Jack Morin Transcript

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This is a transcript of Dr. Jack Morin's presentation, "Clinical Aspects of Anal Sexuality," which he delivered at the 1998 joint conference of the Society for the Scientific Study of Sexuality and the American Association of Sex Educators, Counselors, and Therapists (held in Los Angeles, from November 11-15).

Dr. Jack Morin is the author of Anal Pleasure and Health and The Erotic Mind. He has maintained a psychotherapy practice in San Francisco for more than 20 years, and is a diplomate of the American Board of Sexology. This talk was transcribed and edited for http://www.sexuality.org with the permission of Dr. Morin.

With Dr. Morin's permission, we've also scanned in (and made available as a PDF file) the figures he refers to in this talk. You may wish to download and print out these figures if you plan to read this talk in depth (though you will need the free Adobe Reader program to do so).

If you find Dr. Morin's talk interesting, you may also wish to read Dr. Morin's popular Ten Rules of Anal Sex (again, reprinted here by permission of the author).

This entire transcript is Copyright © 1998 by Dr. Jack Morin. All Rights Reserved.

Let me just launch into this a bit by telling you how I got into this area. Everyone assumes (and it's fine with me that they do) that I must have gotten into this line of research out of my own personal, passionate interest in anal sexuality. That's really not how it happened; it was a total accident. Two things came together at the same time for me in the 70's. One is that I had a horrible case of hemorrhoids; they were recommending surgery and I couldn't sit down without a pillow (you know, one of those doughnut-shaped deals). But also, right around the same time the sexual revolution was full-blown, especially in San Francisco where I'm from. People were coming to me saying, "Well look, I'm hearing more and more about anal sex, it's supposed to be great but it's not great for me; I'm either scared of it or it hurts like hell. Help!"

I was doing sex therapy then, and so I ran off to the library to see what had been done. Of course, nothing had been done on it at all. It started out pretty informally; I said to those people, "Well, you know, nothing much has been done in this area, but why don't we work together and through your experimentation and suggestions we'll find out what's helpful in getting you to the place you want to be." In the meantime, I started poring over anatomy books (which wasn't my habit before then) to try to figure out what's going on back there. As it turned out I was also working on my Ph.D. I was very reluctant to define a new sexual dysfunction (isn't that the last thing we need?), but this was a concern people had that maybe sex therapists could do something about, or people could be doing something about themselves if they knew how to approach it.

I wanted to devise a step-by-step, sex therapy-oriented process with an experiential part which then becomes a catalyst for discussion. I ended up working on this for many years: gathering data and analyzing it and everything. I did what I used to call "Anal Awareness and Relaxation Workshops" in San Francisco. They were extremely popular, particularly amongst gay and bi men, but then as word got around and I did a fair amount of speaking, women started to come to me as well. I never had an opportunity, unfortunately, to do a group of women, but I did work with women individually and with their partners a lot. Not as much as the men, although the proportion has changed in recent times. It's getting closer in terms of the proportion of women to men who present with the kind of concerns we'll be talking about today.

After I finished my doctorate I rewrote my dissertation as a book called Anal Pleasure and Health, which came out in 1981. It did very well because there was a hunger for information - but nobody wanted to talk about it. I did get on a few radio programs, but that was about it; I was never able to do any TV. So it was pretty much just "thrown out there," and it had to be word of mouth. But it's interesting, because up until just last December it remained the only serious book on the subject in the world. So if anybody, especially with the advent of the web, wanted to search about anal sex they would find their way to my book. Also, in 1981 at an AASECT meeting in San Francisco I presented on the research at that time. I have not presented at either SSSS or AASECT since then, until this year, and to my knowledge no one else has presented on this topic either. This is an area that sexologists are interested in learning about but not researching, at least not at this point. Or so it appears.

In my original study, 143 people completed those anal awareness and relaxation workshops. There were 114 men, 21 to 62, with a median age of 30. At that time I worked with only 29 women, ranging in age from 25 to 44, with a median of 32. Most of the women saw me with their partners. In the years since then it's really branched out and gradually more and more physicians have been referring people to me, until now I really see more people who are dealing with anal tension because they have anal medical problems rather than anal sexuality problems. But I'm still very active in both areas.

That's how I got into it, and I do have to mention that a third edition of my book just came out last Spring. I completely rewrote the whole thing; the basic approach is the same, but it's totally updated. I really enjoyed doing it. My other book which will come up briefly in our discussion, The Erotic Mind, came out in 1995 and is about the psychology of desire and arousal.

We have to start with a discussion of the anal taboo; this is the headline: when you think anal, think taboo. Freud made a distinction, a crucial one, between taboos and moral prescriptions, which give reasons for why you shouldn't do this or that bad behavior. Taboos have no justification. None is given; they just are. The anal taboo is passed along through our early training in life: that it's just disgusting back there, we should tune it out as much as possible, not be aware of it, and God forbid not mess with it or enjoy it. The anal taboo encourages us to tune out the anal area, making it a sort of numb part of our bodies that we're just not familiar with and vaguely uncomfortable with. This has major effects on our sexuality. As Masters and Johnson showed, of course, and I guess anyone who paid attention knew before, the anal musculature is totally involved in the orgasmic contractions, which you can feel in your anus. They're exactly the same: the same rate and everything. I'm amazed even to this day in my graduate level sexuality classes how many of the students don't know that all orgasms are to some degree anal orgasms; you can't separate them. That's because the musculature in the pelvic region is all intertwined. The anal sphincter muscles are directly connected to the pelvic floor muscle, which goes throughout the pelvis. I'll get into a little bit of that when we get to anatomy and physiology.

So what does it mean when we have this taboo against a whole part of our anatomy that's intricately involved in sex? One thing is that it reduces our pleasure even if we're not interested in anal sex, because one of the ways we tune it out - to obey the taboo - is to constrict it. We hold tight and that may lead to pain and problems for us. I think this can blunt or certainly limit the potential of our orgasmic responses. I think feeling about an area of the body so closely related in proximity - and in so many other ways - with the genitals has got to carry over. The "badness" rubs off, and I think it affects our sexuality that way, and it most certainly affects the sexuality of people who would like to be able to enjoy anal stimulation of whatever form, but can't because they're too emotionally/psychologically uncomfortable, or can't because of anal muscular tension that makes it just hurt and feel bad rather than pleasurable.

The anal taboo also has major effects on our health. Again, because we tune out and we tend to constrict, that means that there's all kinds of people, millions upon millions, walking around with very tight asses. They're probably not that aware of it until some problem crops up down the road. But if you look at the statistics, hemorrhoids (which are one of the top reasons people go to doctors and one of the most widespread and uncomfortable medical problems in the whole country) can really be fairly easily treated in a wide range of cases by just learning to reverse the effects of the anal taboo. This means to pay attention, to tune in to touch, to look, to explore, and to familiarize with the area. This is the most helpful thing a person can do.

