The medical St Mark’s type is readily available, and the self retaining version is sold as a sex toy called a “butt plug.” The smallest size works well if left in situ for several hours each evening. However, if they are a sexual problem they generally respond to the use of an anal dilator. Piles caused by dilation of an anal venous plexus are no more common in those having receptive anal sex, and are usually caused by straining at stool.Īnal fissures usually arise from constipation rather than receptive anal sex. Retarded ejaculation is common in gay men and may be related to fears of contagion induced by the “safer sex” campaigns. Vaginismus, anorgasmia, and low sex drive occur in lesbians as in heterosexual women There can also be considerable distress for those who find it difficult to establish same sex relationships that could progress to become sexual and committed. 3 Similarly, casual sex can be the reason for patients, male or female, to seek help, realising that, although they are sexually fulfilled, they are “missing out” on the emotional aspects that can be associated with sex as part of a relationship. Sexual dysfunctions should be assessed objectively without a moral stance being taken on the manner in which sexual expression is likely occur. Casual or anonymous sex can provide sexual gratification without the complications of a relationship. Single gay men have a reputation for having many sexual partners, and in urban communities the opportunities for this are widespread. Infidelity in a supposedly closed relationship is probably just as common as among heterosexuals. Others have a strong, committed relationship but with an open acknowledgment that one or both partners also have sexual liaisons elsewhere. Some homosexuals live in a stable partnership and never have sex elsewhere. Gay men and lesbians have as wide a range of sexual lifestyles as does the general community. 2 These values are lower than many other estimates, probably because of the method of the study. Recently, the national survey of sexual attitudes and lifestyles estimated that 1% to 6% of the male population had had such experiences, depending on how homosexuality was defined. Studies have been fraught with methodological errors and with researchers trying to confirm their own preconceptions. It is unclear what proportion of men and women have same sex experiences in their lives. Gay men face practical problems, such as a future application for life insurance, which mean that some patients will not wish to disclose their sexual orientation to their general practitioner, no matter how sympathetic and confidential.
Patients’ reticence-Even if a doctor is comfortable with homosexual patients it does not follow that such patients are comfortable with the doctor. Local genitourinary medicine clinics should be aware of what services are available locally and which are considered as “gay friendly” and can be used as a source of reference. Inaccurate advice-It is unwise to advise patients on subjects that they may know more about than you do, and if anal sex is not something that you know much about it is better to admit this rather than offer inaccurate or misleading advice. It is difficult to focus on the relevant clinical issues if you are having to concentrate on your own discomfort and trying not to express it. If individual clinicians are aware that they are uncomfortable with the issues of gay sex and relationships then they should refer the patient on to somebody else. Some people change their mindĭisapproval-The days when physicians would try to impose their own moral standards on their patients should be long past. The counsellor must be seen to be completely impartial and not encourage any particular outcome. Some choose to remain married, and the couple may need help to reorganise the basis of their heterosexual relationship. These people require careful and compassionate counselling. Help at this time can include (for men especially) information about safer sex, since sexual exploration may present a greater risk of exposure to HIV.Īlthough many gay men and lesbians are aware of their orientation from their earliest sexual thoughts, a sizeable minority do not discover their orientation until later in life, perhaps in a failing marriage and with the responsibilities of parenthood.
However tolerant our society may become, being openly gay still has major implications for future career and family life. If this occurs in adolescence it may be useful to offer counselling to help with the readjustment in life that may be required. People may encounter problems when they become aware of their homosexual orientation and try to match it to their view of an ideal self.