treated in a wide range of cases by just learning to reversethe effects of the anal taboo. This means to pay attention, to tune into touch, to look, to explore, and to familiarize with the area. This isthe most helpful thing a person can do.
As a little aside, when the new edition of AnalPleasure and Health came out, I had a little media boomlet causedby - I won't explain the details - some guy who's connected with all themedia; he did a focus thing in one of his issues on my book, but what hefocused on is, "Jack Morin thinks it's a good idea to put your finger inyour butt every day in the shower for thirty seconds, but Dr. so-and-sosays there's no evidence this is true, and besides the anus prefers tobe left alone." And that was it. For at least two months after that itwas non-stop radio appearances - that just sort of clicked, you know. Iwas on Howard Stern and they did a funny bit about it on Comedy Central,but anyway...
It's harder to prove what the effects of the anal taboo are insociety at large. But what does it mean to society at large forour health, our well-being, our sexuality, and our attitudes, to have onezone of the body that's cut off as forbidden? And what does this do forour abilities to take care of ourselves? This has, I think, public healthimplications that are very broad and obvious. I also think there's a lotof other societal effects that I don't have a way of measuring. Maybe somecreative person will come along who can measure them; I think that wouldbe a great piece of research.
Taboos of all types, it seems to me, are paradoxical phenomena.This means they can either intensify the interest in the taboo object,or act as inhibitors, which make people stay away from the taboo objector behavior. This dual-paradoxical effect is clear when it comes to theanal taboo. It has a big chilling effect, but it also creates for manypeople an extra level of fascination because it's taboo. I haveworked with people - maybe we'll get into it later - where my approachinvolved getting them more comfortable with the anal area, accepting it,and not feeling bad for wanting to enjoy it if that's what they want todo. Many people, once they adopt that attitude, say, "Hey, wait a minute- I'm not getting pain like I used to, but it's not as exciting as it usedto be either, because it's not taboo any more - I want my damn taboo back!"It's like everything else; things kind of go around, and so it now becomespart of the treatment to explore with people the importance of the tabooand discuss ways to keep the taboo alive for excitement purposes, but ina way that doesn't inhibit their health and well-being and relaxation andso forth. Sometimes that's a little bit tricky.
One of the things we need to do - and I would imagine this group has,to a certain extent, already done it or is well on its way - in order towork effectively in clinical settings with a whole range of anal issues,is to be able to recognize the lingering effects of the anal taboo withinourselves. Because, if we're not in touch with it within ourselves, we'renot going to be really good at helping other people get in touch with itwithin themselves. So I think one of the things we need to do is confrontwhat form the taboo takes for each of us. Maybe one form of it in our fieldis that we don't want to be caught studying something that is still kindof taboo. When I got into this research, I was embarrassed about it. ButI couldn't resist the temptation of studying something nobody else hadstudied, so that won out, but I was very embarrassed about it for manyyears. But I'm not any more - that went away somehow. There are some goodsigns that the anal taboo is weakening somewhat, and I would underlinethe "somewhat." People at the sex toys shops, like GoodVibrations and Eve's Garden, are all reporting a tremendous upsurgein anal toy sales: butt plugs and other devices for anal stimulation. Thebooks sell very well through those outlets, and they're talking about howpeople come in at the retail outlets overtly asking questions about analsexuality - even if there are other people in the store. And, people arebuying the book more openly; it's on more and more bookstore shelves. Fora long time it wasn't at all, because no one wanted to be seen buying it.
Audience: What does a butt plug do?
Well, it has a flared base, a narrow area where the sphinctermuscles would be, and then it widens out and narrows again. It's flexible- rigid but flexible - and it's basically for anal stimulation. "Butt plug"refers to the shape where it goes in, near the base, so the sphincter musclescan kind of hold it in place. Some people like to just leave them sit there- during sex or sometimes even when they're not having sex overtly.
Also, while the media interest is another sign that people interestedin anal sex, there are a number of other books in the works aboutit, and another one that came out at the end of last year about anal sexualityfor women.
Audience: Is it your impression that a lot of young people,rather than penile-vaginal intercourse, are turning to anal sex?
I do see some of that; I don't really have any hard data on it,to tell you the truth, but I've observed it anecdotally. I just think thatyounger people are experimenting more, which I think is good if they doit with their eyes open, so to speak.
What I want to do now - and this will be review for a lot of you- is go over the key points we have to be aware of about the anal and rectalanatomy in order to be able to talk intelligently about the subject. That'swhat these drawings are for. Look at the first drawing on your handout;you're looking at the anal opening - the short anal canal is only aboutan inch long, and then it opens up into the lower rectum. That's what we'relooking at in the enlargement here. The reason I wanted to show you this,though, is that it shows pretty clearly that there two anal sphincter muscles:the internal sphincter, which is on the inside, and the external sphincter,which is on the outside. Now, it's important to know this distinction foranyone who's going to be an anal explorer. Because the external sphincteris under central nervous system control, most of us (unless we're totallyout of touch with the area) just by tuning in and sort of deciding to releasecan learn to relax the external sphincter quite easily. The internal sphincteris controlled by the autonomic nervous system, so you may be able to relaxthe external sphincter and not be able to relax the internal one. It alsoseems to be the internal sphincter that stores up tension and stress ona cumulative basis; the anus often becomes what I call a tension zone -very similar to those of us who get the neck and shoulder thing, or theback thing, or the stomach thing, or wherever our tension zone may be.That mainly shows up in the internal sphincter. It really is the chronicinternal sphincter tension that is a major, major cause of hemorrhoids,which we'll talk about later.
You can see by this drawing that the external sphincter does havelayers to it, and kind of wraps around the internal sphincter; they'revery closely linked together. You can't see it in this drawing, but yousort of can see it in the tiny drawings of the male and female pelvis here,where in a very schematic way it shows how the external sphincter is connectedto the PC muscle, the pubococcygeus, the one we exercise in Kegel exercises.It's directly connected. And so if these muscles are tense, then what isit doing to our ability to enjoy orgasm when all those muscles that aresupposed to let go are chronically constricted?
