What is Sexual Health?

Sex & Relationships

Ready? Steady? Wait!

What do you think affects having safer sex?

Sexually Transmitted Infections

Tongues & Bums

Something to get anal about…

HIV: The Facts

EMERGENCY: THINK YOU’VE CAUGHT HIV?

Check Your Balls!

Visiting a Sexual Health Clinic

Rape and Sexual Assault: What to do

Glossary

 

What Is Sexual Health?

Sexual health isn’t just about your penis’ or bum’s health; it also includes the person it’s attached to! Sexual health involves the way you think and more importantly your feelings and emotions about sex and relationships. It affects us all, whether we’re sexually active* or not and can be about pleasure, excitement and love, not just when things go wrong (like catching a Sexually Transmitted Infection – STI).

As teenagers, the whole idea about having sex can be new and exciting, but can feel daunting, so this guide aims to discuss some of the issues you might be too embarrassed to talk about. It doesn’t matter if you’re not sexually active* and reading this guide; it’s putting you in the know, which may come in handy one day.

Good sexual health is about being positive and respecting yourself and your partners*, as well as it being safe and enjoyable. Sex should be fun, and no-one should put you under pressure to do it, whether it’s your boyfriend, best friend or some random guy off the internet! Everyone is equal and should be respected. It’s not just about popping down to your local Sexual Health Clinic; it’s about being educated and aware of your sexual health all round. Remember your sexual health makes up part of your overall health, which is why it is so important.

You should not have sex until you feel ready. For all guys, the legal age of consent is 16 years of age in England, Wales and Scotland (17 in Northern Ireland). However, all sexual health services are available to under 16s, and they will never tell anybody you’ve been, with a few rare exceptions (explained later).

People should treat their sexual health as well as they treat their dental health!

 

Sex & Relationships

There are lots of different types of (sexual and non-sexual*) relationships that guys can have: they can be long-term, short-term, long- or short-distance, over the internet or in person! Any type is fine as long as you are happy and consent to everything, even if you are having casual sex* (remember more partners* = more risk). One thing a lot of young guys tend to forget to do before having sex is talk about it – talk about it to someone who you really trust or someone you’re going to have sex with! If you’re too uncomfortable to talk about it, are you really ready to have sex?

Remember that if you don’t want to have sex you can always say no and at any point. It’s up to you what sexual activities you do and more importantly don’t do (and this includes anal sex). You may like certain things being done to you which you may not like doing to someone else, and that’s fine as well.

Sex isn’t all about penetration (e.g. a penis going up a bum), sex can also be about being close; kissing, cuddling, snuggling and things like that! If anyone ever tells you that gay guys have to have anal sex, don’t believe them, it’s a complete myth! Anal sex is only one sexual activity practised by both men and women of any sexuality.

Remember you have a whole life ahead of you, so you don’t need to rush into anything thinking you have to do it all at once!

Try and avoid big age gaps – they can put you in a vulnerable position (why not talk about this with a youth worker or nurse?) 

 

Ready? Steady? Wait!

Before you go rushing into bed with a guy, remember you’ll need to prepare yourself beforehand… Just like straight people, it’s really important if you’re a guy and having sex with guys you have safer sex*. Sex without a condom is known as barebacking* and no matter what any guy says, it’s a risky business!

Condoms

Penises come in a variety of shapes and sizes, and so do condoms. There is a wide variety of condoms out there which come in different sizes, thicknesses, textures and even flavours! The whole point in using condoms is to stop you passing on or catching STIs, including the Human Immunodeficiency Virus (HIV), as well as preventing unwanted pregnancies (however hard you may try guys, we lack a womb!).

It’s really important you get the right condom for your penis. If it’s too big, it’s likely to slide off, or if it’s too small it is more likely to break. But remember; you can only put a condom on when you have an erection. You could practise with a condom when you masturbate so you won’t feel nervous using a condom with a new partner*.

You may be getting told all the time to wear condoms, but you might wonder: Why? Well, the fact is that STIs and HIV are on the increase every year, and if you’re not using condoms every time you have sex, you’re at risk of picking up STIs and/or HIV. So what, what can they do to me?! STIs if left untreated can do a lot of damage to your body, some of which could be permanent! We are seeing more and more infections among gay men in Sexual Health Clinics throughout the country. This could easily be reduced by guys simply slipping a condom on…

But when can I stop using condoms? This is a question that’s best talked through with a sexual health doctor or nurse at the Sexual Health Clinic.

