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(by Dennis Gray, Senior Health Adviser, Victoria Clinic, London)

 Abstinence ? Yes, abstinence ? If you catch a sexually transmitted infection such as gonorrhoea or chlamydia, abstinence is required until the final check-up confirms that the treatment has worked. Otherwise you may pass the infection on to your partner.

Balls ! Testicular cancer particularly affects men aged between 15 and 40 and can be cured if it’s treated in time. Try this ; stand when you are relaxed after a bath. Using one hand hold each ball, in turn, with your thumb on top and middle and index fingers underneath. Roll gently looking for swelling, tenderness, hardness, lumps or any change in its weight.

Cum, you know about. But what about pre-cum ? Pre-cum is the fluid that comes as anything from a drop to a flood during sexual excitement. Pre-cum helps with sexual lubrication but contains sperm and HIV if you are HIV positive. Any penetration without a condom is risky.

Dimensions, Penis, schlong, willy and stranger names besides have been used to describe the humble organ. Out with your rulers ! Several different studies have shown that the average flaccid length is 4 inches and erect length 6.25 inches. Half of all men have erect lengths between 5.5 and 7 inches. If worries about your penis dimensions interfere with sex or relationships you might need to consult a professional (no, we don’t mean rent-boy). See Erectile dysfunction.

Erectile dysfunction, premature ejaculation or difficulty with sex and relationships affect almost everyone at some time - often at times of emotional stress. Your penis is really just trying to tell you it needs a rest. Most problems will sort themselves out. But for long-term difficulties, psychosexual therapy or counselling can usually help.

Foreskin. Research shows that cut (circumcised) men are a bit less likely to get genital infections, including HIV, than uncut men. These days most men wash frequently and avoid a build-up of that thick, white smelly stuff called smegma. Sometimes men need circumcision if the foreskin won’t go back comfortably during sex or masturbation.

Gonorrhoea can cause a greenish-yellow discharge and pain when peeing. Most men notice the symptoms 3 - 4 days after infection. But there aren’t always symptoms, especially if the infection is in the rectum or throat. It is easily treated with penicillin though there are a few types from South East Asia that have become penicillin-resistant and are treated with another antibiotic.

Herpes is a common viral infection which produces little blisters or ulcers on the genitals, including the bum, and cold sores on the lips. Herpes can feel quite nasty when you catch it, and, for about half of those infected, it reappears every so often. The person with herpes is most infectious when the actual ulcers are present and the day or so before (you might notice a tingly feeling). GPs and GUM clinics may prescribe helpful treatments if it is caught early enough.

Intercourse. Active or passive ? Arthur or Martha ? Insertive and receptive ? Whichever way you like it, take a tip from medical staff doing rectal examination in genitourinary (GUM) clinics. If you lie on your left hand side in bed, he can enter you from behind following the natural line of the bowel. This should be more comfortable. (About six in ten gay men are as happy to be Arthur as Martha). See Safer sex.

Jerk off. Yes, gay men are a community of wankers. A study of gay men’s sexual activities found that we wank six times as much as we suck. Over 90 per cent of gay men have wanked in any one month period.

KY is probably the best known water-based lubricating jelly. Oil-based lubes are unsafe because the oil damages condoms. Lack of adequate lubrication is probably the main cause of torn or lost (inside your bum, not fallen off your bedside table !) condoms.

Liver damage can be caused by the hepatitis viruses A, B and C. Typical symptoms include severe exhaustion, yellowing of skin and the whites of the eyes, very dark urine, whitish faeces (shit). ‘A’ usually comes through faeces getting into the food cycle, ‘B’ from semen (spunk) and sometimes saliva, ‘C’ is more likely to be caught from blood from shared injecting drug use. Although hepatitis A and B can come from sex there appears to be a very small risk that hepatitis C can be caught this way. If you haven’t had one, you should consider vaccination for hepatitis B. You can get the jabs from your GUM clinic. Vaccination for hepatitis A is considered a good idea for travellers to countries with poor hygiene. Hepatitis A usually only affects sufferers for a couple of months but the other type are more dangerous. A few people with hepatitis B, and rather more with hepatitis C, can get serious liver damage or liver cancer later in life.

Molluscum contagiosum is a highly contagious but harmless infection which can be transmitted both sexually and non-sexually. Molluscum have a waxy, pearly appearance and are treated the same way as warts (see Warts). In HIV disease (and sometimes without HIV disease) molluscum can be a problem on the face.