With the next illustration, I want to get you oriented here withthe rectum, because if there's going to be intercourse or insertion ofobjects or a hand or whatever, then we're getting into the rectum. Thislower left-hand drawing shows the relationship of things. There's the descendingcolon, then there's that S-shaped sigmoid colon just up above the rectum,and then the anal opening. You can also see in this drawing on the bottomright something that's very important - a muscle called the pubo-rectalsling. It anchors to the pubic bone on one side, goes around and wrapsbehind the back of the rectum, and comes back and anchors on the pubicbone in the front and the other side. It supports the rectum, and its otherfunction is that it's responsible for the majority of our ability to holdback having a bowel movement even if we need to. It's not mainly the sphinctersthat do that job; it's mainly the job of the pubo-rectal sling, but thepubo-rectal sling can also become chronically tense, and you can imagineby looking at this drawing how, when it contracts, it sort of squishesthe rectum. This, I'm convinced, is a very significant cause of constipationas well as not being able to enjoy the insertion of objects into the rectum.
If you go to the next drawing, you can see another crucial thingto keep in mind and communicate to anyone who talks to you about this stuff:that the rectum is not a straight tube. It's not the same in everyone -obviously, everyone's a little different on everything - but generallyit takes two major curves along its length. You can see in this next drawingthat if you insert an object or a penis in the wrong angle it will runinto the wall just before the first rectal curve, and you're going to geta lot of pain. Some people try anal sex experimentally without learningabout it first; when I have a chance to talk to them and ask them to focusa bit, they'll identify the pain of trying to go through the constrictedsphincters (and that's pretty excruciating), but some will say that afterthey learn how to relax the sphincters they still feel a pain deeper inside- and that's it. That's what it is in almost every case, and this problemis exaggerated when you have excess tension in that pubo-rectal sling.
You also need to be aware that the rectum is not normally a storagearea for feces; they're stored in the colon just above the rectum. Whenpressure builds up there's another sphincter leading into the rectum (atthe top) that opens up, and then the feces start to descend and createthe full feeling that signals us it's time to go poop. If it's not convenientfor us to go poop we'll contract that pubo-rectal sling, and to some extentthe sphincter muscles as well. After bowel movements (depending on theconsistency of the feces and other factors) there is sometimes some leftoverfeces in the rectum, but it's not a storage area for it.
Learning more about the anal and rectal area and how to relaxthis musculature does seem to translate in many cases, particularly ifit's combined with an overall relaxation process, to the whole digestivesystem. I've had some pretty effective work - though not as effective aswith the hemorrhoids - with people who have so-called irritable bowel syndrome,where they fluctuate between constipation and pain and gas and diarrhea;they essentially get very reactive to anything that's going on with theirlives, in their gut. Learning how to relax these areas does sometimes reallyhelp with that.
I'm not going to go into fisting much today because of time constraints,but I wanted to mention a couple things about it now because it relatesto our picture of the anatomy. Fisting refers to the insertion of severalfingers, sometimes the whole hand, and sometimes even the forearm as well,into the rectum. If it involves the forearm, then the fingers are makingtheir way into the lower colon; they're going beyond the rectum. This activityhas maintained a strong popularity. Of course it's a minority activityand I suspect always will be, because even most of us who are relaxed stillcan't do the fisting thing nor would most of us probably want to. But,a lot of people find that fisting is the most intense erotic experiencethey've ever experienced in their lives, that it brings them an incrediblesense of oneness with whoever is doing it to then, and that it's a formof meditation. It takes a ton of time (it's not a quickie), but they getinto altered states of consciousness and just have incredible experiences,sometimes without any genital involvement whatsoever - intense orgasmicexperiences. Handballing is another term for fisting - I think it's better,because most people are fooling around with multiple fingers, and not gettingthe forearm in there. These are the real fisting enthusiasts, who wantto just get bigger and further.
I wanted to at this point mention something about the spectrumof anal pleasure that's available, because when people talk about analsexuality they're usually thinking anal intercourse, and that's such asmall piece of what people do for anal pleasure. Contracting the musclesvoluntarily during sexual experiences can sometimes enhance pleasure, sosometimes people don't even touch there; they're just being aware of andin tune with the anal contractions during orgasm as a way to enhance thepleasure of the orgasm - voluntarily continuing the contractions of theanal muscles as the reflexive ones wear down. It's one way of extendingthe orgasmic experience.
Also, a lot of people really enjoy fingering: either their ownfinger on the external anal opening, usually as part of masturbation, orinserting the finger as part of masturbation. Many couples and partnersenjoy doing this - they do it with each other, or one way. It doesn't haveto be equal, necessarily; maybe one person likes it, and the other persondoesn't mind doing it but doesn't want it (or whatever). There's also oral-analcontact, which is popularly called "rimming" (referring to "around therim" of the anal opening), there's inserting objects like butt plugs ordildos and vibrators, and there's inserting penises. We need to be awareof the whole spectrum, because there's a lot of people who love anal stimulationbut don't want anal intercourse.
I get letters from all over the world thanking me for writingabout anal sex, and one of the biggest subgroups is from straight guyswho say, "I'm so glad I'm not the only one who loves this stimulation -I've always wanted to tell my partner about it but I'm too embarrassedso I just enjoy it on my own, but I've worried in the back of my mind thatthis means I'm gay, even though I'm not attracted to men." It really concernsa lot of guys when they like anal stimulation. I've even had guys who camein and said, "Well, my girlfriend [or my spouse] put her finger up my buttwhile she was giving me a blow-job and I had the best orgasm of my life- does that mean I'm gay?" By what train of logic I'm not sure: "Gays likethe butt stuff" I guess is the thinking there [audience laughter].
I've named a whole spectrum of problems of not being able to enjoythe anus in the way a person might want as "anal spasm," because it alwayshas a great deal to do with contractions in the anal sphincter musclesand the pubo-rectal sling. And so my approach focuses on building awarenessof the whole area, learning how to tune into those muscles to relax them,and then seeing what you want to do - doing some experimenting and settingyour own boundaries. The anal experimentation that most people do is literallygroping in the dark. It's like, "Let me stick it in," essentially. No preparation,no relaxation, all too often minimal-to-no lubrication. And not surprisingly,receivers of anal intercourse who are introduced to it this way often doNOT like it, because the odds are pretty high that it's going to be prettydarn uncomfortable.