If you get condoms from any clinic or buy them, they should come with a little instruction leaflet on how to put one on!

 

Lube

When having penetrative sex it’s really important that you lube up the guy who is giving’s penis and the bum of the guy who is receiving: unlike vaginas, bums don’t lubricate themselves. The inside of your bum (rectum) is covered in a thin layer of mucus, this will act a little bit like lube but it soon rubs off. Using lube makes it a lot more comfortable for both you and your partner*. Make sure you use water-based lube (like KY Jelly or Liquid Silk) rather than an oil-based lube (like Vaseline or baby oil) as they can cause a condom to split. As well as making sex more comfortable, the lube will reduce the chances of the condom splitting and thus reduce the chances of catching an STI or HIV, as the inside of your bum is less likely to tear. Most of the time you’ll never even know if you do tear as the tears can be so tiny.

By using condoms all of the time, you’ll be showing your respect and care for your partner* as well as for yourself! Don’t rely on your partner* to have condoms: be safe and carry your own.

 

Condom Checklist

• Store condoms in a dry place – not too hot or too cold!
• The right size condom for your penis (not the size you’d like to be!)
• If your hands are greasy (e.g. from eating greasy/oily foods!) then wash your hands, as grease/oil can cause condoms to split
• BRITISH HEART MARK and CE MARK (one or both)
• Make sure the date on the packet has not passed today’s date (the year comes before the month e.g. 2009/11)
• Check the condom packet for any damage, like holes or tears, and if you find any don’t use it as the condom will be more likely to split 
• Open the packet carefully making sure you don’t tear the condom with fingernails or your teeth

 

 

What do you think affects having safer sex?

Before you get yourself in a situation where you’re likely to have sex, think about what could affect you having safer sex*? Here are a few ideas other young guys have come up with. Why not pick one and talk about it with a sexual health nurse or youth worker?

•  Low Self Esteem (e.g. Body Image)
• Alcohol
• Destructive Behaviour (e.g. not caring about yourself or others)
• Mental Health
• Bullying
• Loneliness
• Peer Pressure
• Partner Pressure
• Drugs (e.g. Poppers, Ecstasy or ‘E’, Cocaine)
• No Self Acceptance (e.g. not accepting you have feelings towards other guys)
• Lack of Resources and Education
• Misinformation
• Religion
• Not Having Time
• Media
• Parents

 

Sexually Transmitted Infections (STIs)

Sexually Transmitted Infections (STIs) are infections that can be passed on when you’re having sex. Most STIs have no symptoms (asymptomatic), so you’re very unlikely to know you have one without being checked out at a Sexual Health Clinic (see below). However, some STIs you can see, like Genital Warts and Genital Herpes, and these will be evident on the skin around your penis and bum.

Some STIs do have symptoms and if you get any of the following symptoms, you should definitely get it checked out: pain when you pee, peeing more than normal, irritation in your penis, discharge* from your penis or bum, pain in your balls, a painful or painless sore around the genital area or something that just doesn’t feel right down there.

The best way to protect yourself from most STIs is to use a condom. To give yourself further protection you can get Hepatitis A and B vaccinations* (Hep A is explained in Tongues & Bums, see page below). All guys who have sex with guys should be vaccinated against Hep B; it’s definitely worth having and it’s free from Sexual Health Clinics.

Worried you might have caught an STI? The timescale between catching an STI and finding out whether you have one or not varies from STI to STI. However, in general, sexual health doctors and nurses recommend waiting until 2 weeks after you’ve had unprotected sex before having a sexual health screen and then returning in 3 months’ time to cover the HIV ‘window period’ (see below).

The only way you will know if you have an STI is to get tested at a Sexual Health Clinic. There is loads of information out there on individual STIs, look near the back of this guide for local and national services that can provide this.

 

Tongues and Bums

Oral sex is when someone uses their mouth and tongue to explore a person’s penis or bum.  Many people think oral sex is a completely safe thing to do, but there are still risks involved.

Oral sex can be a less risky activity than other types of sex (like anal, vaginal, etc.), but it is definitely not risk free. It’s also worth remembering that STIs, such as Syphilis, Herpes, and Gonorrhoea can be quite easily caught through oral sex. It is also possible to get HIV through oral sex, although this is rare.

Oral sex can be even more risky if you have open cuts or ulcers, or have recently had bleeding gums, a sore throat, tonsillitis, gum disease, or even a recent trip to the dentist.

