What makes sex good?

Following is information to help gay men make decisions about how to keep sex healthy and pleasurable for themselves and their partners. These tips can be either read as a whole or dragged-and-dropped for easy sharing by website and app owners, as well as by public health organizations.


Sex is a fundamental part of life. From making out to all the positions found in the Kama Sutra to the vast world of kink, fetishes, and toys, it seems there are a million and one ways people find sexual pleasure. What follows is information to help you make decisions about how to keep sex healthy and pleasurable for yourselves and your partners.

Let’s start with three basics:

  1. Sex is supposed to be fun and feel good. That’s why we spend so much time thinking about it, planning for it, searching it out, and actually doing it. And most of the time – all of the time, if we’re lucky! – it does feel good to think about it, plan for it, search it out, and do it. If not – if ten minutes, or ten hours or ten days after sex you don’t feel good about it — check in with yourself: Why don’t you feel good about it? What could have made it feel better?
  2. Know what you want (and why). Sometimes you want sex because you want to feel someone next to you; sometimes you’re so horny you can’t think about anything else; and sometimes you want an intimate connection. And that means that you may want something very different from a one-night stand than from a main partner. The clearer you are with yourself about what’s driving you, the better the sex will feel. And that leads to the third basic point:
  3. Ask for what you want. The adage “different strokes for different folks” takes on a whole new meaning when it comes to sex. You may be into fucking, he may not be; he may want to fuck on the first date, you may want to wait; he may be into condoms, and you may not be. While putting your preferences in a profile screen may help signal your desires to a potential partner, it’s not a substitute for talking openly about what you do and don’t want. Always make sure to communicate before things get hot.

Read more about one gay man’s experience trying to figure out what he wants from sex in this article by the Promiscuous Gay Nerd, Jake Sobo.

Prevention Options

Almost everything we do carries some level of risk, from walking around our house to driving our car, from working out in the gym to enjoying adventure sports. Some risks, such as getting struck by lightning, are so small we rarely stop to think about them. Similarly, some sexual activities may carry a theoretical risk of HIV transmission, but the number of reported and confirmed cases of transmission resulting from them is very small.

And the good news about HIV, in particular, is this: it’s much harder to be infected with HIV than to catch the flu.

In any case, there are tools to minimize your risk. It’s up to you to decide the prevention option that is best to help you have healthier sex. When it comes to gay sex, HIV is transmitted through semen or blood – which can be prevented by the use of condoms. Even if semen or blood are exchanged, if you or your partner is HIV positive with an undetectable viral load or is HIV negative and on PrEP, then the likelihood of transmission falls to near zero.


Condoms & Lube

  • Condoms (aka rubbers) and lube work best when used together, and can prevent STDs, HIV, and pregnancy when used correctly.
  • Lube reduces the friction that can cause condoms to break or tear. Water-based or silicone-based lubes are best because oil-based lubes – such as petroleum jelly, mineral oil, massage oil, and body lotions – can cause latex to weaken and break.
  • But rubbers are not always 100% percent effective in protecting against some STDs, such as HPV or herpes, which can infect areas that condoms don’t cover.

PrEP

  • PrEP stands for “Pre-Exposure Prophylaxis.” This is for HIV-negative men who want to protect themselves from HIV infection. The Pre in PrEP means that you can take prescription medications before you come in contact with HIV to help reduce your risk of contracting the virus. It’s not 100% effective – but, when taken daily, it’s pretty darned close. The more regularly you take it, the better it works.
  • When PrEP is combined with other prevention strategies, such as using condoms or TasP, (Treatment as Prevention, or taking HIV medications that not only keep HIV-positive guys healthy, but also dramatically reduce HIV transmission), the risk of contracting HIV is minimized even further.

But remember that PrEP only protects against HIV, so use condoms if you want to protect yourself from other STDs as well.