As you therapists may have noticed, there's an increasing numberof people with concerns about anal sexuality. Gay men will just come in,and maybe it's because I'm "Dr. Anal," but they'll come in and say, "Iwanna get fucked and I can't." Most people are not that direct about it.They may not mention it to you at all, actually. It may not be the numberone presenting problem, but if you don't at some point learn how to inquireabout their attitudes and feelings and fantasies about anal sexuality,you may miss something very important. There are many couples for whomwanting or not wanting anal play is a major source of conflict. They maynot talk about it that much because the big "no" was said a long time ago,but there's still smoldering resentment about it; relational conflict isone way that it manifests. Sometimes when people come in with sexual avoidance,it may be that they've had very bad anal experiences with a partner whostill wants to keep having them, so they just want to "Stay away"; theytry to avoid sex. I've seen it involved, in various degrees, in cases ofreduced desire as well. This has occurred in people who know internally(and will tell you if they're comfortable enough), that anal fantasiesare important to them; it's very erotic to them one way or the other. Theywant to be able to take that over into behavior but they don't know how,or they're afraid, or they're embarrassed, or whatever. In some peoplethat contributes to getting them out of touch with the inner wellspringof their erotic life; they're cut off from it because they just can't doanything with it, and so the whole thing starts to wither.
An indirect effect of anal spasm that may have nothing to do withsex is anxiety. One of the things to keep in mind is that anal muscle tensionis very primitive. It operates on the survival level, very much part ofthe fight-or-flight response. Normally, if we were very afraid, our sphincterswould open up and we would defecate on the spot, which would lighten theload so we could increase our chances of escaping. Well, we unlearned thata long time ago, and so now what we do when we're super-tense is clenchlike crazy. A lot of people who have various anxiety disorders are keepingthemselves on a hair-trigger where anything can set them off into anxiety,and are partly maintaining it by having their anuses chronically tied up.I do try to get people who are working with anxiety disorders to pay attentionto their anus (they won't get into sex unless that's where they want togo with it), and I have found that in working with anxiety it's very helpfulif the person can learn to release the tension that they tend to carryanally. Combined with the other things you would do, this is a major adjunctto effective work with anxiety disorders. I can't go into that but I wantedto at least mention it.
I have depression mentioned in your outline as another indirecteffect. This hasn't come up as often, but there are people - similar tothe ones I was describing earlier - for whom the anal area would ordinarilybe very important (and maybe it is fantasy wise), but they can't do anythingwith it. There are lots of indirect reasons why it contributes during sometimes to people being depressed. I've had men - mostly straight men, butother orientations as well - who will come in depressed. They'll have asituational depression out of the realization - something will remind them,like a strong fantasy - that they would really like to get fucked, or havesomething stuck in back there; it throws them into a turmoil about theirsexual orientation, and in some cases there's reason for that turmoil becausethey really are confused. I'm working with a guy right now who just happensto be really obsessive and always has to have a fear, and his fear rightnow is that he had an anal fantasy with a guy and now he's afraid he'sgay. But he's never felt any attraction for men at all. So in his caseit's just that he needs something to be afraid of.
When it comes to anal tension, there are two important distinctionswe need to make. First we need to look at whether the anal tension they'reexperiencing global (in other words, it happens all the time) or situational(it happens only when someone's trying to put something up their butt).This distinction between global and situational is one that people arenot very prepared to make, generally speaking. So in raising it I'll say,"I'm wondering: is your anus tense a lot of the time, or just when you'restressed out, or only when your partner moves his or her finger near youranus, or just with a particular person [or whatever]? Have you noticed?"Many will initially say, "No, not that much; I think I'm pretty relaxed."Some will say, "I think I'm pretty tense, because I have these horriblehemorrhoids [or whatever it might be]." But generally speaking, the reasonfor raising this question is not to get the answer; you raise this questionas part of initiating curiosity: "Is my anus tense all the time or not,and what does this mean and what's that all about?" As the person getscurious about that, you can fairly easily initiate them into somethingpretty benign like having them touch their external anal opening when they'rein the shower, and just having them notice what they notice. That's a bigdeal for some people, but most people can do it reasonably comfortably.Sometimes I'll just ask a client, "Do you feel anything right now?" I wouldsay that, generally speaking with a few exceptions, if a person cannottune into their anus and tell you whether it's pretty tense or pretty relaxed,it's tense. Because if it wasn't tense they would be more in tune withit, at least to some degree.
The other distinction we want to make, as we do in other sexualdysfunctions, is whether we're talking about a primary or secondary dysfunction.Has it always been a problem, or did it crop up more recently (or at somepoint along the way) that made you aware of it? The most common secondaryscenario is that someone tried to stimulate them anally in a way that didn'tfeel good or safe. Of course, you get more serious cases where people dosuffer anal trauma; there's anal rape, there's anal date rape, there'sforce and coercion, there's getting drunk and engaging in sexual activitiesthat happen in less than consensual ways, etc.
Another major source of anal trauma is medical procedures. Almostall the treatments they think of hurt really bad, and one of the majorcauses of anal tension is pain. How ironic that in trying to solve analmedical problems the physicians would be prescribing stuff which hurtsand causes more pain, more tension, and more problems.
In my work primary-global tension is most common. In other words they'vealways been tense and anal stimulation has never worked very well for themsexually even when they wanted it to. The primary-global pattern constitutesless than half of the people I have studied, but it's the biggest singlesubgroup. I have to say a little bit more about trauma: we have the medicaltrauma, we have the sexual trauma, we have childhood sexual trauma involvingthe anus, and we have enemas. It used to be a common practice that if youwere constipated they'd stick this enema thing up your butt. I can't tellyou how many people come to me with this as a major lasting trauma- an invasion of the first order. It's a rape, but it's intended as treatmentat home and is done by a parent who's having you strip your clothes off,turn your butt over, sticking stuff up your butt, and then watching youshit. It's very, very traumatic for a lot of people; thank God this isn'treally "in" any more, although I'm sure some parents still do it just outof creative thoughts on how to torture their kids.
Now I want to briefly go over with you the process I use, whichis outlined in much more detail in my book, to help people become moreaware and more relaxed. The first thing we have to do is broach the topic.We've already talked about how to do that to a certain extent, but unlesssomeone is reasonably comfortably presenting to you early on that, "Gee,we'd kind of like to experiment anally," or "I would," or "I tried it andit sort of was nice," or "It could be nice," or "My friends say it's nicebut it hurts," it will come up in more indirect ways. Especially when thisis the case, we have to look at how we invite discussions of this topic.I've mentioned one way, which is to raise the question of, "Are you intune with your anus right now?", "Is it tense all the time, or only sometimes?",or "Are you curious about that?" People get more curious about it whenyou tell them that their chronic tension is a major cause of anal medicalproblems. The timing is important. I work a lot with inner sexual conflicts,which I address in my book TheErotic Mind. One thing I've learned is that if you ask too soon,"Are you interested in anal sex?", you run the risk of getting the "officialanswer" which the client is then locked into for a significant period oftime. It will be harder for them to say, "Well, I didn't really tell youthe truth before," and they'll be ashamed and so forth, so don't ask themright away unless they're clearly open enough. You can beat around thebush and see if they'll touch on it.