There are several ways to reduce the risk of catching STIs or HIV when having oral sex:

• Use flavoured condoms or dams*
• If a condom or dam* is not used, avoid ejaculating (cumming) into your partner’s* mouth and vice versa
• Look after your mouth: the risk of catching an STI or HIV increases if you have bleeding gums, ulcers, or cuts so it’s a good idea not to brush your teeth or floss before oral sex 

 

Rimming

Rimming is when someone uses their mouth and tongue to explore someone else’s bum. You might cringe at the very thought, but some people enjoy it. Some guys rim as it helps them to relax before penetration. It may be a good idea to prepare yourself before you get rimmed, and your partner* may find this better too. You can do this just by having a wash or shower beforehand.

Unfortunately rimming can have its downsides, and it is another way of picking up infections like Hepatitis A (or Hep A as it’s sometimes called). Hep A is a virus which is found in poo, even in tiny bits of poo that you can’t even see! If you are unlucky and catch Hep A it can make you very ill for weeks, maybe even months. Unfortunately there is no treatment available for Hep A except resting and no alcohol or recreational drugs for a very long time!

If you like to rim, it would be a good idea to get a Hep A vaccination*, which can prevent you from getting the virus. Some Sexual Health Clinics offer Hep A vaccinations, if not you can have this done privately at your GP practice. To prevent getting Hep A and other STIs it’s recommended you use a dam* or even a piece of cling film (non-microwavable!) in between your mouth and his bum as this stops you and him sharing STIs!

 

Something to get anal about…

Lots of people have anal sex and for many reasons; some do it as it feels like they can get really close to their partner*, and some do it simply for pleasure. First of all, just because you prefer having sex with guys does not mean you have to have it up the bum!

You might hear guys saying they are a Top or they are a Bottom, or some even say they’re Versatile – these are all preferred ‘roles’. There are no rules as to which one you should choose to be, nor is there a rule to say you can’t change your mind. It’s all about preference and keeping yourself safe and happy.

It is common for most young guys to think about anal sex and what it might feel like, like whether it’s going to hurt or not. It can feel uncomfortable at first but preparing as best you can will help. You will have to decide what works best for you. Don’t be pressured into doing it, and if you are unsure take your time and think about why you want to do it.

 

Bottom

Being a Bottom means that the other guy puts his penis into your bum.

Other names: Passive, Receptive, Receiving, Taking.

It may make it easier when you first have sex to talk to one another, especially if it’s your first time as you may find it discomforting or worrying. For some people it may hurt or give you the feeling that you need to go to the toilet. However anal sex should feel more comfortable with a bit of foreplay and relaxation, and plenty of lube. If you think it isn’t for you then that is absolutely fine!

• Get comfortable with the guy you’re with, you can’t relax properly if you’re not comfortable with him which also means your anal sphincter (bum hole) will not relax
• Make sure your partner* has put a condom on and then put plenty of lube on, just inside your bum hole and on his penis too
• You must tell your partner* if he needs to stop or slow down as he won’t feel if he’s hurting you
• It’s best not to touch your penis when he’s entering (as this can make your bum hole tighten)
• Deep breathing can help you to relax
• If your bum hole clenches, wait about 30 seconds and then try again

 

Top

Being a Top means that you are the one who is putting your penis into the other guy’s bum.

Other names: Active, Insertive, Penetrative, Giving.

It’s best if you read the Bottom section of this guide so you and your partner* can work together so that you both enjoy having anal sex. It’s really important that you listen to the other guy and stop if he says stop or wait if he says wait: you won’t be able to feel any pain he might be experiencing. Go steady especially if it’s his first time.

Once you’ve ejaculated (cum), your penis will go soft, so remember to hold on to the base of the condom as you pull it out.

Versatile means you take both roles of being a Top and a Bottom. Some guys always like to stick with top or bottom roles whoever they’re sleeping with, while others find they can vary their role depending on their mood and the person they’re with. 

 

HIV

HIV stands for Human Immunodeficiency Virus and it affects both men and women no matter what sexual tendencies you have. HIV damages the body’s immune system (the part of the body that keeps you fit and well) so that over time HIV can make you become vulnerable to illnesses and infections.

