Primary care of anally receptive men.

The practice of anal intercourse among pairs of male partners involves both insertive anal intercourse (IAI) and receptive anal intercourse (RAI); individuals may participate in either or both activities. Many nurse practitioners do not possess adequate knowledge to counsel their patients on this subject or to treat the common health care problems that may be associated with it. The purpose of this column is to provide information about the care of men who practice anal intercourse so that nurse practitioners may continue to provide comprehensive and nonjudgmental care to all individuals. Because of the history of stigma and discrimination against the gay community, many men who practice IAI and RAI with other men may choose not to identify themselves as gay or homosexual. Although this discussion is of anal intercourse among men, women may practice receptive anal intercourse and have specific health care needs related to it as well. Sexual Issues The rectum is a vulnerable area in terms of sexually transmitted diseases (STDs), and information about safer sex is important for the sexually active individual. The first and most effective means of primary prevention of STDs is the barrier method, practiced by use of condoms during intercourse. The most common material is latex, although polyurethane condoms are becoming more readily available for the latex-allergic population. Sheepskin condoms should be avoided because they may be porous enough to allow viruses to be transmitted through the condom. Dental dams made of latex may also be used; users must remember which side of the barrier is “up.” Common household products such as plastic wrap are also used, but there is a risk for contamination by changing sides as well as the threat of choking on the product if swallowed or aspirated. (The plastic wrap products labeled “microwavable” are porous and should not be used sexually.) Before applying condoms, one should inspect both the package and the condom itself to make sure there has been no accidental perforation. Applying condoms all the way up to the base of the penis is important so they do not fall off during intercourse. Lubricants should be used with condoms to prevent breakage and reduce friction; these must be water based, because oil-based lubricants may change the chemical nature of the latex in the condom and facilitate breakage. The products made specifically for this purpose are widely available in pharmacies and will say that they are water based on the label, as this need is widely recognized by the manufacturers. The ubiquitous petroleum jelly (Vaseline) and vegetable shortening (Crisco), which both have histories of use as sexual lubricants, are oil based and can be damaging to latex. Oral-genital contact (fellatio) has potential risk of transmission of STDs and should be negotiable between partners. Even if the insertive partner does not ejaculate, the sexual lubricating fluid, commonly called “pre-cum,” produced in the prostate gland, is known to contain HIV. The organisms of gonorrhea, syphilis, and herpes, when present in the urethra, may also be transmitted to partners without ejaculation, so we cannot tell patients that this activity is completely safe, only that it is made safer when a barrier method is used. Steps taken to reduce the risk of physical trauma during sex also reduce the risk of infection and injury. “Fisting” is anal penetration by the partner’s fingers, hand, or wrist. Fingers and hands should be rendered least capable of causing trauma by well-trimmed fin