If you haven't had an opportunity to discuss anal sexuality, whetheror not you're interested in it personally, with other people both clinicallyand outside of the clinical setting, I would really encourage you to doso more. Make a point of it, because it's going to make you more comfortablediscussing it and putting it into words, even if you're already comfortablein your head. I think that we communicate our comfort level a lot to ourclients, and they really can sense it. So we really need to know exactlyhow we feel about it. Sometimes anal discussions and experiments can bea very nice part of a larger process of erotic self-discovery. You mightbring it up by asking them, "Do you ever enjoy any kind of anal stimulation?"You can preface it (and this is very helpful) by saying, "You know, a lotof couples like to touch each other anally during their lovemaking; haveyou two ever thought of that or tried it?" If you present it that way,then it's normalized right off the bat and no big deal. Basically, I findthat once you open the question of anal touch, and if the client picksup your comfort level and it seems to flow pretty well, they'll go whereverthey need to go with it.
In working with a person who wants to learn how to relax or enjoyanal stimulation more than they're able to, the number one thing you haveto work with them on, before you do anything else, is to get them to seethe crucial importance of making with themselves a "no-pain-ever commitment."The belief is widespread, even among people with a lot of anal experience,that it hurts at first when you have anal intercourse, but if you bearit for a little while the pain will go away and it will feel good. Thisis a very unhelpful approach, because basically what's happening is theanal sphincters are saying, "No, No, No!", but you're plunging ahead anyway,and at some point the muscles will just give up. They'll go into spasm- that's the initial pain - and then they'll collapse: that's the so-called"feel good" moment. When people learn to explore anal insertion withoutany pain, they realize, "Oh, what I used to call 'feeling good' was simplythe pain going away!" So, no pain ever is crucial. The agreement is tomake sure nothing will be done by you or anyone else that will cause youany anal discomfort whatsoever. This involves assertiveness training alittle bit, because you have to be able to know your limits, set them,and say when you're uncomfortable. In sex, as in life in general, you knowhow hard this is for many people to do this. So, the no-pain-ever agreementis something that should be discussed throughout."
In actual practice when someone wants to do something to them,and it's going to hurt or they're afraid it's going to hurt, are they actuallygoing to say, "I don't want to do that right now"? Many will not; they'lljust grit their teeth and bear. Perhaps they feel their partner is moredesirable than they are, or they're afraid of losing or disappointing theirpartner, or whatever it might be.
It's important to define the goals that they have, and their motivations,for wanting to do this. Is the goal just to find out what they might enjoyanally, how relaxed they can become, and what they want? Is the goal tohelp with anal discomfort caused by a medical problem or the beginningsof a medical problem? Is the goal to be able to have intercourse with apartner?
I make a big distinction between performance and pleasure-orientedgoals. When people come in and say, "I'd really like to be able to haveanal intercourse because my partner wants it so much; I want to be ableto please him [or her]," that's what I mean by performance. Pleasure hasto do with, "I think there's something in this for me, I've gotten hintsthat this stimulation can feel good, I want to enjoy it more, and I don'twant to be blocked in the ways that I am." The difference between the motivationsof pleasure vs. performance was strongly correlated with outcome success,the effectiveness of the entire process. Of the people who completed therapy,which in the group setting was eight weeks and in individual or couplestherapy was more variable, two-thirds of those who were doing it to pleasetheir partners had success. It blew me away their success rate was thathigh. But for those who were doing it for pleasure the percentage wentup to 89%.
The first steps I've already talked about: engaging someone incuriosity about what's going on back there, and maybe touching themselvesin the shower. I also talk with people about getting out the old hand mirrorand taking a look. People might initially think, "Yuck" - they don't wantto it. This is understandable given our training. Very often that is theresponse when they first try it, and maybe the first several times, a certaindegree of revulsion. But I can't emphasize how important it is for peopleto develop genuine comfort with the area. If you think of the rest of yourbody, is there any part of your body that you're comfortable with thatyou don't look at one way or another, at least occasionally? So why shouldit be any different with the anus? But sometimes people can't do this asa first step; sometimes people can touch it in the shower more easily thanthey can look at it. This does not have to be done in any particular order.
I encourage people to explore themselves with their finger inthe shower every day, just to develop a good health habit. It's part ofthe way I shower - partly for cleanliness and partly to check in back there,to take a couple deep breaths and start the day with a relaxed anus. Forpeople who have goals for pleasure, this is the best way to distinguishthe internal from the external anal sphincter. You can actually feel them;put your finger in and rub around, and you'll be able to feel the externalring and the internal ring. And then, if you take some deep breaths andrelease, you'll be able to feel the external one relaxing. The internalone may not relax; there may be training involved in learning how to voluntarilyrelax the internal one, and it's also the internal one that stores thetraumatic and painful memories. I believe in cellular memory; it's at leasta great metaphor.
What we're doing here, is to use the finger and use the fingeras a biofeedback device. In the early days of my research, I did have abiofeedback device made for anal insertion. There is now a group of urologistswho are recognizing the role of tension in chronic pelvic pain and otherproblems, and are using biofeedback to record the data all day long andthen feed it into the computer so they can track it. But the finger worksjust as well, so I dropped the equipment, because if a person can justinsert their finger and take some deep breaths and tune in, they'll eventuallylearn how to let go.
What I encourage people to do, especially with the internal sphincter,is to feel it and then if it tenses up a little to just say to themselves,"It's tense, it's tense, it's tense." Then, if they feel it relaxing, tosay to themselves, "Relaxing, relaxing, relaxing." Just say what goingon as you sense it with your finger. That's the basic biofeedback principle:that by gathering a steady stream of information you will begin to developvoluntary control even over so-called involuntary functions. Just as peopledo with heart rate and blood pressure and all kinds of other things theycan learn, and learn surprisingly easily if they just practice consistentlyover a period of time.