As a little aside, when the new edition of Anal Pleasure and Health came out, I had a little media boomlet caused by - I won't explain the details - some guy who's connected with all the media; he did a focus thing in one of his issues on my book, but what he focused on is, "Jack Morin thinks it's a good idea to put your finger in your butt every day in the shower for thirty seconds, but Dr. so-and-so says there's no evidence this is true, and besides the anus prefers to be left alone." And that was it. For at least two months after that it was non-stop radio appearances - that just sort of clicked, you know. I was on Howard Stern and they did a funny bit about it on Comedy Central, but anyway...

It's harder to prove what the effects of the anal taboo are in society at large. But what does it mean to society at large for our health, our well-being, our sexuality, and our attitudes, to have one zone of the body that's cut off as forbidden? And what does this do for our abilities to take care of ourselves? This has, I think, public health implications that are very broad and obvious. I also think there's a lot of other societal effects that I don't have a way of measuring. Maybe some creative person will come along who can measure them; I think that would be a great piece of research.

Taboos of all types, it seems to me, are paradoxical phenomena. This means they can either intensify the interest in the taboo object, or act as inhibitors, which make people stay away from the taboo object or behavior. This dual-paradoxical effect is clear when it comes to the anal taboo. It has a big chilling effect, but it also creates for many people an extra level of fascination because it's taboo. I have worked with people - maybe we'll get into it later - where my approach involved getting them more comfortable with the anal area, accepting it, and not feeling bad for wanting to enjoy it if that's what they want to do. Many people, once they adopt that attitude, say, "Hey, wait a minute - I'm not getting pain like I used to, but it's not as exciting as it used to be either, because it's not taboo any more - I want my damn taboo back!" It's like everything else; things kind of go around, and so it now becomes part of the treatment to explore with people the importance of the taboo and discuss ways to keep the taboo alive for excitement purposes, but in a way that doesn't inhibit their health and well-being and relaxation and so forth. Sometimes that's a little bit tricky.

One of the things we need to do - and I would imagine this group has, to a certain extent, already done it or is well on its way - in order to work effectively in clinical settings with a whole range of anal issues, is to be able to recognize the lingering effects of the anal taboo within ourselves. Because, if we're not in touch with it within ourselves, we're not going to be really good at helping other people get in touch with it within themselves. So I think one of the things we need to do is confront what form the taboo takes for each of us. Maybe one form of it in our field is that we don't want to be caught studying something that is still kind of taboo. When I got into this research, I was embarrassed about it. But I couldn't resist the temptation of studying something nobody else had studied, so that won out, but I was very embarrassed about it for many years. But I'm not any more - that went away somehow. There are some good signs that the anal taboo is weakening somewhat, and I would underline the "somewhat." People at the sex toys shops, like Good Vibrations and Eve's Garden, are all reporting a tremendous upsurge in anal toy sales: butt plugs and other devices for anal stimulation. The books sell very well through those outlets, and they're talking about how people come in at the retail outlets overtly asking questions about anal sexuality - even if there are other people in the store. And, people are buying the book more openly; it's on more and more bookstore shelves. For a long time it wasn't at all, because no one wanted to be seen buying it.

Audience: What does a butt plug do?

Well, it has a flared base, a narrow area where the sphincter muscles would be, and then it widens out and narrows again. It's flexible - rigid but flexible - and it's basically for anal stimulation. "Butt plug" refers to the shape where it goes in, near the base, so the sphincter muscles can kind of hold it in place. Some people like to just leave them sit there - during sex or sometimes even when they're not having sex overtly.

Also, while the media interest is another sign that people interested in anal sex, there are a number of other books in the works about it, and another one that came out at the end of last year about anal sexuality for women.

Audience: Is it your impression that a lot of young people, rather than penile-vaginal intercourse, are turning to anal sex?

I do see some of that; I don't really have any hard data on it, to tell you the truth, but I've observed it anecdotally. I just think that younger people are experimenting more, which I think is good if they do it with their eyes open, so to speak.

What I want to do now - and this will be review for a lot of you - is go over the key points we have to be aware of about the anal and rectal anatomy in order to be able to talk intelligently about the subject. That's what these drawings are for. Look at the first drawing on your handout; you're looking at the anal opening - the short anal canal is only about an inch long, and then it opens up into the lower rectum. That's what we're looking at in the enlargement here. The reason I wanted to show you this, though, is that it shows pretty clearly that there two anal sphincter muscles: the internal sphincter, which is on the inside, and the external sphincter, which is on the outside. Now, it's important to know this distinction for anyone who's going to be an anal explorer. Because the external sphincter is under central nervous system control, most of us (unless we're totally out of touch with the area) just by tuning in and sort of deciding to release can learn to relax the external sphincter quite easily. The internal sphincter is controlled by the autonomic nervous system, so you may be able to relax the external sphincter and not be able to relax the internal one. It also seems to be the internal sphincter that stores up tension and stress on a cumulative basis; the anus often becomes what I call a tension zone - very similar to those of us who get the neck and shoulder thing, or the back thing, or the stomach thing, or wherever our tension zone may be. That mainly shows up in the internal sphincter. It really is the chronic internal sphincter tension that is a major, major cause of hemorrhoids, which we'll talk about later.

You can see by this drawing that the external sphincter does have layers to it, and kind of wraps around the internal sphincter; they're very closely linked together. You can't see it in this drawing, but you sort of can see it in the tiny drawings of the male and female pelvis here, where in a very schematic way it shows how the external sphincter is connected to the PC muscle, the pubococcygeus, the one we exercise in Kegel exercises. It's directly connected. And so if these muscles are tense, then what is it doing to our ability to enjoy orgasm when all those muscles that are supposed to let go are chronically constricted?

With the next illustration, I want to get you oriented here with the rectum, because if there's going to be intercourse or insertion of objects or a hand or whatever, then we're getting into the rectum. This lower left-hand drawing shows the relationship of things. There's the descending colon, then there's that S-shaped sigmoid colon just up above the rectum, and then the anal opening. You can also see in this drawing on the bottom right something that's very important - a muscle called the pubo-rectal sling. It anchors to the pubic bone on one side, goes around and wraps behind the back of the rectum, and comes back and anchors on the pubic bone in the front and the other side. It supports the rectum, and its other function is that it's responsible for the majority of our ability to hold back having a bowel movement even if we need to. It's not mainly the sphincters that do that job; it's mainly the job of the pubo-rectal sling, but the pubo-rectal sling can also become chronically tense, and you can imagine by looking at this drawing how, when it contracts, it sort of squishes the rectum. This, I'm convinced, is a very significant cause of constipation as well as not being able to enjoy the insertion of objects into the rectum.