PEP

  • PEP stands for “Post-Exposure Prophylaxis.” The Post in PEP means that you take prescription medications after you’ve been exposed to HIV. While PrEP, condoms, and HIV treatment are all very effective at preventing HIV transmission, sometimes during sex things can happen that leave you wondering if one of you got exposed to HIV. PEP is a great back-up. If you are HIV-negative but recently had unprotected sex with a guy whose HIV status you didn’t know, for example, consider taking PEP to prevent a possible HIV infection. If you have HIV, and think there’s a chance you exposed someone else to HIV, you can tell that person about PEP.
  • You need to start PEP medicines within 72 hours – the sooner the better. Talk to your doctor right away if you think you might have been infected. You can also get PEP medicines at your local hospital’s emergency room or at a 24-hour clinic.

Hepatitis A, Hepatitis B, Bacterial Meningitis, and HPV vaccines

  • You can get vaccinated against Hepatitis A, Hepatitis B, and bacterial meningitis – and, until you’re 26 years old, you can also get vaccinated against certain strains of HPV. In fact, the CDC recommends that gay, bisexual, and other men who have sex with men get the 3 shots required to be protected from HPV before the age of 26. You can talk to your doctor about these shots.

Treatment as Prevention (TasP)

  • Taking HIV medications is wonderfully effective at keeping HIV-positive individuals healthy, and with every new advancement the medications get better – to the point where the life expectancy of people with HIV becomes closer and closer to that of HIV-negative individuals.
  • There’s an additional, important benefit to being on treatment. If you’re living with HIV, are on treatment, and have an undetectable viral load – meaning there’s so little virus in your body that it can’t be measured by a standard test – the odds of infecting someone during sex approach zero. This HIV prevention strategy is known as Treatment as Prevention, or TasP.
  • If you are HIV-negative and a person you’re planning to have sex with discloses that he (or she) is living with HIV, consider asking if he (or she) is taking HIV treatment and has an undetectable status. You two can also talk about how to protect each other further by using other prevention options.

Evaluating Your Sexual Network

  • What is your sexual network? It’s how you’re connected to people sexually, and includes the people you’ve had sex with plus the people they’ve had sex with.
  • More sexual partners and more unprotected sex can mean increasing your chances of encountering an STD or HIV. But you can make adjustments to your sexual network to reduce your risk of contracting something.
  • You can reduce the number of people you have sex with; you can agree to be monogamous (and only have sex with your partner); or you can be abstinent (not have sex at all). Or you can make agreements about the kinds of sex you’ll have with a main partner and what you’ll have with casual partners.

With this information in mind you can now feel empowered the next time you have sex. Communicate with your partner about what you are and are not willing to do. Ultimately, the amount of risk you take on is a personal decision. Make the choice that’s right for you, and take care of your health – and your partner’s – as best you can. And don’t forget to HAVE FUN!


Adapted from HealthySexual

Types of Sex

Understanding the different types of sex, and what each entails, will help you figure out what you want out of your sex life — and help you communicate better with your partners. Sex with a partner can be broadly bucketed into four types: anal, oral, mutual masturbation, and vaginal/front-hole. Sex toys, which can be used alone or with a partner, make up a fifth category.

Each type of sex will carry different risks when it comes to spreading STDs and HIV. The degree of risk depends mostly on how likely it is that body fluids will be exchanged between partners.

Anal Sex

Take-Aways:

  • Condoms, PrEP, and Treatment as Prevention (TasP) are the most effective forms of protection against HIV before exposure. PEP is an effective means of protection against HIV after possible exposure. Condoms are the only form of protection against other STDs
  • While it’s safer to top than to bottom, either person can get STDs if not using condoms (and HIV, if neither one of you is on PrEP or HIV treatment)
  • Use lots of water- or silicone-based lube to prevent tearing during sex, especially when using condoms
  • Get screened for STDs and HIV every three months if you’re sexually active. Ask your doctor about screening for HPV-related anal cancers, as well as penile and mouth cancers, especially if you are HIV-positive or a bottom

Unprotected anal sex is the easiest way for STDs/HIV to be transmitted during sex, although the exact degree of risk can depend on many factors. Acute HIV infection increases the likelihood of transmission during anal sex dramatically, and it is at this stage that most people are unaware they have been infected.