The next step, especially for those wanting anal intercourse, is toexperiment with a butt plug, which come in a whole range of sizes. If thepeople you're working with are tense, new to all this, and uncomfortable,then small butt plugs are called for. They're a great way to begin, andshould be inserted very gently. The no-pain-ever commitment applies. Lubricantis necessary, too! I guess this is the point where I have to mention somethingabout lubrication. For easy cleanup the water soluble lubes are good; forthese experimental phases of just inserting and developing a little comfort,I do recommend the water-soluble lubricants. But for prolonged insertionof an object or a penis or whatever, I think most people want it oily andgreasy. Some people like thin oil, some people like the thick goopy stuff.
Once a person can insert something comfortably, they might wantto try that insertion with a masturbation session. If this becomes pleasurable,then they may be ready to doing some experimentation with a partner. Butbefore I go to the partner stuff I want to emphasize that you've got tosomehow address feces disgust. The training is so intense to find it disgusting.As infants we're totally neutral about it, but we don't stay that way forlong. How do you overcome this? Well, there are two ways to go, and I likea combination of the two. Most of us probably are not going to like feces,but it is very realistic for us to not be so freaked out by them. If you'reinserting an object and pull it out and there's a little bit of shit onit, this does not have to be an emergency. For some people it really is,it's such a turn-off that it's unbelievable.
The other approach is for people to learn how to clean themselvesto reduce the chances that they're going to encounter poop in the firstplace. Here we're talking about anal douching, which can be done in a numberof ways. You can get one of those disposable enemas in the drug store overthe counter, like a Fleet enema, and dump out the crap that's in thereand put in warm water. It has a very nice flexible lubricated tip thatyou can then insert, and then squeeze the water through. This will justclean out the lower rectum. Hold the water in a little bit and then siton the toilet and let it out. Some people repeat this several times.
For those who want a cleaner rectum further up, you can get oneof those douche-bag hot water bottles with the nozzle on it, and just hangit up let gravity move the water. They offer a higher volume of water andbetter cleaning. For those who really get into it, there are devices thatattach to the shower. You have to be careful about the water pressure.If you just use warm water it doesn't seem to upset the natural bacterialstuff in the lining, irritate the lining, or mess anything up; I've neverseen a problem with it.
Audience: At what point along the way does insertion becomea problem? I have no idea how long the particular mechanism you're talkingabout is, but some of the dildos out there are fairly substantial...
Well, I encourage people to start with something small, wherethey're sure (or pretty sure) there's not going to be any pain. I encouragepeople to not necessarily yank the thing out if it hurts, but back it offgently and sit there and breathe. And then there's a question that needsto be asked: "Does this sensation I'm getting right now hurt, or is itjust different?" Because we're used to rectal pressure, but not pressurecoming in that way. Some people will feel that pressure is weird, as ifthey're going to have a bowel movement. So they have to get used to itto a certain extent, but that's different from actual pain.
Audience: On the subject of not upsetting the biologicalbalance of the area, what about ejaculate upsetting that balance? If Imay speak personally, my bowel movements change, over a period of about24 hours afterwards.
Well, apart from the safe sex considerations, and assuming theseare two monogamous people, both healthy, not using condoms... I again havenever heard of semen being an irritant. It's hard to differentiate what'scausing what, because if you're having an anal sex experience people doget sometimes some blood or some irritation, especially if it's too vigorous,or goes on longer than they want. It might be the intercourse itself ratherthan the semen.
Audience: Also, depending on what lubricant is being used,there might be some residual lubricant...
There could be a residual effect. The oilier or greasier lubescan hang around until your next bowel movement, but the water-based willwash out.
Audience: Putting an oil-based [lubricant] on the mucousmembranes - that's something you don't do with the vagina...
Well, but the vagina doesn't wash out as regularly; it's not a"through-system" as regularly. Pretty much daily the rectum is a through-system,and so it cleans out more easily. I do think there are more issues withoil-based lubricants used vaginally than used anally.
Audience: Can the "cleaning-out" phase you're describingcause erectile difficulties in men?
I have never heard of that one... What I am aware of isthat many guys who enjoy anal stimulation, if they're really focused onit, may lose their erection. This concerns them. It may be a reflectionof some discomfort or anxiety, but if they're relaxed and enjoying themselvesit may also be a reflection of shifting the erotic attention away fromthe genitals to the anus and rectum.
One more thing I have to say about working with clients aboutfeces disgust is that you've got to acknowledge it - which shouldn't betoo hard to do. I also think that language communicates so much about ourcomfort or discomfort. In working with someone, I will start out usingthe word "feces," especially if they're more formal in the way they speak.I take cues from them on how they talk about sexual activities and genitals,and if they're using slang terms and not being formalistic I'll usuallyswitch over to "shit" or "poop." Casual words can help to reduce the negativecharge. And when people do talk about their bad feelings about feces, orhow strongly they react sometimes, validate that; don't say, "Oh, you don'thave to react that extremely," because that's not going to help. It justbecomes another thing to feel bad about: "I'm reacting too extremely!"Encourage them to accept how they feel, and not communicate that they shouldfeel something different.
Then, if a person wants to move toward partner stimulation, Ireally recommend that they don't begin with intercourse. It's really greattraining towards being able to have healthful and pleasurable intercourseif they develop the habit of fingering and massaging each other (or especiallywhoever is going to be the receiver) as part of the prelude, so that relaxationis built into the process. That's why I encourage people to do a lot oftouching with a partner, without intercourse. Some of the partners justwon't do it. They say, "Yes, I'd like to have intercourse but I don't wantall this rigmarole, I don't want to think about it that much, I don't wantyour finger down there," and so on. You have to honor where people are,but you can ask them to elaborate on what their feelings are and try tounderstand where they're coming from, to see if there's a way they canaddress the underlying issues.
I also recommend to couples who have feces concerns, "Well, whydon't you experiment after you bathe or shower together, so each of youcan maybe wash the area with your finger and make sure it's clean, andthen you're just going to not encounter that." And then some people, ifthey become comfortable with a butt plug of whatever size, may ask a partnerto do that.
With intercourse, I've mentioned that not only can it be pain-free,but that it should be pain-free; pain is really a sign of not beingsufficiently relaxed - that's what pain means. Pain is not the first phaseof anal intercourse, it's a sign that you're not sufficiently relaxed,that you're not ready. Usually it's a matter of going back to some analmassage first, or maybe the current conditions aren't right.
Audience: Are you saying that, independent of the amountof experience that one has had, that pain is nevertheless an indicatorof something being done wrong?