If you go to the next drawing, you can see another crucial thing to keep in mind and communicate to anyone who talks to you about this stuff: that the rectum is not a straight tube. It's not the same in everyone - obviously, everyone's a little different on everything - but generally it takes two major curves along its length. You can see in this next drawing that if you insert an object or a penis in the wrong angle it will run into the wall just before the first rectal curve, and you're going to get a lot of pain. Some people try anal sex experimentally without learning about it first; when I have a chance to talk to them and ask them to focus a bit, they'll identify the pain of trying to go through the constricted sphincters (and that's pretty excruciating), but some will say that after they learn how to relax the sphincters they still feel a pain deeper inside - and that's it. That's what it is in almost every case, and this problem is exaggerated when you have excess tension in that pubo-rectal sling.

You also need to be aware that the rectum is not normally a storage area for feces; they're stored in the colon just above the rectum. When pressure builds up there's another sphincter leading into the rectum (at the top) that opens up, and then the feces start to descend and create the full feeling that signals us it's time to go poop. If it's not convenient for us to go poop we'll contract that pubo-rectal sling, and to some extent the sphincter muscles as well. After bowel movements (depending on the consistency of the feces and other factors) there is sometimes some leftover feces in the rectum, but it's not a storage area for it.

Learning more about the anal and rectal area and how to relax this musculature does seem to translate in many cases, particularly if it's combined with an overall relaxation process, to the whole digestive system. I've had some pretty effective work - though not as effective as with the hemorrhoids - with people who have so-called irritable bowel syndrome, where they fluctuate between constipation and pain and gas and diarrhea; they essentially get very reactive to anything that's going on with their lives, in their gut. Learning how to relax these areas does sometimes really help with that.

I'm not going to go into fisting much today because of time constraints, but I wanted to mention a couple things about it now because it relates to our picture of the anatomy. Fisting refers to the insertion of several fingers, sometimes the whole hand, and sometimes even the forearm as well, into the rectum. If it involves the forearm, then the fingers are making their way into the lower colon; they're going beyond the rectum. This activity has maintained a strong popularity. Of course it's a minority activity and I suspect always will be, because even most of us who are relaxed still can't do the fisting thing nor would most of us probably want to. But, a lot of people find that fisting is the most intense erotic experience they've ever experienced in their lives, that it brings them an incredible sense of oneness with whoever is doing it to then, and that it's a form of meditation. It takes a ton of time (it's not a quickie), but they get into altered states of consciousness and just have incredible experiences, sometimes without any genital involvement whatsoever - intense orgasmic experiences. Handballing is another term for fisting - I think it's better, because most people are fooling around with multiple fingers, and not getting the forearm in there. These are the real fisting enthusiasts, who want to just get bigger and further.

I wanted to at this point mention something about the spectrum of anal pleasure that's available, because when people talk about anal sexuality they're usually thinking anal intercourse, and that's such a small piece of what people do for anal pleasure. Contracting the muscles voluntarily during sexual experiences can sometimes enhance pleasure, so sometimes people don't even touch there; they're just being aware of and in tune with the anal contractions during orgasm as a way to enhance the pleasure of the orgasm - voluntarily continuing the contractions of the anal muscles as the reflexive ones wear down. It's one way of extending the orgasmic experience.

Also, a lot of people really enjoy fingering: either their own finger on the external anal opening, usually as part of masturbation, or inserting the finger as part of masturbation. Many couples and partners enjoy doing this - they do it with each other, or one way. It doesn't have to be equal, necessarily; maybe one person likes it, and the other person doesn't mind doing it but doesn't want it (or whatever). There's also oral-anal contact, which is popularly called "rimming" (referring to "around the rim" of the anal opening), there's inserting objects like butt plugs or dildos and vibrators, and there's inserting penises. We need to be aware of the whole spectrum, because there's a lot of people who love anal stimulation but don't want anal intercourse.

I get letters from all over the world thanking me for writing about anal sex, and one of the biggest subgroups is from straight guys who say, "I'm so glad I'm not the only one who loves this stimulation - I've always wanted to tell my partner about it but I'm too embarrassed so I just enjoy it on my own, but I've worried in the back of my mind that this means I'm gay, even though I'm not attracted to men." It really concerns a lot of guys when they like anal stimulation. I've even had guys who came in and said, "Well, my girlfriend [or my spouse] put her finger up my butt while she was giving me a blow-job and I had the best orgasm of my life - does that mean I'm gay?" By what train of logic I'm not sure: "Gays like the butt stuff" I guess is the thinking there [audience laughter].

I've named a whole spectrum of problems of not being able to enjoy the anus in the way a person might want as "anal spasm," because it always has a great deal to do with contractions in the anal sphincter muscles and the pubo-rectal sling. And so my approach focuses on building awareness of the whole area, learning how to tune into those muscles to relax them, and then seeing what you want to do - doing some experimenting and setting your own boundaries. The anal experimentation that most people do is literally groping in the dark. It's like, "Let me stick it in," essentially. No preparation, no relaxation, all too often minimal-to-no lubrication. And not surprisingly, receivers of anal intercourse who are introduced to it this way often do NOT like it, because the odds are pretty high that it's going to be pretty darn uncomfortable.

As you therapists may have noticed, there's an increasing number of people with concerns about anal sexuality. Gay men will just come in, and maybe it's because I'm "Dr. Anal," but they'll come in and say, "I wanna get fucked and I can't." Most people are not that direct about it. They may not mention it to you at all, actually. It may not be the number one presenting problem, but if you don't at some point learn how to inquire about their attitudes and feelings and fantasies about anal sexuality, you may miss something very important. There are many couples for whom wanting or not wanting anal play is a major source of conflict. They may not talk about it that much because the big "no" was said a long time ago, but there's still smoldering resentment about it; relational conflict is one way that it manifests. Sometimes when people come in with sexual avoidance, it may be that they've had very bad anal experiences with a partner who still wants to keep having them, so they just want to "Stay away"; they try to avoid sex. I've seen it involved, in various degrees, in cases of reduced desire as well. This has occurred in people who know internally (and will tell you if they're comfortable enough), that anal fantasies are important to them; it's very erotic to them one way or the other. They want to be able to take that over into behavior but they don't know how, or they're afraid, or they're embarrassed, or whatever. In some people that contributes to getting them out of touch with the inner wellspring of their erotic life; they're cut off from it because they just can't do anything with it, and so the whole thing starts to wither.