While topping is generally less risky than bottoming, both are considered high-risk activities without protection. Studies have suggested that bottoming without protection poses 18 times more risk for HIV infection than does vaginal sex without protection, and as much as 14 times more risk than topping without protection. In fact, bottoming without protection is the most common method of HIV transmission in MSM. Bottoming is riskier because the rectal tissue is not only already more susceptible than our external skin to the spread of infection, it also lacks natural lubrication – which can lead to small tears during penetration that can give STDs and HIV direct access to the bloodstream. The chance of HIV infection for a bottom is greatest when someone cums in their butt. Still, pulling out does not greatly reduce risk of transmission, as pre-cum has been shown to contain high levels of HIV. Poppers, and possibly douching, can increase risk for bottoms, because poppers increase the blood flow to rectal tissues and douching flushes out the mucus layers that lubricate and protect the rectal/gut wall, facilitating the entry of HIV.

For tops, HIV can be present at high levels in secretions and blood from the rectal tissues and can then enter through the lining of the urethra, or through small cuts, abrasions or open sores on the penis. Research has shown that men who are circumcised have a lower risk of becoming infected with HIV and other STDs or transmitting these infections if they already have them. This is because circumcised men have much fewer bacteria living on and around the penis, which gives them an advantage when it comes to fighting off infections like HIV.

Many other factors can also increase the likelihood of HIV infection during anal sex. Having an existing STD can make both partners more susceptible, since inflamed tissue or open sores provide an easier route for HIV transmission.

In addition, rectal bleeding, caused by numerous things including hemorrhoids, certain STDs, herpes lesions, the prior use of sex toys, and fingering/fisting, can increase the risk for both partners. If you notice uncontrolled rectal bleeding, you should seek medical attention right away.

Luckily, there are ways to reduce the chances of getting anything more than pleasure from anal sex. Using plenty of water- or silicone-based lube can prevent chafing and tears and make for a smoother ride. It’s important, particularly for the bottom, to relax before insertion and remember to take a break if anything starts to feel painful.

Protection from HIV infection can take on a number of forms, including condoms (male and female), PrEP, and Treatment as Prevention (TaSP). PEP is an effective means of protecting yourself against HIV after possible exposure. Remember, though, that condoms are the best way to prevent passing along STDs.

If you don’t use these methods, there are also a number of alternative risk reduction strategies that, while not nearly as reliable or effective, have been shown to lead to better health outcomes than doing nothing at all. These include:

strategic positioning, or sero-positioning, which means the negative partner takes only the top role with partners of positive or unknown status
withdrawal, or having the top pull out before cumming in the bottom’s butt
serosorting, or choosing partners whom you believe to have the same HIV status as you
negotiating safety, or agreeing, between two HIV negative partners, that unprotected sex with a regular HIV-negative partner is acceptable, while agreeing to disclose test results and sex outside the partnership (and limit risk with outside partners) (CDC on negotiated safety).

Whether you like to top or bottom, it’s always a good idea to communicate with your partner about your HIV status and ask about his.

Also consider asking your doctor about screening for HPV-related anal cancers, as well as for penile and mouth cancers, especially if you are HIV-positive or bottom, and if any strange warts or lumps appear in those areas.

Helpful resources on how to have better anal sex:
The Gay Men’s Health Charity
PositivePeers
Down an’ Dirty: Douching

Adapted from HIV=, POZ, WebMD, SFAF, National LGBT Cancer Network, NAM: aidsmap

Oral Sex

Take-aways:

  • The risks of oral sex are different for different STDs. They also depend on what type of oral sex you’re having, and whether you’re the one giving or receiving. Generally, receiving oral sex is safer than giving it.
  • The risk of HIV transmission is extremely low during oral sex. However, there is a higher risk of contracting other STDs, such as gonorrhea, syphilis, chlamydia, HPV, and herpes.
  • Get screened for STDs and HIV every three months if you’re sexually active. Ask your doctor about screening for HPV-related mouth cancers if you notice any strange lumps or warts in those areas.