NSU or non-specific urethritis is an inflammation in the urethra, the tube inside your penis. It might hurt when you pee or a yellowish cloudy fluid may ooze out. Sometimes NSU is caused by a bug called chlamydia which is treated with antibiotics. But NSU can also arise spontaneously. Some men are susceptible to it and too much alcohol can make it worse.

Oral sex can spread infections such as gonorrhoea, herpes and syphilis. Although it’s not a major route of HIV infection, it’s probably best not to let your partner cum in your mouth. Rimming is oral sex with your partner’s bum and can transmit bugs, including hepatitis A, from the bowel to the mouth. Contrary to popular belief rimming is unlikely to be significantly involved with the spread of hepatitis B, unless blood is present.

Prostate gland. Take your middle finger, add lube and put it in your bum. That big lump you can feel just inside is your prostate gland. It makes part of the seminal fluid (which together with the sperm makes up spunk), and is responsible for much of the pleasurable feelings from anal sex. As men age the prostate can swell and restrict the flow of urine and a check-up to rule out cancer is required. Men over 40, particularly those with a family history of prostate cancer, should discuss check-ups with their GUM clinic doctor.

Quellada. Crabs, or pubic lice, are tiny dark blood-sucking creatures which like our coarse body hair. You can see their black eggs attached to the pubic hairs. Treatment is simple - wash the bedding and the clothes you have been using and apply Quellada or Derbac (available from chemists without prescription) to your hairy bits. Scabies is caused by even smaller creatures which cause itching by - wait for it - burrowing through your skin. Your chemist will have Derbac or other topical treatments for this annoying little beastie, too.

Rape and sexual assault. About ten per cent of all men, and a higher proportion of gay men, have been forced into some form of unwanted sexual activity. Sexual assault often leads to feelings of shame and guilt. The legal system and the police have become more sympathetic than they used to be. ‘Survivors’ operates a helpline on Mondays and Wednesdays from 7.00 pm - 10.00 pm on 0171-833 3737.

Safe sex. Only blood and semen can transmit HIV between two men. In practice unprotected anal intercourse (anal sex without condoms) is the main way HIV is caught during sex. The risk from unprotected passive anal sex is higher than from unprotected active anal sex - but both activities are unsafe. Some people are thought to have caught HIV from sucking, even though it’s much less risky than unprotected anal sex, so avoid cumming in your partner’s mouth. Untreated genital infections dramatically raise the chance of HIV infection through unprotected sex. The risk of infection from a partner with HIV each time you have unprotected anal sex is in the order of one in a hundred. But the risk can vary widely depending on many factors, including the state of people’s health at the time of unprotected sex. We know that people are much more likely to have unsafe sex when they are depressed or elated. See Xtra-Strong.

Thrush is a fungal infection that can cause itchiness, redness and inflammation under the foreskin. An anti-fungal cream should eliminate it in most cases.

Urinary Tract Infections are caused by bugs from the bowel entering the bladder. But urine is fun for those who like their sex wet, and luckily it cannot transit HIV infection.

Vagina. 10 per cent of gay men have been here in the last year or so. Unprotected sex with a woman can expose you to the same infections you can catch from a man. If you are gay it is easy to forget about your risk of HIV infection if you have unprotected sex with a woman, although for her you are a ‘high risk’ partner and she should take precautions, too. Chlamydia, in particular poses a threat to women’s sexual health ; left untreated it can cause fertility problems. Because it is so much easier to become pregnant than to catch HIV, watch those cummy fingers, too.

Warts are the most common sexually transmitted infection. Genital warts can appear on the penis, anus or surrounding area and are caught by direct touch from your partner’s wart. Treated by painting on liquids that freeze or burn them, the warts usually need repeat treatments over several weeks.

Xtra-strong condoms are the essential item for safer intercourse. The three more widely available stronger brands which are suitable for anal sex are Durex Ultra Strong, Mates Superstrong and HT Specials. You should store condoms away from heat and always use a water-based lubricant. If you place a condom in a container of baby oil for just a few minutes, holes will start to appear.

Yaws is a childhood infection in tropical countries which is indistinguishable in blood tests from the sexually transmitted infection syphilis. Syphilis is not very common nowadays in Western countries but is routinely tested for at GUM clinics. If syphilis is left untreated for years, the heart or brain can be impaired. The treatment (usually ten days of antibiotic injections in the bum) is the same for both infections.

Zzzzzz. Get some sleep ! Your sexual health is intimately connected with your physical and psychological health. Taking regular exercise, learning to recognise when you are over-stressed, getting enough sleep, using alcohol and drugs sensibly, and developing good social (and family) relationships will all contribute to a healthy lifestyle - and a happy sex life.

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