An indirect effect of anal spasm that may have nothing to do with sex is anxiety. One of the things to keep in mind is that anal muscle tension is very primitive. It operates on the survival level, very much part of the fight-or-flight response. Normally, if we were very afraid, our sphincters would open up and we would defecate on the spot, which would lighten the load so we could increase our chances of escaping. Well, we unlearned that a long time ago, and so now what we do when we're super-tense is clench like crazy. A lot of people who have various anxiety disorders are keeping themselves on a hair-trigger where anything can set them off into anxiety, and are partly maintaining it by having their anuses chronically tied up. I do try to get people who are working with anxiety disorders to pay attention to their anus (they won't get into sex unless that's where they want to go with it), and I have found that in working with anxiety it's very helpful if the person can learn to release the tension that they tend to carry anally. Combined with the other things you would do, this is a major adjunct to effective work with anxiety disorders. I can't go into that but I wanted to at least mention it.

I have depression mentioned in your outline as another indirect effect. This hasn't come up as often, but there are people - similar to the ones I was describing earlier - for whom the anal area would ordinarily be very important (and maybe it is fantasy wise), but they can't do anything with it. There are lots of indirect reasons why it contributes during some times to people being depressed. I've had men - mostly straight men, but other orientations as well - who will come in depressed. They'll have a situational depression out of the realization - something will remind them, like a strong fantasy - that they would really like to get fucked, or have something stuck in back there; it throws them into a turmoil about their sexual orientation, and in some cases there's reason for that turmoil because they really are confused. I'm working with a guy right now who just happens to be really obsessive and always has to have a fear, and his fear right now is that he had an anal fantasy with a guy and now he's afraid he's gay. But he's never felt any attraction for men at all. So in his case it's just that he needs something to be afraid of.

When it comes to anal tension, there are two important distinctions we need to make. First we need to look at whether the anal tension they're experiencing global (in other words, it happens all the time) or situational (it happens only when someone's trying to put something up their butt). This distinction between global and situational is one that people are not very prepared to make, generally speaking. So in raising it I'll say, "I'm wondering: is your anus tense a lot of the time, or just when you're stressed out, or only when your partner moves his or her finger near your anus, or just with a particular person [or whatever]? Have you noticed?" Many will initially say, "No, not that much; I think I'm pretty relaxed." Some will say, "I think I'm pretty tense, because I have these horrible hemorrhoids [or whatever it might be]." But generally speaking, the reason for raising this question is not to get the answer; you raise this question as part of initiating curiosity: "Is my anus tense all the time or not, and what does this mean and what's that all about?" As the person gets curious about that, you can fairly easily initiate them into something pretty benign like having them touch their external anal opening when they're in the shower, and just having them notice what they notice. That's a big deal for some people, but most people can do it reasonably comfortably. Sometimes I'll just ask a client, "Do you feel anything right now?" I would say that, generally speaking with a few exceptions, if a person cannot tune into their anus and tell you whether it's pretty tense or pretty relaxed, it's tense. Because if it wasn't tense they would be more in tune with it, at least to some degree.

The other distinction we want to make, as we do in other sexual dysfunctions, is whether we're talking about a primary or secondary dysfunction. Has it always been a problem, or did it crop up more recently (or at some point along the way) that made you aware of it? The most common secondary scenario is that someone tried to stimulate them anally in a way that didn't feel good or safe. Of course, you get more serious cases where people do suffer anal trauma; there's anal rape, there's anal date rape, there's force and coercion, there's getting drunk and engaging in sexual activities that happen in less than consensual ways, etc.

Another major source of anal trauma is medical procedures. Almost all the treatments they think of hurt really bad, and one of the major causes of anal tension is pain. How ironic that in trying to solve anal medical problems the physicians would be prescribing stuff which hurts and causes more pain, more tension, and more problems.

In my work primary-global tension is most common. In other words they've always been tense and anal stimulation has never worked very well for them sexually even when they wanted it to. The primary-global pattern constitutes less than half of the people I have studied, but it's the biggest single subgroup. I have to say a little bit more about trauma: we have the medical trauma, we have the sexual trauma, we have childhood sexual trauma involving the anus, and we have enemas. It used to be a common practice that if you were constipated they'd stick this enema thing up your butt. I can't tell you how many people come to me with this as a major lasting trauma - an invasion of the first order. It's a rape, but it's intended as treatment at home and is done by a parent who's having you strip your clothes off, turn your butt over, sticking stuff up your butt, and then watching you shit. It's very, very traumatic for a lot of people; thank God this isn't really "in" any more, although I'm sure some parents still do it just out of creative thoughts on how to torture their kids.

Now I want to briefly go over with you the process I use, which is outlined in much more detail in my book, to help people become more aware and more relaxed. The first thing we have to do is broach the topic. We've already talked about how to do that to a certain extent, but unless someone is reasonably comfortably presenting to you early on that, "Gee, we'd kind of like to experiment anally," or "I would," or "I tried it and it sort of was nice," or "It could be nice," or "My friends say it's nice but it hurts," it will come up in more indirect ways. Especially when this is the case, we have to look at how we invite discussions of this topic. I've mentioned one way, which is to raise the question of, "Are you in tune with your anus right now?", "Is it tense all the time, or only sometimes?", or "Are you curious about that?" People get more curious about it when you tell them that their chronic tension is a major cause of anal medical problems. The timing is important. I work a lot with inner sexual conflicts, which I address in my book The Erotic Mind. One thing I've learned is that if you ask too soon, "Are you interested in anal sex?", you run the risk of getting the "official answer" which the client is then locked into for a significant period of time. It will be harder for them to say, "Well, I didn't really tell you the truth before," and they'll be ashamed and so forth, so don't ask them right away unless they're clearly open enough. You can beat around the bush and see if they'll touch on it.

If you haven't had an opportunity to discuss anal sexuality, whether or not you're interested in it personally, with other people both clinically and outside of the clinical setting, I would really encourage you to do so more. Make a point of it, because it's going to make you more comfortable discussing it and putting it into words, even if you're already comfortable in your head. I think that we communicate our comfort level a lot to our clients, and they really can sense it. So we really need to know exactly how we feel about it. Sometimes anal discussions and experiments can be a very nice part of a larger process of erotic self-discovery. You might bring it up by asking them, "Do you ever enjoy any kind of anal stimulation?" You can preface it (and this is very helpful) by saying, "You know, a lot of couples like to touch each other anally during their lovemaking; have you two ever thought of that or tried it?" If you present it that way, then it's normalized right off the bat and no big deal. Basically, I find that once you open the question of anal touch, and if the client picks up your comfort level and it seems to flow pretty well, they'll go wherever they need to go with it.