Yes! It's an indicator that the person is not relaxed enough tofully enjoy what they're trying to do. Whether it's getting fucked by abig penis, or a big dildo, or a small one for that matter, if it hurtsthen that hurt is a message: "OK, let's stop for now." What some peoplewill do, though, is ask their partner to very slowly insert as they takesome deep breaths, and once he is inside to just sit there; then there'san adapting and a relaxing. It sometimes can happen in only a few seconds,or maybe it takes a little longer. A lot of people have very comfortablenon-pain intercourse starting out that way. And then slowly more movementcan begin. But those people who jam the old penis in there and start pumping,that's more likely to hurt, though it doesn't hurt for everyone. Thosewho really like it and have learned how to relax with it can just go rightfor it...
Audience: I was told that anal toys should all have bases,but you mentioned some toys without bases, so I'm curious what's goingon there...
I say to people, "If you want to insert something that doesn'thave a base, make sure it's smooth - and realize that it's not meant forvigorous insertion." The base of the butt plug - and most dildos have abase also - allows them to get as passionate as they want and not accidentallyshove it all the way in. But it is important that people know if they doshove something in there, like a Zucchini or whatever, that they don'thave to panic and run off to the emergency room. They can just sit downand relax. It'll come out. Sometimes you hear about people who do insertand "lose" strange objects inside. Some are anal enthusiasts who go toofar, but a lot of them are people who don't go far enough, in the sensethat they don't bother to learn about the area first. They just start stickingstuff in.
Audience: I'm curious, for people who work with women withvaginismus, if the same tools apply. That is, you do have dilators...
I think the vaginismus analogy is very close, and it's not justthe dilators: it's the familiarity with the area, it's tuning into theemotions that may be stored there or triggered there. The memories, thefears, the anxieties. It's very similar.
For experimenting with anal intercourse, it seems to work verywell for a lot of people if the receiver is in a position where they cancontrol the rhythm and depth of the penetration. So, the receiver on topor side-by-side tends to be very good. Also, a circular motion rather thanthe in-and-out thing can work well; some people like that a lot betterand don't want to do the in-and-out motion at all. It's more like, "Movearound in there, don't pound me."
There are many sources of pleasure when it comes to anal and rectalstimulation; there's lots to be stimulated. There's an incredibly richsupply of nerve endings all around the anal opening. The rectum is a littlebit like the inner part of the vagina: more responding to pressure andnot quite as surface sensitive. In males you have the bulb of the penisterminating in the perineal area right next to the anus, and it is actuallyanchored to the same muscle that the external sphincter is anchored to.I think that guys often get a lot of indirect stimulation on the innerpart of their penis; things are getting moved around. Women are talkingmore about just what the boundaries are of the whole clitoral body; it'smuch bigger than most of us think, and there's lots of indirect stimulationthere, too.
Audience: How important is prostate stimulation for men?
Lots of guys love prostate massage and stimulation and say itintensifies their ejaculation; many love the feel of it and some don't.One of the things that has had a big impact on me is the realization thatyou never can get inside someone else's experience and compare pleasure- impossible! But you can ask. Keep in mind that women who like anal stimulationare every bit as enthusiastic about it as men who like anal stimulation.The prostate may be a factor for men, as may that prostatic-like tissuein the G-spot zone for women. But a lot of other things are in terms ofnerve endings, and interaction with all the musculature there, like I wastalking about before. So there's lots to get stimulated, but the prostateis one area that a lot of men really focus on. I think it's become a thingamong some men, where "prostate stimulation" becomes kind of a code wordfor "feels good to be fucked in the butt." I encourage guys, if they wantto tune into their prostate, to stimulate it by taking their longest finger,inserting it all the way, moving it toward the front of the body, and thengently rubbing. Especially if they do that during masturbation in the sustainedplateau phase where they're highly aroused, the prostate is going to beenlarged and kind of hard and lumpy. You can feel it very easily, and thenyou can rub it to see if you like that feeling, whether it affects yourejaculation, or whatever. So that's very easy to experiment with.
Here's one of the most common questions that comes up: if peopleare going for larger and larger objects, if they're into fisting, etc.,is there a risk of a loss of musculature control, so that the person isgoing to be "too loose"? Interestingly enough, there were a couple of studiesdone medically (with an anti-anal-sex bias, actually) looking for loosemuscles; that was their hypothesis, but they couldn't find it. And I'venever seen it.
I do suggest that people who want to explore anal sexuality doKegel exercises; we're not only toning up the whole pelvic floor (and thevaginal muscles in women), we're toning up the rectal muscles, and we'retoning up the sphincters, and I think that is really going to eliminateany prospects of getting too loose. When the big stuff is inserted withoutpain, the insertion is not accomplished through stretching; it's accomplishedthrough relaxation. So you just go back to your normal tonicity after you'redone relaxing. People who want to enjoy anal sex should be regularly doingtheir Kegels. I include it as part of the shower habit: put your fingerin, do some contractions, breathe, and voila you're done.
OK, I now want to shift gears away from the practicalities andinto the meanings and the fantasies, the erotic dimension of anal sexuality.
I've been very interested, especially with my studies of the psychologyof eroticism, in the meanings of anal sexuality for various kinds for people- positive as well as negative. I've already talked about how stronglybeing anally receptive is associated with "gayness" in men, even in menwho are not gay. It's also associated with being in the "woman's role"for a man to be the receiver of anal intercourse, in particular. This becomesa big issue, and even gay guys who love the pleasure and find it theirfavorite fantasy will often have bad feelings about themselves becausewhat they like to imagine getting fucked by other guys; they don't havea problem with the gayness, they have a problem with "I'm not a man" feeling.The connection there is really intense, and I think it's important to bringit up with people, to ask them about it or flag it as something they mightwatch for. I may ask questions like, "What do you think a guy is like whoreceives intercourse a lot, who likes to receive it a lot more than giveit?" "What do you think of such a guy?" It's good to explore some of theattitudes about it, because this can be a major impediment to enjoyment.
Women don't have this homophobia thing, as far as I can tell,with anal stimulation; there's no association there. One of the big thingsthat does come up for women is the belief that really slutty women wantanal sex. It brings up the virgin/slut dichotomy big time for a lot ofwomen. That would be the rough equivalent of the "I'm not a man" concernamong guys.