AIDS (Acquired Immunodeficiency Syndrome) is caused by HIV. When a person has AIDS it means that their immune system is very weak and they have developed certain infections or conditions. If HIV is left undiagnosed for a very long time then your immune system will suffer badly, to the point where you will be diagnosed with AIDS. People don’t die of AIDS; they die of an AIDS-related illness. Everyone needs to be extra careful, as HIV is on the increase every year in the UK.

How is it passed on? HIV is mainly passed on in the following ways:

• By unsafe sex
• By sharing injecting equipment when using drugs
• Blood-to-blood contact (as well as receiving infected blood, or blood products; all blood in the UK is screened so don’t worry!!)
• From mother to baby

You cannot catch HIV from kissing, hugging, or sharing towels or cutlery!

 

Signs and Symptoms

Shortly after getting infected with HIV you may have a flu-like illness, though most people won’t notice that they have been infected and will feel healthy for a long time after becoming HIV positive.

However, when people have lived with HIV for many years symptoms will start to show. Symptoms vary from person to person and occur when the immune system is so damaged that other infections begin to cause health problems.

 

Tests and Treatments

The only way to find out if a person has HIV or not, is to have an HIV test.

After a discussion about the test and the consequences of the result, a sample of blood will be taken. However, bear in mind that results for any sex you have had in the last 3 months may not show up in a blood test, as HIV can take up to three months to be found in the blood. This is called the HIV ‘window period’.

The drugs available to treat HIV can really slow down the damage that HIV does to the immune system. People who are HIV positive can now stay healthy for many years with anti-HIV drugs. Taking anti-HIV drugs isn’t an easy option, as they can have many nasty side effects like prolonged tiredness, vomiting and diarrhoea. The good news is that anti-HIV drugs are getting better nowadays and their side effects are being reduced.

Sexual health doctors and nurses can support and monitor you. The majority of people who are HIV positive, if monitored properly, will live a long and healthy life. However, being HIV positive can mean a whole lifestyle change.

The only way you can protect yourself and your partners* from HIV is by using condoms or femidoms*. Everyone in society needs to be aware of HIV. Remember HIV doesn’t discriminate against anyone; it is happy to live with gay, bi or straight people, single or married, rich or poor, young or old.

HIV is always being researched and one day HIV may well be curable or even preventable (via a vaccine), who knows? But at the moment, there is no cure for HIV, and no cure for AIDS.

Do you know your HIV status? There’s only one way to find out, get a test!  

 

EMERGENCY PEP: THINK YOU’VE CAUGHT HIV?

If you think you have been put at risk of becoming infected with HIV, for any reason, (like you didn’t use a condom, or it split with someone you think might be HIV positive,) then there are drugs which could prevent you contracting HIV called Post-Exposure Prophylaxis (PEP). This treatment consists of taking 1 month’s worth of a combination of anti-HIV drugs.

This should be accessed within 3 days/72 hours (the closer to the first hour of exposure the better, as the success rate decreases with time) from having been put at risk. You can go to any hospital that has an Emergency Department or Sexual Health Clinic and they should have it available or at least know who will. The doctor will assess how much risk you have been put at to see whether you need PEP or not. It is the decision of the doctor to decide if your risk warrants PEP, and is not something that a patient can have on demand.

PEP is not 100% effective, and there are risks involved in taking it. PEP should not be considered lightly; there can be are many side effects and it can restrict or change your lifestyle temporarily.

 

Check Your Balls!

Testicular cancer is rare but it is the most common cancer in men aged 14 to 45. Remember, it’s normal to have one testicle which hangs lower than the other; this is nothing to worry about.

Symptoms of testicular cancer include:

• A hard lump on the front or side of a testicle
• An increased firmness of a testicle
• Swelling or enlargement of a testicle
• A heavy feeling in the scrotum
• A dull ache in the lower stomach, groin or scrotum
• Pain or discomfort in a testicle or in the scrotum
• An unusual difference between one testicle and the other

If you have these symptoms it could be a number of so many different things – so try not to worry, testicular cancer is rare.

Even if you may only think you have any of these symptoms, go to your GP without delay – it’s better to be safe than sorry. Guys who have had testicular cancer usually enjoy a normal sex life afterwards too (a replacement testicle can be put in). For more information, check out: http://www.cancerhelp.org.uk/type/testicular-cancer/about/testicular-selfexamination

If testicular cancer is caught early enough it’s nearly always curable

 

 

Visiting a Sexual Health Clinic

Sexual Health Clinics are places where you can go and get supported, tested and treated for STIs and HIV. They can also offer counselling about pretty much anything to do with sex, as well as providing free condoms and lube! They are open to people of all ages and sexualities. It can be quite scary seeing other people there, but just remember that you’re there because you’re taking responsibility for managing your own health. Sexual Health Clinics are run by specially trained sexual health doctors and nurses. You may feel embarrassed at first and feel like the staff might judge you, but they won’t; they’re more interested in your health and well-being.