In working with a person who wants to learn how to relax or enjoy anal stimulation more than they're able to, the number one thing you have to work with them on, before you do anything else, is to get them to see the crucial importance of making with themselves a "no-pain-ever commitment." The belief is widespread, even among people with a lot of anal experience, that it hurts at first when you have anal intercourse, but if you bear it for a little while the pain will go away and it will feel good. This is a very unhelpful approach, because basically what's happening is the anal sphincters are saying, "No, No, No!", but you're plunging ahead anyway, and at some point the muscles will just give up. They'll go into spasm - that's the initial pain - and then they'll collapse: that's the so-called "feel good" moment. When people learn to explore anal insertion without any pain, they realize, "Oh, what I used to call 'feeling good' was simply the pain going away!" So, no pain ever is crucial. The agreement is to make sure nothing will be done by you or anyone else that will cause you any anal discomfort whatsoever. This involves assertiveness training a little bit, because you have to be able to know your limits, set them, and say when you're uncomfortable. In sex, as in life in general, you know how hard this is for many people to do this. So, the no-pain-ever agreement is something that should be discussed throughout."

In actual practice when someone wants to do something to them, and it's going to hurt or they're afraid it's going to hurt, are they actually going to say, "I don't want to do that right now"? Many will not; they'll just grit their teeth and bear. Perhaps they feel their partner is more desirable than they are, or they're afraid of losing or disappointing their partner, or whatever it might be.

It's important to define the goals that they have, and their motivations, for wanting to do this. Is the goal just to find out what they might enjoy anally, how relaxed they can become, and what they want? Is the goal to help with anal discomfort caused by a medical problem or the beginnings of a medical problem? Is the goal to be able to have intercourse with a partner?

I make a big distinction between performance and pleasure-oriented goals. When people come in and say, "I'd really like to be able to have anal intercourse because my partner wants it so much; I want to be able to please him [or her]," that's what I mean by performance. Pleasure has to do with, "I think there's something in this for me, I've gotten hints that this stimulation can feel good, I want to enjoy it more, and I don't want to be blocked in the ways that I am." The difference between the motivations of pleasure vs. performance was strongly correlated with outcome success, the effectiveness of the entire process. Of the people who completed therapy, which in the group setting was eight weeks and in individual or couples therapy was more variable, two-thirds of those who were doing it to please their partners had success. It blew me away their success rate was that high. But for those who were doing it for pleasure the percentage went up to 89%.

The first steps I've already talked about: engaging someone in curiosity about what's going on back there, and maybe touching themselves in the shower. I also talk with people about getting out the old hand mirror and taking a look. People might initially think, "Yuck" - they don't want to it. This is understandable given our training. Very often that is the response when they first try it, and maybe the first several times, a certain degree of revulsion. But I can't emphasize how important it is for people to develop genuine comfort with the area. If you think of the rest of your body, is there any part of your body that you're comfortable with that you don't look at one way or another, at least occasionally? So why should it be any different with the anus? But sometimes people can't do this as a first step; sometimes people can touch it in the shower more easily than they can look at it. This does not have to be done in any particular order.

I encourage people to explore themselves with their finger in the shower every day, just to develop a good health habit. It's part of the way I shower - partly for cleanliness and partly to check in back there, to take a couple deep breaths and start the day with a relaxed anus. For people who have goals for pleasure, this is the best way to distinguish the internal from the external anal sphincter. You can actually feel them; put your finger in and rub around, and you'll be able to feel the external ring and the internal ring. And then, if you take some deep breaths and release, you'll be able to feel the external one relaxing. The internal one may not relax; there may be training involved in learning how to voluntarily relax the internal one, and it's also the internal one that stores the traumatic and painful memories. I believe in cellular memory; it's at least a great metaphor.

What we're doing here, is to use the finger and use the finger as a biofeedback device. In the early days of my research, I did have a biofeedback device made for anal insertion. There is now a group of urologists who are recognizing the role of tension in chronic pelvic pain and other problems, and are using biofeedback to record the data all day long and then feed it into the computer so they can track it. But the finger works just as well, so I dropped the equipment, because if a person can just insert their finger and take some deep breaths and tune in, they'll eventually learn how to let go.

What I encourage people to do, especially with the internal sphincter, is to feel it and then if it tenses up a little to just say to themselves, "It's tense, it's tense, it's tense." Then, if they feel it relaxing, to say to themselves, "Relaxing, relaxing, relaxing." Just say what going on as you sense it with your finger. That's the basic biofeedback principle: that by gathering a steady stream of information you will begin to develop voluntary control even over so-called involuntary functions. Just as people do with heart rate and blood pressure and all kinds of other things they can learn, and learn surprisingly easily if they just practice consistently over a period of time.

The next step, especially for those wanting anal intercourse, is to experiment with a butt plug, which come in a whole range of sizes. If the people you're working with are tense, new to all this, and uncomfortable, then small butt plugs are called for. They're a great way to begin, and should be inserted very gently. The no-pain-ever commitment applies. Lubricant is necessary, too! I guess this is the point where I have to mention something about lubrication. For easy cleanup the water soluble lubes are good; for these experimental phases of just inserting and developing a little comfort, I do recommend the water-soluble lubricants. But for prolonged insertion of an object or a penis or whatever, I think most people want it oily and greasy. Some people like thin oil, some people like the thick goopy stuff.

Once a person can insert something comfortably, they might want to try that insertion with a masturbation session. If this becomes pleasurable, then they may be ready to doing some experimentation with a partner. But before I go to the partner stuff I want to emphasize that you've got to somehow address feces disgust. The training is so intense to find it disgusting. As infants we're totally neutral about it, but we don't stay that way for long. How do you overcome this? Well, there are two ways to go, and I like a combination of the two. Most of us probably are not going to like feces, but it is very realistic for us to not be so freaked out by them. If you're inserting an object and pull it out and there's a little bit of shit on it, this does not have to be an emergency. For some people it really is, it's such a turn-off that it's unbelievable.

The other approach is for people to learn how to clean themselves to reduce the chances that they're going to encounter poop in the first place. Here we're talking about anal douching, which can be done in a number of ways. You can get one of those disposable enemas in the drug store over the counter, like a Fleet enema, and dump out the crap that's in there and put in warm water. It has a very nice flexible lubricated tip that you can then insert, and then squeeze the water through. This will just clean out the lower rectum. Hold the water in a little bit and then sit on the toilet and let it out. Some people repeat this several times.

For those who want a cleaner rectum further up, you can get one of those douche-bag hot water bottles with the nozzle on it, and just hang it up let gravity move the water. They offer a higher volume of water and better cleaning. For those who really get into it, there are devices that attach to the shower. You have to be careful about the water pressure. If you just use warm water it doesn't seem to upset the natural bacterial stuff in the lining, irritate the lining, or mess anything up; I've never seen a problem with it.

Audience: At what point along the way does insertion become a problem? I have no idea how long the particular mechanism you're talking about is, but some of the dildos out there are fairly substantial...

