not a mind-reader, and appearances can be deceptive. Be
aware that many people, when faced with a question
about someone's sexual identity, tend to categorize
people into the less societally accepted roles. For example,
a heterosexual man who has sex with a man is assumed
to be a closeted gay, but a homosexual man who has sex
with a woman is not assumed to be a closeted straight.
that minority. We all know that unprotected anal coitus
is a risk factor for HIV transmission, but it may surprise
some that more heterosexuals take part in anal coitus
than homosexuals. The point is: talk with all your patients
about anal safer sex practices. The assumption that you
can choose whom to advise on this issue will unfortunately
be proved wrong too often.
best piece of advice you can give to patients interested in
exploring anal sex is to make sure anything inserted into
to the anus has a flange to prevent it from being lost in
the rectum. A second safety technique, which should also
be included, is attaching a string to the device to allow
for retrieval if the flange fails to prevent the object from
being lost in the rectum. Discussions of how to prevent
colonic perforations (smooth soft toys, exceedingly short
fingernails, quick referral for bleeding) should also be
emphasized, in addition to safer sex advice. Information
about sexually transmitted diseases (STDs) that can be