3 min

The direction of your erection

Dr. Paul MacPherson looks at the scope of Sexual Health

Credit: Capital Xtra files

If someone had asked me to list the three things that interest me the most, gay men, sex and health probably would have topped my list. So when I was asked to write a column about sexual health, naturally I accepted.

For many of us, sex is an important part of our lives. It certainly feels good and can be a lot of fun. It can be pure recreation, or a way to let someone special know he is an intimate part of your life. Physically, sex can also be a bit of a workout, raising our heartrate and exercising muscles.

Sex can also make us feel good psychologically. During sex, endorphins are released in our brains providing a sense of euphoria, a natural high. Sex can also add to our sense of self-esteem, making us feel attractive and desirable. All of these things are good for us and enhance both our physical and emotional health.

So sex is good. And it should be uncomplicated. There is a penis, a mouth and an anus, and one fits nicely in the other two. Slip on a condom and it becomes “safe,” right?

But the truth is, sex is not so simple.

When we talk about sexual health we generally think safer sex and most of us think about HIV. But how we deal with HIV is different from how we deal with syphilis. And how we deal with syphilis is different from how we deal with our emotional well-being. Our sexual health includes our penises, but also includes the rest of our bodies and our minds.

Sex should be emotionally safe. Past sexual abuse and low self-esteem can make sex emotionally unsafe. Sex can become a coping mechanism for anxiety or depression, a way to “drown out” feelings of insecurity, fear or loneliness. Depending on how an encounter plays out, sex can make a person feel devalued and that can fulfill a sense of low self-esteem. Your feelings are very much a part of your sexual health. What is more, feelings of low self-esteem, depression, anxiety, anger or even elation can lead us to take risks during sex that we may not otherwise take. Talk to a counsellor or your doctor about your feelings and reactions around sex. Most of all, be honest with yourself.

While role playing can be fun and exciting, physical abuse is another thing entirely. We should all feel physically safe within our relationships and when we have sex. If you find yourself in an abusive relationship, again talk to a counsellor or your doctor. When you hook up with guys at the clubs or over the internet, keep your physical safety in mind.

Of course our sexual health does includes dealing with sexually transmitted infections. Some infections, like HIV and herpes, remain for life. Others like genital warts are tough, but generally yield to persistent treatment. Syphilis, gonorrhea and chlamydia are easily treated, but infection with these organisms may or may not be obvious. Giardia, which is not technically considered a sexually transmitted disease, is often passed on during sex and causes profuse and chronic diarrhea. How you can reduce your risk of acquiring any of these infections differs depending on the infection and the way you have sex.

At its most basic, sexual health obviously involves how your penis works. Difficulties getting or maintaining an erection, problems reaching an orgasm or premature ejaculation are not uncommon problems. Most guys feel uncomfortable discussing these issues. But more than likely, your doctor has talked with someone else with similar issues before you. If you are open and direct, chances are your doctor will be open too. If not, find a physician with whom you can talk openly. You owe it to yourself.

Sexual health is about you. As gay men we tend to be very open about sex. Most of us enjoy sex a lot. Most of us think about sex a lot. Most of us talk about sex a lot. But how much do most of us really know about sex? Over the next several issues we will discuss a number of sexually transmitted infections, how to reduce your risks and how to recognize them if you get them. The idea is to be informed and to live a healthy, sexy life.

* Dr MacPherson is an assistant professor of medicine at the University of Ottawa, a specialist in the Division of Infectious Diseases at the Ottawa Hospital General Campus and a staff scientist at the Ottawa Health Research Institute. He is also a member of the Gay Men’s Wellness Initiative of Ottawa.