If you ask people, "What's wrong with being gay?" and especiallyif you specifically ask, "What's wrong with being a gay man?" the answeralways seems to come down to, "Because gay men are not real men." And soI'm an advocate of the idea that homophobia is an offshoot femiphobia:the fear of womanliness. This raises the question, "What's so damn badabout being womanly or feminine, anyhow?" Maybe you can say homophobiais a form of sexism. If you deconstruct it far enough, you'll probablyfind a bedrock of sexism there.
I want to talk about power and anal sex. The association betweenpower, tops and bottoms, particularly in anal intercourse is so incrediblyintense that it's actually very difficult for a person to escape it. Ittakes a real act of conscious effort. When power gets all intertwined withanal stimulation for a man or a women, it can have paradoxical effects.Power dynamics, if they don't feel comfortable or the person doesn't liketheir role, can result in tension. Clenching the anal muscles may be ourway of saying, "No way, I don't like this."
Audience: Jack, what do you mean by the "power dynamic"?
The feeling of, "I'm the receiver, therefore I'm the bottom, thereceptive one," as opposed to the inserter, whose supposedly the dominantone. Those images are so strongly in place that it's very hard to get outfrom under them. For some people those images are a major block to enjoyinganal sex. Guys will say, "I'd like to get fucked, but I don't want to seemyself as unmanly or feminine; I don't want it to be about surrenderingor humiliation." Just as a woman might say, "I want to get fucked anally,but I don't want to see myself as this total slut."
So the top/bottom thing is very hard to bypass, and people oftenjust learn how - if they're going to get into it - to enjoy the feelingsof receptivity. I do encourage people to talk about it if they're botheredby the power thing; if they're saying they're the passive one, maybe theycould talk about receptivity instead. It's a much more active positionwhen you're involved and not just an orifice sitting there. Receptivityis actually a very active experience: physiologically and emotionally,there's a lot going on. So I encourage people to talk about that.
A lot of gay guys, you know, will talk about "pushy bottoms" -people who really like to be in the receptive position for anal intercourse,and are very assertive about it. They make it all happen, they take charge,they direct or choreograph the whole thing. They wouldn't usually be thoughtof as the dominant partner, but in actual practice they are.
Audience: Talking about the power axis, what about thewomen in those situations?
The women I've worked with, because of our training on what penis-in-vaginaintercourse means, tend to be more familiar with that receptive feelingand have an easier time being comfortable with it and not feeling as ifit's out of sync with their femininity. But, I have worked with many womenwho are damn sick of always being the bottom - especially if they're thebottom throughout the relationship, not just in bed. Sometimes anal intercoursewith the woman receptive becomes the catalyst for really getting in touchwith how pissed off she is about being "one down" so much of the time.So that has to be dealt with.
Audience: I'm not sure you understood the question; I wasasking about the woman's side with straight men who enjoys receiving analstimulation from a woman.
Oh yes, this can be very difficult. Guys often write me and say,"Well, I can't ask my partner, she'd laugh me out of town." But some ofthem do, and very often they do get turned down because their partnerseither think it's yucky or weird or unmanly to want that. Usually a womanin that situation is more concerned about, "What's wrong with my partnerthat he wants stuff up his butt?" It's an issue particularly if he wantshis female partner to insert a dildo or butt plug and maybe vigorouslystimulate him, or to strap on a dildo and fuck him. A lot of women findit interesting and very strange - hard to get used to - to be in that role.It's not the traditionally feminine thing to do.
Audience: Have you ever found, in the situation where thewoman is sick of being the bottom (and the anal sex brings that out), thatcounseling to where this turnabout can occur and she gets the idea to dohim, could fix any of that?
Well, I think that's a creative idea, and some have come to seeit that way: "Hey, this is kind of cool!" Some women whom I've worked withtell me that their husbands say they'd like to try anal sex: "Can we canwe can we?" he asks, and she says "No no no," and he says "Please pleaseplease" - you know how men can be [audience laughter]. And so she'll say,"OK, I'll try this or read something maybe," and lets say she gets intoit. But then if I happen to be working with a couple like that, I'll raise- just to shake things up - the topic of, "Well, as you two explore thisarea, you Joe (or whoever it is), maybe you want to get to know your anusbecause maybe she's going to want to do some of this to you. What wouldthat be like? How would you both feel about that?" It's a great way todiscuss power dynamics and imagery. However, if that's too far out forthem or too scary it won't shake things up so much as shut them down. Soyou have to be good with your timing here.
Now, a little word about SM, where we take the power axis to theedge, where a symbol of power becomes pain. I think of SM as technicallyhaving two dimensions: one is the search for intense stimulation near orat the pleasure/pain boundary, and the other is the desire psychologicallyto be humiliated, etc. I think the big focus has to be on those who likethe pleasure/pain boundary with anal stimulation, because there you'vegot the potential for some damage if they go too far. It's very possiblethough to get into imagining and, in a way, "feeling" that there's painand an overwhelming intensity, but also to have a part of oneself that'sobserving just enough to know and monitor, "Is this the fantasy/fun pain,or am I really hurting here?" That distinction is crucial for pleasure/painboundary anal play. We really need to make a distinction between the feelingof intensity bordering on pain, and the pain itself.
Audience: This is one of the few times I would tend toagree with the theory that it's probably not a good idea to be very drunkor stoned the first time you try this, because when that happens you can'tfeel.
Well, I don't think that "very drunk" is good any time with analplay for exactly that reason; people do a variety of unsafe and unwisethings when they're drunk that they wouldn't do otherwise.
Another thing with SM is that I work with people who can enjoyanal stimulation, but have strong associations with dominance and submission(maybe with SM overtones) and realize that, for them, it's just too scary.And so I think it's really important that they give themselves permissionto keep that for fantasy and enjoy anal stimulation in other ways. We dothis all the time in all kinds of ways, and there's nothing weird aboutmaking this differentiation for those who aren't comfortable actually doingthe very things that excite them. This is confusing for some people whodon't make a clear distinction: mostly what they fantasize is what theywant to do. Then there are those who wonder: "Why don't I want to do thisthing that excites me so much in my masturbation fantasies?" And so youkind of have to work with that, to reassure them that thinking and doingare two different things.
People have different levels of enthusiasm about power imageryin sex in general. I for one like the power stuff to be very subtle - Ialways have - but with other people there's a whole spectrum of attitudes.Many people, when they do the exploration, discover they like sensuousanal play that is more a feeling of intimate sharing rather than a powerexchange (not that power exchanges can't be intimate). That's just notwhat turns them on; they want to experience anal stimulation as an actof shared pleasure as opposed to an act of dominance and submission. Alot of people feel they don't need the power thing because it's like, "Thisis so intimate to let you in here to feel this, I feel so close to you,the sensations are overwhelming." It's a sense more of closeness than ofdominance and submission for those who get into that.
