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Try out PMC Labs and tell us what you think. Learn More. We live in an era in which the nature, function, and structure of the family have been thrown into question. Many, for example, would consider an unmarried couple, a single mother, and homosexual couples as equally legitimate expressions of the family unit. Islam takes a more conservative stance, arguing that the family is a divinely inspired institution, with marriage at its core.
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Learn More. The range of sexual dysfunctions encountered in gay men and lesbians is the same as that found in men and women in general, and the skills needed to help them are the same. That said, there are areas of concern, both for patients and doctors, that merit particular consideration.
People may encounter problems when they become aware of their homosexual orientation and try to match it to their view of an ideal self. If this occurs in adolescence it may be useful to offer counselling to help with the readjustment in life that may be required. However tolerant our society may become, being openly gay still has major implications for future career and family life.
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. Although 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.
These people require careful and compassionate counselling. Some choose to remain married, and the couple may need help to reorganise the London wives to fuck of their heterosexual relationship. The counsellor must be seen to be completely impartial and not encourage any particular outcome.
Presumptions —When counselling gay people about sex, it is important not to have preconceived ideas about their sexual repertoire. Be honest with yourself; if you are uncomfortable with gay people refer the patient to someone else. If an adolescent is confused about his or her sexuality try to help the patient to adjust. Disapproval —The days when physicians would try to impose their own moral standards on their patients should be long past. 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.
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.
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. 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.
It is unclear what proportion of men and women have same sex experiences in their lives. Studies have been fraught with methodological errors and with researchers trying to confirm their own preconceptions. Gay men and lesbians have as wide a range of sexual lifestyles as does the general community. Some homosexuals live in a stable partnership and never have sex elsewhere.
Karen celis, johanna kantola, georgina waylen, and s. laurel weldon
Others have a strong, committed relationship but with an open acknowledgment that one or both partners also have sexual liaisons elsewhere. Infidelity in a supposedly closed relationship is probably just as common as among heterosexuals. Single gay men have a reputation for having many sexual partners, and in urban communities the opportunities for this are widespread. Casual or anonymous sex can provide sexual gratification without the complications 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.
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.
Gay men —Anal sex remains a taboo subject even for many professional sexual discussions; however, it is widely practised in most communities. Sexual activity is protean in all groups, and gay men are no different in this. Mutual masturbation, oral sex, and anal sex can be considered core activities, although many gay men do not practise anal sex at all. Lesbians —Mutual masturbation, oral sex, caressing, and penetration with fingers or sex toys can be considered as core activities. Once they have sought help, gay men and women are often less reticent in discussing at length and in detail specific sexual acts.
It is therefore useful for a doctor to be forearmed with a basic vocabulary of gay sex, although many men and women who perform these activities will lack the words to describe them, and few people of any orientation are likely to have all the activities in their personal behavioural repertoire.
Most gay men will not fit exclusively into either of the roles implied by the old fashioned heterosexual model, and if the words are applied to oral sex great confusion may result.
Gay male oral sex includes two sexual acts, fellatio and irrumation—cock sucking and face fucking respectively—depending on whether it is the mouth sucking or the penis thrusting that is the main act. When it is necessary to determine who did what, it is easier to talk about insertive and receptive partners to avoid confusion. Erectile dysfunction is being seen increasingly, usually of an organic type, in those with late stage HIV infection, although whether this is an effect of the virus or of the antiviral drugs is not yet clear.
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. Anal fissures usually arise from constipation rather than receptive anal sex.
However, if they are a sexual problem they generally respond to the use of an anal dilator. A topical anaesthetic such as EMLA cream may be used on the first few occasions, until healing is under way. Female sexual problems —Like heterosexual women, lesbians can suffer from vaginismus, primary or secondary, and from anorgasmia and low sexual drive see earlier article by Butcher.
Sexually transmitted diseases are common in people with many sexual partners, which includes some homosexual men. The ease of transmission of most sexual infections is similar for vaginal and anal sex, with the exception of HIV, which is much more easily spread by anal sex.
Strong condoms greatly reduce this risk. Oral sex, while a recognised route of transmission, is considered to be relatively safe for HIV, but it is a common means of acquiring gonorrhoea and non-specific urethritis. Lesbians are considered a low risk group for HIV infection. Sexually transmitted diseases are common in all gay people with a high of different partners. The transmission of infection through vaginal and anal intercourse is no different, apart from HIV. The greater incidence of hepatitis B is an indicator of a large of partners, not of specific sexual practices.