Oral sex includes fellatio, or sucking/blowjob/giving head (mouth-to-penis); cunnilingus, or eating out (mouth-to-vagina); and analingus, or rimming (mouth-to-butt). It’s possible to get an STD in the mouth/throat by performing oral sex. It’s also possible, but less likely, to become infected while receiving from a partner who has an infection in his or her mouth/throat, though the risk of becoming infected while receiving is generally lower. HIV transmission is very unlikely through any type of oral sex.

To reduce your risk of infection, keep the mucous membranes in your mouth healthy. A good risk-reduction strategy is to avoid performing oral sex for about 45 minutes after you brush your teeth, floss, or have dental work, and not having it at all if you have open sores. The most effective prevention strategy against all STDs is to use condoms or dental dams during oral sex; condoms, PrEP, and TasP are the most effective at preventing HIV transmission.


Sucking

Blowjobs are a part of almost all gay men’s sex lives. While there have been cases of HIV transmission through oral sex, they’re very, very, very uncommon.

STDs commonly transmitted through sucking include gonorrhea, syphilis, and chlamydia for both partners; HPV (genital warts) for the one sucking; oral herpes (HSV-1) on the genitals for the one getting sucked; and a few others. A few facts about STDs commonly passed along through oral sex:

  • HPV is the leading cause of throat cancer in all men, with the risk of transmission increasing with the number of oral sex partners
  • While there is a slight risk of getting genital herpes (HSV-2) in the mouth from giving head, the risk is greater that a man receiving a blowjob will contract HSV-1 (oral herpes) around his genitals from a partner
  • While there is a theoretical risk of hepatitis B or hepatitis C transmission if cum or blood is exchanged through sucking, there have been no documented cases of this happening. But MSM are at increased risk of getting hepatitis A and shigella if they suck on a penis that has just been inside a butt
  • Fortunately, there are safe and effective vaccines available for hepatitis A and B and certain low- and high-risk strains of HPV

While it is safest to avoid having your partner ejaculate in your mouth, if you do get a taste of cum (or precum) it is best to spit or swallow rather than let it sit in your mouth. If you’re taking PrEP every day as prescribed or performing oral sex on a partner who is undetectable, HIV transmission is very unlikely. Using condoms while sucking can add a further layer of protection. Flavored condoms and lube are an option if you hate the taste of rubbers.


Eating out

Cunnilingus is considered a very low risk activity for almost all STDs. However, the receiver does run the risk of contracting oral herpes in their genital area from the person eating them out; it is rarer for the giver to contract genital herpes around their mouth. There is potential risk for HPV transmission. The risk of HIV transmission, on the other hand, is extremely low for both partners. The reliability of reports of cases of transmission from eating out is questionable. Still, dental dams are an effective means of protection against all possible STDs, and PrEP and TaSP are effective against HIV.

Tips on how to eat out.


Rimming

Rimming, or licking someone’s butthole for sexual pleasure, is generally considered a low-risk activity for most STDs, and a negligible-risk activity for HIV transmission. However, certain parasitic and bacterial infections that affect the digestive system, such as shigella, giardiasis, cryptosporidium, and amebiasis, may be passed along to the giver. Washing beforehand can make this less likely.

There is also risk of Hepatitis A transmission if you are not vaccinated, and a theoretical risk of contracting HPV for the person doing the rimming. The theoretical risk of HIV infection for the giver stems from the presence of blood in the rectum (as a result, for instance, of fingering, fisting, or using sex toys); blood from bleeding gums introduced into the rectum by the tongue could also infect the receiver. Dental dams, PrEP, and TasP are all effective means of protection against this minimal risk of HIV. Dental dams also further protect against parasitic infections and other STDs.

Tips on how to eat an ass by porn star Levi Michaels.