Well, I encourage people to start with something small, where they're sure (or pretty sure) there's not going to be any pain. I encourage people to not necessarily yank the thing out if it hurts, but back it off gently and sit there and breathe. And then there's a question that needs to be asked: "Does this sensation I'm getting right now hurt, or is it just different?" Because we're used to rectal pressure, but not pressure coming in that way. Some people will feel that pressure is weird, as if they're going to have a bowel movement. So they have to get used to it to a certain extent, but that's different from actual pain.

Audience: On the subject of not upsetting the biological balance of the area, what about ejaculate upsetting that balance? If I may speak personally, my bowel movements change, over a period of about 24 hours afterwards.

Well, apart from the safe sex considerations, and assuming these are two monogamous people, both healthy, not using condoms... I again have never heard of semen being an irritant. It's hard to differentiate what's causing what, because if you're having an anal sex experience people do get sometimes some blood or some irritation, especially if it's too vigorous, or goes on longer than they want. It might be the intercourse itself rather than the semen.

Audience: Also, depending on what lubricant is being used, there might be some residual lubricant...

There could be a residual effect. The oilier or greasier lubes can hang around until your next bowel movement, but the water-based will wash out.

Audience: Putting an oil-based [lubricant] on the mucous membranes - that's something you don't do with the vagina...

Well, but the vagina doesn't wash out as regularly; it's not a "through-system" as regularly. Pretty much daily the rectum is a through-system, and so it cleans out more easily. I do think there are more issues with oil-based lubricants used vaginally than used anally.

Audience: Can the "cleaning-out" phase you're describing cause erectile difficulties in men?

I have never heard of that one... What I am aware of is that many guys who enjoy anal stimulation, if they're really focused on it, may lose their erection. This concerns them. It may be a reflection of some discomfort or anxiety, but if they're relaxed and enjoying themselves it may also be a reflection of shifting the erotic attention away from the genitals to the anus and rectum.

One more thing I have to say about working with clients about feces disgust is that you've got to acknowledge it - which shouldn't be too hard to do. I also think that language communicates so much about our comfort or discomfort. In working with someone, I will start out using the word "feces," especially if they're more formal in the way they speak. I take cues from them on how they talk about sexual activities and genitals, and if they're using slang terms and not being formalistic I'll usually switch over to "shit" or "poop." Casual words can help to reduce the negative charge. And when people do talk about their bad feelings about feces, or how strongly they react sometimes, validate that; don't say, "Oh, you don't have to react that extremely," because that's not going to help. It just becomes another thing to feel bad about: "I'm reacting too extremely!" Encourage them to accept how they feel, and not communicate that they should feel something different.

Then, if a person wants to move toward partner stimulation, I really recommend that they don't begin with intercourse. It's really great training towards being able to have healthful and pleasurable intercourse if they develop the habit of fingering and massaging each other (or especially whoever is going to be the receiver) as part of the prelude, so that relaxation is built into the process. That's why I encourage people to do a lot of touching with a partner, without intercourse. Some of the partners just won't do it. They say, "Yes, I'd like to have intercourse but I don't want all this rigmarole, I don't want to think about it that much, I don't want your finger down there," and so on. You have to honor where people are, but you can ask them to elaborate on what their feelings are and try to understand where they're coming from, to see if there's a way they can address the underlying issues.

I also recommend to couples who have feces concerns, "Well, why don't you experiment after you bathe or shower together, so each of you can maybe wash the area with your finger and make sure it's clean, and then you're just going to not encounter that." And then some people, if they become comfortable with a butt plug of whatever size, may ask a partner to do that.

With intercourse, I've mentioned that not only can it be pain-free, but that it should be pain-free; pain is really a sign of not being sufficiently relaxed - that's what pain means. Pain is not the first phase of anal intercourse, it's a sign that you're not sufficiently relaxed, that you're not ready. Usually it's a matter of going back to some anal massage first, or maybe the current conditions aren't right.

Audience: Are you saying that, independent of the amount of experience that one has had, that pain is nevertheless an indicator of something being done wrong?

Yes! It's an indicator that the person is not relaxed enough to fully enjoy what they're trying to do. Whether it's getting fucked by a big penis, or a big dildo, or a small one for that matter, if it hurts then that hurt is a message: "OK, let's stop for now." What some people will do, though, is ask their partner to very slowly insert as they take some deep breaths, and once he is inside to just sit there; then there's an adapting and a relaxing. It sometimes can happen in only a few seconds, or maybe it takes a little longer. A lot of people have very comfortable non-pain intercourse starting out that way. And then slowly more movement can begin. But those people who jam the old penis in there and start pumping, that's more likely to hurt, though it doesn't hurt for everyone. Those who really like it and have learned how to relax with it can just go right for it...

Audience: I was told that anal toys should all have bases, but you mentioned some toys without bases, so I'm curious what's going on there...

I say to people, "If you want to insert something that doesn't have a base, make sure it's smooth - and realize that it's not meant for vigorous insertion." The base of the butt plug - and most dildos have a base also - allows them to get as passionate as they want and not accidentally shove it all the way in. But it is important that people know if they do shove something in there, like a Zucchini or whatever, that they don't have to panic and run off to the emergency room. They can just sit down and relax. It'll come out. Sometimes you hear about people who do insert and "lose" strange objects inside. Some are anal enthusiasts who go too far, but a lot of them are people who don't go far enough, in the sense that they don't bother to learn about the area first. They just start sticking stuff in.

Audience: I'm curious, for people who work with women with vaginismus, if the same tools apply. That is, you do have dilators...

I think the vaginismus analogy is very close, and it's not just the dilators: it's the familiarity with the area, it's tuning into the emotions that may be stored there or triggered there. The memories, the fears, the anxieties. It's very similar.

For experimenting with anal intercourse, it seems to work very well for a lot of people if the receiver is in a position where they can control the rhythm and depth of the penetration. So, the receiver on top or side-by-side tends to be very good. Also, a circular motion rather than the in-and-out thing can work well; some people like that a lot better and don't want to do the in-and-out motion at all. It's more like, "Move around in there, don't pound me."

There are many sources of pleasure when it comes to anal and rectal stimulation; there's lots to be stimulated. There's an incredibly rich supply of nerve endings all around the anal opening. The rectum is a little bit like the inner part of the vagina: more responding to pressure and not quite as surface sensitive. In males you have the bulb of the penis terminating in the perineal area right next to the anus, and it is actually anchored to the same muscle that the external sphincter is anchored to. I think that guys often get a lot of indirect stimulation on the inner part of their penis; things are getting moved around. Women are talking more about just what the boundaries are of the whole clitoral body; it's much bigger than most of us think, and there's lots of indirect stimulation there, too.

Audience: How important is prostate stimulation for men?