This of course is tricky when one person wants to do it withoutthe power and the other person is really into it - you're got a big negotiationjob there.
The time is flying, but I just wanted to mention a few thingshealth-wise.
First the so called "female," or Reality, condom. It's not approvedfor anal sex, but then neither are latex condoms. The FDA's thinking is,"We can't approve a product that's used for illegal activity in so manystates." What a bunch of bull.
It comes pre-lubricated, and there's extra lubricant in the box.Here it is, it's kind of baggy as you can see, and not very aesthetic.This is the biggest problem so many women have with it: "It's ugly." Butwhen it's inserted in the vagina it can be done ahead of time, likewiserectally. This inner ring is supposed to hook behind the cervix and helphold it in place. For anal intercourse some people don't mind the flexibleinner ring, and maybe it does keep it from slipping out past the sphincters.The ring outside is attached, and it has to stay on so the whole thingdoesn't slide in. For those who find the inner ring irritating, just pullit out.
It has a few advantages. It's tougher than latex, it doesn't breakdown with oils (because it's polyurethane, not latex), and if you use itvaginally or anally and fuck for a little while and then want to take abreak and do other things but come back to fucking later, then insteadof having to go through the rigmarole of putting on another condom youcan just leave it in and come back to fucking later; you can leave it inthrough the whole encounter, and it can go in before the encounter so youdon't even have to bother with it during the encounter. They're about $3each.
Audience: People who are allergic can also use it.
That's another advantage, if there's a latex allergy involved,but I mainly like the ability to stop and start - the playful aspect. Ithink it makes play easier. That latex focus: "Now we're going to fuck,and we have to go through to the bitter end" limits us. Why not do it fora while and then do something else? Also, the insertive partner in analintercourse likes this, because instead of having your penis wrapped likea sausage your penis is rubbing against it causing friction - it feelsbetter. Both women and men have good reports in terms of the receivers,vaginally or anally. It does make noise though; it crinkles. You know,put on some music [audience laughter].
Audience: What about sensitivity?
It seems to be fine.
Audience: It's much better than latex.
You think so? I've heard mixed reports on that, and I think there'sa lot of room for personal preference.
Audience: Polyurethane transmits heat better.
Heat is transmitted better.
Audience: When those first came out we got our staff togetherat Planned Parenthood, and I gave anybody who wanted them both Realitycondoms and latex condoms. The ones who had been used to using birth controlpills and no barriers didn't like it. But the ones who always used latexcondoms thought this was much better. I'm not talking about anal penetration,but vaginally.
So I think this is a good option to consider. It could drop inprice, and it may if it becomes more popular...
Audience: Has the word gotten out?
Somewhat. It still has a long way to go. In San Francisco lastyear, STOP-AIDS did a study - it's an ongoing study - where they distributea questionnaire along with free Reality condoms to gay men. They ask themto try them and then fill out the questionnaire. The satisfaction rateis up close to the 80%'s I think.
Obviously with anal stuff and anal experimentation it increasesthe need to be safe-sex-conscious and to be able to be clear about that,so it carries over in, during, and through the moments of highest passion.You have to work at developing those skills.
One more thing, and then we'll open it up for discussion a littlebit here. I just want you to know that aspects of the basic approach: awareness,breathing, touch, looking, gentle finger insertion, and self-exploration,is a wonderful process for those who are recovering or trying to recoverfrom anal medical problems, even if they've gone so far as to have surgery;start with gentle external massage in warm tubs of water. I've got guidelinesfor self-healing in the back of AnalPleasure and Health that spell it out step-by-step.
Audience: What are the health issues for anal-oral play?
The concern with anal-oral contact is not HIV, particularly. We'rereally concerned about parasites and Hepatitis A. This is a major routeof transmission. The risk can be reduced pretty drastically by washingthe area, but a lot of people who like rimming like the natural smellsof the area. They don't want it squeaky-soapy clean; that's a turn-off.So, that's a tough one. What I try to do with people who feel that wayis for them to become more discriminating in whom they do it with. Don'tdo it casually, certainly, and do it with people whom you know long enoughto have some hints about what's going on health-wise with them. But youdon't really know, necessarily, who's carrying parasites around, or HepatitisA.
Oh, and don't share toys without cleaning them...
Audience: I don't want to open up the whole issues of fissures,but what about the health issues - the chances of getting torn by longfingernails?
Oh, I'm really glad you brought this up. It's not a sidetrackat all; I just neglected to mention it. Any time a finger is going in there(one's own, or one's partner's), there has to be consciousness about trimmingthe fingernail, and smoothing them to be sure there are no rough edges.This is especially important in fisting.
Audience: Shouldn't fisters be wearing gloves anyway?
Well, that's what they say, but as a practical matter most fistersdon't wear gloves. Actually, I think fisting - in and of itself - is avery low-risk activity if it's done via relaxation. The problem is whenpeople are fisted and then someone fucks them, which you're not supposedto do, because you're really going to the max in terms of expanding thetissue. There's a chance of microscopic tears you might not know about,or surface abrasions, that would provide entry points for semen, and HIVthat might be in semen, if you got fucked afterwards.
Audience: Wouldn't you be using a condom?
That would help, of course. In general, the fisting enthusiastswho are really thoughtful about it also recommend that after a fistingsession you give your anus and rectum a break for a few days; just takereally good care of it.
Audience: What kind of injuries happen, and what can youdo about them?
The injuries, fundamentally, that happen are fissures: scrapesor tears. I don't know what the frequency is, it's not as great as youmight think, but they do happen. Mostly they happen with rough, vigorous,intercourse where the receiver is ignoring strong pain signals. For peoplewho have the no-pain-ever commitment and don't let anything happen thathurts, injury is very rare.
When injuries occur, they tend not to occur in the rectum. Generallythey occur in the anal canal or around the anal opening - the entryway,which is about an inch long - or at the juncture between the anal canaland the rectal tissue. There's a seam there, and that can tear. Or, ifthey have hemorrhoids, it can irritate their hemorrhoids. But if peopledo it without pain, and gently, it can actually help the hemorrhoids.
Any final comment before we wrap up?
I hope there's something here that's been useful to you; thankyou all very much!