Sexual Health Clinics will never tell anybody you’ve been to see them and anything you tell them will be kept completely confidential, even if you are under 16. The only time they will tell someone else (like social services) is when either you or another person is in serious danger of being hurt and they will only do this after talking about it with you first.

Sexual Health Clinics have their own health record system, which the rest of the hospital and your GP cannot access. When you go to the clinic for the first time, you will have to register, where they will need to take some personal details down like your name, address, date of birth, etc. You could even make up your name (like Donald Duck, but if you do make up your name, make sure you remember it!), the fact is, it doesn’t matter as long as you’re receiving the right healthcare!

Get tested – how? It’s not as bad as some people may make it out to be. The only things they would ask for are a small sample of your blood, a urine sample, and possibly a swab (the size of a tiny cotton bud) from your penis, bum or throat (depending on what type of sex you have). They will also ask a few questions about your sex life and history*. The doctors and nurses there won’t do anything that you don’t want them to do. Often tests are as simple as peeing in a pot and are not embarrassing or painful – no matter what other guys may have told you!

Results – how do I get them? There are a lot of options on how you can choose to be contacted: via a text message, phone call, or you can even request to pop back in a couple of weeks. Remember: a negative result means you are free of infection, and a positive result means you have something.

To find your nearest Sexual Health Clinic, log on to: http://www.tht.org.uk/howwecanhelpyou/clinicfinder/

“Sexual Health Clinics can sometimes be called GUM, GU Medicine or Genito-Urinary Medicine Clinics” 

 

Rape and Sexual Assault: What to do

If somebody touches you or does something to you sexually that makes you feel unhappy, it can be very confusing and make you feel distressed. Some people may not be sure as to what exactly happened to them and may feel unsure about what to do next. It is very important that you seek professional help and support if you feel that you may have been raped or sexually assaulted. If you are in immediate danger then always phone 999 for the police.

The police will always have someone for you to speak to about what happened which can be arranged by you calling or visiting your local police station. It is important to know that the police have a duty to investigate what has happened. This does not always lead to a prosecution or conviction but it may do so. There are also rape crisis and other appropriate agencies who can support you, which you can be referred onto either through yourself, the police or a sexual health clinic (as well as other young people services).

There are many helplines who can confidentially help you talk through your options and make sense of how you may be feeling.

Have a look at these sites for help: http://www.thehavens.co.uk/

 

Glossary

Bareback – this is penetrative sex (e.g. anal sex) without a condom.

Casual sex – this is sex with a person who is not a boyfriend or a regular partner, e.g. a one-off.

Dam – also known as a dental dam, this is a small square of flavoured latex, which can be used for rimming.

Discharge – is a fluid (which is not urine, cum or precum) that comes out of a guy’s urethra (the penis hole!) it can be clear, coloured and possibly thick.

Femidoms – also known as a female condom, this can also be used safely for anal sex between guys. You can insert this into the bum or by putting it on the penis first. It might be more comfortable if you take the loose plastic ring out of it first though.

Non-sexual (relationships) – it’s totally up to you if you want to have sex when you’re in a relationship. Some guys prefer not to for lots of different reasons.

Partners – someone you are having sexual relations with, whether it be regular or a one-off.

Safer sex – is when you take precautions when you have sex to reduce the chances of getting infections, e.g. using condoms, dams*, having a Hep B vaccine, etc.

Sex life and history – a ‘sexual history’ is where you will be asked personal questions, such as when you last had sex, who with, what type of sex, etc. This is so a doctor or nurse can assess your sexual health needs and provide appropriate care.

Sexually active – someone who has started engaging in sexual activities with another person.

Vaccination – an injection that could prevent a particular infection, e.g. Hep B.

 

© 2009 Michael Fanner (author)

All of the advice and information in this guide was written to the best of the author’s knowledge at the time of publication. This guide has been used by the Royal College of Nursing and University of Greenwich in their postgraduate and professional development courses and has been presented at the UK Department of Health’s HIV and AIDS Prevention Strategy Conference.