Lots of guys love prostate massage and stimulation and say it intensifies their ejaculation; many love the feel of it and some don't. One of the things that has had a big impact on me is the realization that you never can get inside someone else's experience and compare pleasure - impossible! But you can ask. Keep in mind that women who like anal stimulation are every bit as enthusiastic about it as men who like anal stimulation. The prostate may be a factor for men, as may that prostatic-like tissue in the G-spot zone for women. But a lot of other things are in terms of nerve endings, and interaction with all the musculature there, like I was talking about before. So there's lots to get stimulated, but the prostate is one area that a lot of men really focus on. I think it's become a thing among some men, where "prostate stimulation" becomes kind of a code word for "feels good to be fucked in the butt." I encourage guys, if they want to tune into their prostate, to stimulate it by taking their longest finger, inserting it all the way, moving it toward the front of the body, and then gently rubbing. Especially if they do that during masturbation in the sustained plateau phase where they're highly aroused, the prostate is going to be enlarged and kind of hard and lumpy. You can feel it very easily, and then you can rub it to see if you like that feeling, whether it affects your ejaculation, or whatever. So that's very easy to experiment with.

Here's one of the most common questions that comes up: if people are going for larger and larger objects, if they're into fisting, etc., is there a risk of a loss of musculature control, so that the person is going to be "too loose"? Interestingly enough, there were a couple of studies done medically (with an anti-anal-sex bias, actually) looking for loose muscles; that was their hypothesis, but they couldn't find it. And I've never seen it.

I do suggest that people who want to explore anal sexuality do Kegel exercises; we're not only toning up the whole pelvic floor (and the vaginal muscles in women), we're toning up the rectal muscles, and we're toning up the sphincters, and I think that is really going to eliminate any prospects of getting too loose. When the big stuff is inserted without pain, the insertion is not accomplished through stretching; it's accomplished through relaxation. So you just go back to your normal tonicity after you're done relaxing. People who want to enjoy anal sex should be regularly doing their Kegels. I include it as part of the shower habit: put your finger in, do some contractions, breathe, and voila you're done.

OK, I now want to shift gears away from the practicalities and into the meanings and the fantasies, the erotic dimension of anal sexuality.

I've been very interested, especially with my studies of the psychology of eroticism, in the meanings of anal sexuality for various kinds for people - positive as well as negative. I've already talked about how strongly being anally receptive is associated with "gayness" in men, even in men who are not gay. It's also associated with being in the "woman's role" for a man to be the receiver of anal intercourse, in particular. This becomes a big issue, and even gay guys who love the pleasure and find it their favorite fantasy will often have bad feelings about themselves because what they like to imagine getting fucked by other guys; they don't have a problem with the gayness, they have a problem with "I'm not a man" feeling. The connection there is really intense, and I think it's important to bring it up with people, to ask them about it or flag it as something they might watch for. I may ask questions like, "What do you think a guy is like who receives intercourse a lot, who likes to receive it a lot more than give it?" "What do you think of such a guy?" It's good to explore some of the attitudes about it, because this can be a major impediment to enjoyment.

Women don't have this homophobia thing, as far as I can tell, with anal stimulation; there's no association there. One of the big things that does come up for women is the belief that really slutty women want anal sex. It brings up the virgin/slut dichotomy big time for a lot of women. That would be the rough equivalent of the "I'm not a man" concern among guys.

If you ask people, "What's wrong with being gay?" and especially if you specifically ask, "What's wrong with being a gay man?" the answer always seems to come down to, "Because gay men are not real men." And so I'm an advocate of the idea that homophobia is an offshoot femiphobia: the fear of womanliness. This raises the question, "What's so damn bad about being womanly or feminine, anyhow?" Maybe you can say homophobia is a form of sexism. If you deconstruct it far enough, you'll probably find a bedrock of sexism there.

I want to talk about power and anal sex. The association between power, tops and bottoms, particularly in anal intercourse is so incredibly intense that it's actually very difficult for a person to escape it. It takes a real act of conscious effort. When power gets all intertwined with anal stimulation for a man or a women, it can have paradoxical effects. Power dynamics, if they don't feel comfortable or the person doesn't like their role, can result in tension. Clenching the anal muscles may be our way of saying, "No way, I don't like this."

Audience: Jack, what do you mean by the "power dynamic"?

The feeling of, "I'm the receiver, therefore I'm the bottom, the receptive one," as opposed to the inserter, whose supposedly the dominant one. Those images are so strongly in place that it's very hard to get out from under them. For some people those images are a major block to enjoying anal sex. Guys will say, "I'd like to get fucked, but I don't want to see myself as unmanly or feminine; I don't want it to be about surrendering or humiliation." Just as a woman might say, "I want to get fucked anally, but I don't want to see myself as this total slut."

So the top/bottom thing is very hard to bypass, and people often just learn how - if they're going to get into it - to enjoy the feelings of receptivity. I do encourage people to talk about it if they're bothered by the power thing; if they're saying they're the passive one, maybe they could talk about receptivity instead. It's a much more active position when you're involved and not just an orifice sitting there. Receptivity is actually a very active experience: physiologically and emotionally, there's a lot going on. So I encourage people to talk about that.

A lot of gay guys, you know, will talk about "pushy bottoms" - people who really like to be in the receptive position for anal intercourse, and are very assertive about it. They make it all happen, they take charge, they direct or choreograph the whole thing. They wouldn't usually be thought of as the dominant partner, but in actual practice they are.

Audience: Talking about the power axis, what about the women in those situations?

The women I've worked with, because of our training on what penis-in-vagina intercourse means, tend to be more familiar with that receptive feeling and have an easier time being comfortable with it and not feeling as if it's out of sync with their femininity. But, I have worked with many women who are damn sick of always being the bottom - especially if they're the bottom throughout the relationship, not just in bed. Sometimes anal intercourse with the woman receptive becomes the catalyst for really getting in touch with how pissed off she is about being "one down" so much of the time. So that has to be dealt with.

Audience: I'm not sure you understood the question; I was asking about the woman's side with straight men who enjoys receiving anal stimulation from a woman.

Oh yes, this can be very difficult. Guys often write me and say, "Well, I can't ask my partner, she'd laugh me out of town." But some of them do, and very often they do get turned down because their partners either think it's yucky or weird or unmanly to want that. Usually a woman in that situation is more concerned about, "What's wrong with my partner that he wants stuff up his butt?" It's an issue particularly if he wants his female partner to insert a dildo or butt plug and maybe vigorously stimulate him, or to strap on a dildo and fuck him. A lot of women find it interesting and very strange - hard to get used to - to be in that role. It's not the traditionally feminine thing to do.

Audience: Have you ever found, in the situation where the woman is sick of being the bottom (and the anal sex brings that out), that counseling to where this turnabout can occur and she gets the idea to do him, could fix any of that?