Adapted from NAM: AIDS Map, Cleveland Clinic, TheBody.com, STDcheck.com, American Sexual Health Association, San Francisco AIDS Foundation, The National Health Service, SF City Clinic: Hepatitis, SF City Clinic: STD Chart

Vaginal/Front-hole Sex

Take-aways

  • Unprotected vaginal/front-hole sex has a high risk of STD and HIV transmission for both partners. The risk is greater for the person being penetrated
  • Condoms, PrEP, and TasP are extremely effective forms of protection against HIV transmission. PEP is an effective means of protection against HIV after possible exposure. Condoms are the only method that can prevent both pregnancy and STDs/HIV when used alone
  • Withdrawal before ejaculation seems to be more effective in reducing transmission during vaginal/front-hole sex than anal sex, but condoms and PrEP are still the most effective
  • Along with recommended frequent HIV and STD testing, women and trans men should also make sure to get screened for HPV-related cervical cancer about every 3 years during their regular gynecological health check-up.

While vaginas may not be a regular part of a cis gay man’s sex life, many bisexual and trans men (female-to-male transgender people), as well as trans women who have had surgical vaginoplasty, may consider vaginal/front-hole sex very pleasurable.

“Trans men” is an umbrella term used to refer broadly to men who were designated female at birth who now live as a male. The sexuality, genital anatomy, and type of sex trans* individuals have varies based on their identity and whether they have decided to take hormones and/or have surgery, such as genital reassignment. If you’re trans*, or considering a partner who’s trans*, you may want to check out two great resources:  “Primed: A Sex Guide for Trans Men Into Men” and Safer Sex for Trans Bodies, both of which are provided in BHOC’s Resources for Trans* Inclusivity.

Vaginal/front-hole sex can lead to pregnancy, so if you’re not trying to have a child any time soon, consider birth control, such as condoms (male and female) or hormonal contraception (such as the pill or IUDs). It is possible for trans men who have not had hysterectomies to get pregnant, even if they are on testosterone, since testosterone is not a 100 percent effective birth control method. Condoms are the only method that can prevent both pregnancy and STDs/HIV when used alone.

Unprotected vaginal/front-hole sex is considered riskier than both mutual masturbation and oral sex when it comes to the transmission of almost all STDs, but generally less risky than unprotected anal sex. Similar to oral and anal sex, the person being penetrated has a higher chance of STD/HIV infection than the insertive partner. Also, it is possible to pass along yeast infections during vaginal/front-hole sex. And switching from the butt to the vagina/front-hole while fucking or fingering without washing in between can increase a person’s chance of contracting a urinary tract infection.

Many factors affect the level of HIV-risk associated with vaginal/front-hole sex, including the viral load of the poz (HIV+) partner, the presence of STDs in either partner, vaginal/front-hole health, douching, and penile circumcision. The levels of HIV in vaginal/front-hole fluid, and therefore infectiousness, may vary. They are likely to be highest around the time of menstruation, when HIV-bearing cells shedding from the cervix are most likely to be found in vaginal/front-hole fluid, along with blood. Therefore, unprotected sex is more risky for the transmission of HIV around the time of menstruation.

Condoms are the only way of preventing STD infection during vaginal/front-hole sex, and PrEP and TasP are also extremely effective in preventing HIV transmission. Withdrawal before ejaculation seems to be more effective in reducing transmission during vaginal/front-hole sex than in anal sex, although condoms and PrEP are still the most effective.

Adapted from PrEP Facts, NAM: aidsmap, CDC: PrEP, CDC: Screening, CATIE

Masturbation

Take-aways:

  • Mutual masturbation is as safe as it gets, other than masturbating alone. There’s a small risk of getting one of the STDs that’s transmissible by skin-to-skin contact (for example, herpes, HPV, or even crabs)
  • If you’re into fisting, wash your hands, use lube to prevent tearing, and keep your fingernails short. You may want to try using internal condoms, latex gloves, or finger cots (for fingering) to prevent STD and HIV infection. The biggest risk from fisting comes from fucking afterwards without a condom

Mutual masturbation usually involves fingering, hand jobs, and fisting – basically, anything you can do to get your partner off with your hands. While having sex with your hands is one of the safest kinds of sex, there are still some risks.  Your hands carry potentially harmful bacteria that can cause urinary tract infections, and having open cuts or sores on your hands or coming into direct contact with any types of lesions, growths, or discharges from your partner could plausibly result in the spread of STDs. Some STDs only require skin-to-skin contact to be transmitted, such as HPV, herpes, syphilis, and crabs. Still, masturbating with someone else is about as low risk as it gets.

