Stomach Pain After Anal Sex

Dear Dr. Bill,

I have recently started dating a new guy (he is 23) and we have had anal sex twice now and the day after he gets stomach pain (cramping) and nausea. He does not have diarrhea or anything like that, just the cramps. Last week, he went to the doctor and the doctor gave him a CT scan because the doctor thought it could be Crohn’s disease. My guy did not tell him that he had anal sex the night before, but did tell the doctor he was gay.

He has an appointment with a specialist next month to confirm the diagnosis of Crohn’s. I have a feeling that it is not Crohn’s but that since I am very thick, that I am pumping a lot of air into his bowels and it is gas pain. Last time this happened to him with another guy, the doctor prescribed an antacid and this took the pain away. This time the doctor has prescribed Prednisone. He has decided not to take it, as there are a lot of side effects.

I have been researching this question online with no real answers.

Thank you in advance for your help.

People's systems react differently to anal sex [especially if it's a comparatively new or infrequent experience] and getting gas or nausea is certainly not unusual, or necessarily something to worry about. Undoubtedly this condition will clear up in time. I suggest if this guy sees any more doctors he tells him or her that he engages in anal sex as a bottom, as it will help in their diagnosis. [If he feels he is in any way being judged, he should see another doctor.] As for prednisone, it is prescribed for a great many conditions, including cancer, arthritis, AIDS, etc., often in combination with other drugs, but a doctor would probably not prescribe it for gas or indigestion. The guy may have other medical conditions you may not know about.

Tops and Condoms

Do "tops" have to wear condoms? Anon.

Yes. Bare-backing is not a good idea either for tops or bottoms. Although it certainly does not occur as often, there have definitely been cases of a top contracting HIV from a bottom partner.

In other words, use condoms whether you're a top, a bottom, or versatile.

Stay safe and have a great time!

Bare-Backing Lover

My lover and I have an open relationship but recently I learned to my GREAT distress that he has been bare-backing -- and he's a bottom. He doesn't seem to be possessed of the self-hatred that you've mentioned, but when it's so easy to have your sex partner slip on a condom ... I just can't understand his behavior. What can I do about this? Anon.

Frankly, I can't understand his behavior either. [For the record, bare-backing is engaging in anal sex without using a condom.] I know some tops complain that they don't like to wear condoms, that it interferes with the sensations that they feel [although in that case I would recommend experimenting with different types of condoms, and there are plenty] but it shouldn't make that much difference to a bottom (and again bottoms can also experiment with different types of condoms). Let me make it clear that unprotected anal sex is the absolutely riskiest behavior for gay men. While it is much, much riskier for bottoms, there have been documented cases of tops getting HIV because they didn't use a condom as well.

As for your lover's behavior, there are several explanations [besides the fact that he's being very stupid]. If he's very young, he may feel he's invincible and that bad things only happen to other people -- even though, to everyone else, he is "other people." It's possible his "extra-marital" relationships occur when he's under the influence of something, and he's careless. People who are sexually active should carry condoms at all times and be prepared for every circumstance. If your sex partner says he doesn't have a condom, pull one out of your pocket -- pronto. If he doesn't want to use it, say good-night -- no matter how hot he is. Some sexual experiences just aren't worth the danger.

HIV may not be the death sentence that it once was, but people should by no means take it casually. AIDS is still a serious medical condition that can impact a person's entire life. Simply being HIV positive, while nothing to despair over necessarily, can have a serious effect on a person's general health and social status. Too many people, of all races, genders and orientations, mistakenly believe that HIV/AIDS is "no big deal." You have to make sure that your lover is made aware of this by showing him this and other posts on the subject, nagging him until it finally sinks in. Not only is he risking his own health, but yours as well.

You and your partner need to get tested for HIV and other sexually transmitted diseases. Again, being HIV positive, even having AIDS, is not the end of the world, as there are treatments that can help patients lead a more or less normal life [although it must be said that not everyone responds to treatment, which is another reason to swear off bare-backing]. But the fact that AIDS may be more treatable than it once was, does not mean that it's nothing to worry about. And other STDs are on the rise.