Faeco-oral spread of pathogens such as Giardia and hepatitis A are well recorded from oro-anal sexual contact.
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Minor episodes of diarrhoea may be related to faecal exposure, and are often self limiting. If they persist, stool culture will usually pick up any bacterial cause, and if the culture is negative it is better to treat for pd giardiasis than do extensive investigations to attempt to prove the diagnosis. Hepatitis B, though commoner in gay men, has not been shown to be spread by specific sexual London wives to fuck and may simply be a marker of exposure to a greater of sexual partners.
Immunisation against hepatitis A and B is recommended by the Department of Health for all men with male sexual contacts. This means that, in absolute s, there are more heterosexuals having anal sex than there are gay men. There are little published data on how many heterosexual men would like their anus to be sexually stimulated in a heterosexual relationship.
Anecdotally, it is a substantial. What data we do have almost all relate to penetrative sexual acts, and the superficial contact of the anal ring with fingers or the tongue is even less well documented but may be assumed to be a common sexual activity for men of all sexual orientations. The nerve supply to the anal margin is the same as that to the genitalia, coming from S4, and the pectinate line roughly marks the division between sensitivity to touch and temperature externally and perception of little more than stretch internally.
The external anal sphincter is made of striated muscle and can be brought under voluntary control, whereas the internal sphincter, which is a thickening of the intrinsic muscle layer of the gut, is made of smooth muscle and is autonomic, opening in response to stretch stimuli. Explore the perianal area with a finger covered in lubrication. Petroleum jelly is a good choice at this stage, but it must be substituted with a water based lubricant before intercourse with a condom is attempted.
Gentle pressure with a finger moving in a circle round the anus will relax the sphincter enough to be able to insert one digit. Once the finger can be comfortably accommodated, begin to stretch the sphincter with circling motions inside the anus. Mutual masturbation, oral sex, caressing, and penetration with fingers or sex toys can be considered as core activities of lesbian sex.
Infection with Neisseria gonorrhoeae can occur through oral sex as well as vaginal and anal sex. In absolute s there are more heterosexuals having anal sex in Britain than there are gay men. The picture of the gay couple is by Fly De Consultants and reproduced with permission of the Terrence Higgins Trust. The picture of a woman with a dildo and harness is reproduced with permission of Housk Randall. The picture of gay men in a night club is by Nathan Cox and reproduced with permission of Gaze International. The electron micrograph of gonorrhoea bacterium is by A B Dowsett and reproduced with permission of Science Photo Library.
National Center for Biotechnology InformationU. Journal List BMJ v. Robin Bell. Copyright and information Disclaimer. This article has been cited by other articles in PMC. Avoiding prejudice Presumptions —When counselling gay people about sex, it is important not to have preconceived ideas about their sexual repertoire. Counselling gay men and women Be honest with yourself; if you are uncomfortable with gay people refer the patient to someone else If an adolescent is confused about his or her sexuality try to help the patient to adjust Do not have preconceived ideas Take the opportunity to discuss safe sex with gay men A married man or woman might benefit from couples counselling Sexual orientation is not always fixed.
Some people change their mind. Sexual activities It is unclear what proportion of men and women have same sex experiences in their lives. Spectrum of activity Gay men —Anal sex remains a taboo subject even for many professional sexual discussions; however, it is widely practised in most communities.
Terminology Once they have sought help, gay men and women are often less reticent in discussing at length and in detail specific sexual acts.
Problems Erectile dysfunction is being seen increasingly, usually of an organic type, in those with late stage HIV infection, although whether this is an effect of the virus or of the antiviral drugs is not yet clear. Infections Sexually transmitted diseases are common in people with many sexual partners, which includes some homosexual men. Infections associated with homosexual activity Sexually transmitted diseases are common in all gay people with a high of different partners Their management is the same as in the heterosexual community The transmission of infection through vaginal and anal intercourse is no different, apart from HIV Hepatitis A and Giardia are spread through oro-anal contact The greater incidence of hepatitis B is an indicator of a large of partners, not of specific sexual practices.