A few strategies can help reduce risk even more. Make sure to wash your hands. And don’t forget to keep your fingernails short and use lots of lube before sticking your hands anywhere. It’s important to prevent tears, which could increase the risk of contracting an STD, especially if you’re engaging in riskier types of sex later on.


Handjobs

Jacking off a man poses no risk of HIV transmission.


Fingering

While it is theoretically possible that someone who has an open cut or fresh abrasion on his or her finger or hand can be infected with HIV if coming into contact with blood in the anus or vagina or vaginal secretions, there has never been a documented case of HIV transmission via fingering. Therefore, HIV risk is negligible.


Fisting

Helpful resources and instructions on how to make fisting fun and healthy:

In terms of STDs and HIV, the biggest risk from fisting is actually not from the fisting itself, but from having sex without condoms right after. Consider using internal condoms or latex gloves to reduce risk of transmission of STDs and HIV. If you decide not to use condoms but want to cut the risk of HIV transmission, consider fucking first and then fisting. Fisting first may cause tears and bleeding in the butt, making barebacking afterwards more risky for HIV transmission. Fisting while on PrEP or with an undetectable partner will also provide protection from HIV.

While fisting, make sure to start with your fingers, and take it slow when going in and out with your hand. Also use plenty of lube: There’s never such thing as too much lube during fisting. If you plan to go from fisting first to fucking afterwards you should consider using water-based lube; oil-based lubes can get messy and damage latex condoms later. You can also choose to use non-latex condoms afterwards.


Adapted from The Gay Men’s Health Charity, TheBody.com, NAM: aidsmap: Fingering and Fisting; NAM: aidsmap: Mutual Masturbation

Toys

Take-aways:

  • Use plenty of lube when inserting sex toys, such as dildos and vibrators, up your butt. Start small and work your way up to bigger toys
  • Keep your toys clean by washing them with soap and water after each use
  • Avoid sharing toys with partners unless you wash them
  • Silicone and hard plastic are good choices for non-toxic sex toys

Sex toys can be an exciting addition to playing in the bedroom. But there are a few things to keep in mind to stay healthy while having fun. First, use plenty of lube when inserting dildos, butt plugs, vibrators, beads or any other toy up your or someone else’s butt. This will help minimize the risk of cuts and abrasions during sex. Be sure to use the right lube for the right toy, since some silicone-based lubes can have a chemical reaction with silicone toys that breaks them down.

When sticking things up your butt, start small and work your way up to bigger toys, and avoid pushing objects up too far. If you manage to get a toy stuck up there, try to relax and push it out slowly, using lots of lube and a pushing motion while squatting. Sometimes a warm bath can also help to relax your muscles. If this doesn’t work, don’t be too embarrassed to visit your local emergency department – you certainly won’t be the first case the doctors there have seen!

Make sure to keep your toys clean by washing them with hot water and soap after each use on yourself or your partner; germs can live in scratches, cracks, and holes on the toy. Some toys have pieces with batteries that can’t get wet, so read the instructions provided with your toy on how to wash and store them.

Don’t share sex toys, because sharing them or using them on multiple partners could spread HIV and STDs through the exchange of fluids such as blood, anal mucus, or vaginal secretions. If toys are the right shape and size, covering them with a condom – making sure you put a new condom on if you’re using it with a partner — will also help prevent the transmission of STDs and HIV. PrEP is also an effective means of protecting yourself against HIV. You can get extra large condoms if your toy is on the bigger side; female (internal) condoms are useful for such toys.

Silicone and hard plastic are good choices for non-toxic sex toys. Some other sex toys can have chemicals that can leach out of the plastic, vinyl, or rubber and into the skin, potentially causing itching and rashes. Many also contain phthalates, which is considered a possible human carcinogen by the Environmental Protection Agency.

Adapted from Gay Men’s Health CharityDown an’ DirtyUC Berkeley Wellness