As for self-hatred, I've no doubt that some people who indulge in risky behavior have serious emotional issues, but in your lover's case it may simply be carefree, foolish recklessness on his part. If drugs or alcohol are influencing his behavior, then those issues must be addressed as well. [Don't get so drunk or fucked up that you can't wear a condom or remember to insist that your sex partner put one on.]

I'm in favor of open relationships. But for them to work, both partners have to be responsible. Which means safe sex at all times -- no exceptions!

Nag your lover about this until it sinks in.

"Kinkiness," HIV, and Gays

I was with my supposedly gay-friendly relatives the other day, and they seemed to be of the impression that gay men were much kinkier, "dirtier," in their sexual habits than straight people, and even implied that's why many gays had HIV. What is the truth about this? Angry in Albany.

There is absolutely nothing to suggest that gay men or lesbians are any kinkier or "dirtier"than heterosexuals. Any studies that suggest so are probably put together by homophobic Focus on the Family-type groups. Believe me, all of the sexual practices that some people might consider "edgier" -- water sports, rimming, anal intercourse, sadomasochism, and so on -- are practiced by heterosexuals as well as homosexuals. Besides, HIV can be spread by such "vanilla" [non-kinky or average] activities as "normal" heterosexual penetration. Tell your relatives that the heterosexual community, like the homosexual community, is quite diverse, and just because they don't practice the kinkier sexual stuff doesn't mean that's true of their straight friends or other straight people. Suggesting that the sexual habits of gay men are responsible for AIDS, for instance, is blatant homophobia.

Sadly, even in this day and age there are people (gay and straight, gay-friendly or not) who still see homosexuals as "abnormal" and kinky. [Not that there's anything wrong in being kinky!]

Tops or Bottoms?

What percentage of gay men are tops and what percentage are bottoms? Anon.

I have never, ahem, actually done a scientific survey on this subject, but I would say it's about evenly divided. Of course there are men who are versatile, both top and bottom, but judging from what I see on gay dating/sex/friendship sites, there don't seem to be as many of them.

I can tell you that in my experience you can't assume the butcher gay men are automatically tops and the "femmes" are bottoms, because sometimes the reverse is true. When two men get together, it's two men getting together -- neither one is the "lady." Men who are bottoms should never feel that they are somehow less male because of it. There are some men who think of themselves as being "straight" because they are always the top when they have sex with another guy -- they're fooling themselves.

And, as usual, I remind everyone to stick to safe sex. This is true even if you are a top. Although there have been fewer cases of HIV infection in men who are tops than bottoms, it does happen. When it comes to anal penetration, always wear a condom.

Unsafe Sex

I'm gay but I can't understand why there are guys who take it up the ass without a condom, who even get ticked off if the top wants to use one? What's up with that? I would never have anal sex without a condom. Jerry.

To put it bluntly, they're nuts -- and so are you if you don't use a condom (glad to hear that you do). Guys like that are playing with fire; even if their sex partners say they're HIV negative doesn't mean they are, or that they've even been tested. I assume these guys have a crazy love of danger, think they're somehow immune to HIV or bad luck, have some kind of death wish, or thrive on taking nutty chances. Some will simply say that it feels better without a condom. Maybe (I'm a top man myself)? But even if the sensation is a bit muted isn't it better if it's safe?

These guys not only don't care about themselves, they don't care about you. Yes, you can contract HIV even if you are a top and have sex with a bottom. If you indulge in anal sex, always use a condom.

Why do these guys take such unnecessary risks (and there are straight guys like this as well as gay guys)? I guess it's all about the thrill, immediate gratification without responsibility. Or sheer stupidity? Younger gay guys did not grow up with dozens of their friends horribly wasting away and dying from AIDS. Older guys figure most of their life is over already, so who cares? They all think that if you contract HIV all you have to do is take a pill. HIV may no longer be a death sentence for most, but there are still serious social, sexual and health complications, and there are quite a few people who do not respond to medications. HIV infection is still a serious matter.

Avoid guys like this. At the very least insist on safe sex and condoms when you''re with them or just walk out the door.

There are plenty of more responsible guys in the gay community.