Well, I think that's a creative idea, and some have come to see it that way: "Hey, this is kind of cool!" Some women whom I've worked with tell me that their husbands say they'd like to try anal sex: "Can we can we can we?" he asks, and she says "No no no," and he says "Please please please" - you know how men can be [audience laughter]. And so she'll say, "OK, I'll try this or read something maybe," and lets say she gets into it. But then if I happen to be working with a couple like that, I'll raise - just to shake things up - the topic of, "Well, as you two explore this area, you Joe (or whoever it is), maybe you want to get to know your anus because maybe she's going to want to do some of this to you. What would that be like? How would you both feel about that?" It's a great way to discuss power dynamics and imagery. However, if that's too far out for them or too scary it won't shake things up so much as shut them down. So you have to be good with your timing here.

Now, a little word about SM, where we take the power axis to the edge, where a symbol of power becomes pain. I think of SM as technically having two dimensions: one is the search for intense stimulation near or at the pleasure/pain boundary, and the other is the desire psychologically to be humiliated, etc. I think the big focus has to be on those who like the pleasure/pain boundary with anal stimulation, because there you've got the potential for some damage if they go too far. It's very possible though to get into imagining and, in a way, "feeling" that there's pain and an overwhelming intensity, but also to have a part of oneself that's observing just enough to know and monitor, "Is this the fantasy/fun pain, or am I really hurting here?" That distinction is crucial for pleasure/pain boundary anal play. We really need to make a distinction between the feeling of intensity bordering on pain, and the pain itself.

Audience: This is one of the few times I would tend to agree with the theory that it's probably not a good idea to be very drunk or stoned the first time you try this, because when that happens you can't feel.

Well, I don't think that "very drunk" is good any time with anal play for exactly that reason; people do a variety of unsafe and unwise things when they're drunk that they wouldn't do otherwise.

Another thing with SM is that I work with people who can enjoy anal stimulation, but have strong associations with dominance and submission (maybe with SM overtones) and realize that, for them, it's just too scary. And so I think it's really important that they give themselves permission to keep that for fantasy and enjoy anal stimulation in other ways. We do this all the time in all kinds of ways, and there's nothing weird about making this differentiation for those who aren't comfortable actually doing the very things that excite them. This is confusing for some people who don't make a clear distinction: mostly what they fantasize is what they want to do. Then there are those who wonder: "Why don't I want to do this thing that excites me so much in my masturbation fantasies?" And so you kind of have to work with that, to reassure them that thinking and doing are two different things.

People have different levels of enthusiasm about power imagery in sex in general. I for one like the power stuff to be very subtle - I always have - but with other people there's a whole spectrum of attitudes. Many people, when they do the exploration, discover they like sensuous anal play that is more a feeling of intimate sharing rather than a power exchange (not that power exchanges can't be intimate). That's just not what turns them on; they want to experience anal stimulation as an act of shared pleasure as opposed to an act of dominance and submission. A lot of people feel they don't need the power thing because it's like, "This is so intimate to let you in here to feel this, I feel so close to you, the sensations are overwhelming." It's a sense more of closeness than of dominance and submission for those who get into that.

This of course is tricky when one person wants to do it without the power and the other person is really into it - you're got a big negotiation job there.

The time is flying, but I just wanted to mention a few things health-wise.

First the so called "female," or Reality, condom. It's not approved for anal sex, but then neither are latex condoms. The FDA's thinking is, "We can't approve a product that's used for illegal activity in so many states." What a bunch of bull.

It comes pre-lubricated, and there's extra lubricant in the box. Here it is, it's kind of baggy as you can see, and not very aesthetic. This is the biggest problem so many women have with it: "It's ugly." But when it's inserted in the vagina it can be done ahead of time, likewise rectally. This inner ring is supposed to hook behind the cervix and help hold it in place. For anal intercourse some people don't mind the flexible inner ring, and maybe it does keep it from slipping out past the sphincters. The ring outside is attached, and it has to stay on so the whole thing doesn't slide in. For those who find the inner ring irritating, just pull it out.

It has a few advantages. It's tougher than latex, it doesn't break down with oils (because it's polyurethane, not latex), and if you use it vaginally or anally and fuck for a little while and then want to take a break and do other things but come back to fucking later, then instead of having to go through the rigmarole of putting on another condom you can just leave it in and come back to fucking later; you can leave it in through the whole encounter, and it can go in before the encounter so you don't even have to bother with it during the encounter. They're about $3 each.

Audience: People who are allergic can also use it.

That's another advantage, if there's a latex allergy involved, but I mainly like the ability to stop and start - the playful aspect. I think it makes play easier. That latex focus: "Now we're going to fuck, and we have to go through to the bitter end" limits us. Why not do it for a while and then do something else? Also, the insertive partner in anal intercourse likes this, because instead of having your penis wrapped like a sausage your penis is rubbing against it causing friction - it feels better. Both women and men have good reports in terms of the receivers, vaginally or anally. It does make noise though; it crinkles. You know, put on some music [audience laughter].

Audience: What about sensitivity?

It seems to be fine.

Audience: It's much better than latex.

You think so? I've heard mixed reports on that, and I think there's a lot of room for personal preference.

Audience: Polyurethane transmits heat better.

Heat is transmitted better.

Audience: When those first came out we got our staff together at Planned Parenthood, and I gave anybody who wanted them both Reality condoms and latex condoms. The ones who had been used to using birth control pills and no barriers didn't like it. But the ones who always used latex condoms thought this was much better. I'm not talking about anal penetration, but vaginally.

So I think this is a good option to consider. It could drop in price, and it may if it becomes more popular...

Audience: Has the word gotten out?

Somewhat. It still has a long way to go. In San Francisco last year, STOP-AIDS did a study - it's an ongoing study - where they distribute a questionnaire along with free Reality condoms to gay men. They ask them to try them and then fill out the questionnaire. The satisfaction rate is up close to the 80%'s I think.

Obviously with anal stuff and anal experimentation it increases the need to be safe-sex-conscious and to be able to be clear about that, so it carries over in, during, and through the moments of highest passion. You have to work at developing those skills.

One more thing, and then we'll open it up for discussion a little bit here. I just want you to know that aspects of the basic approach: awareness, breathing, touch, looking, gentle finger insertion, and self-exploration, is a wonderful process for those who are recovering or trying to recover from anal medical problems, even if they've gone so far as to have surgery; start with gentle external massage in warm tubs of water. I've got guidelines for self-healing in the back of Anal Pleasure and Health that spell it out step-by-step.

Audience: What are the health issues for anal-oral play?

The concern with anal-oral contact is not HIV, particularly. We're really concerned about parasites and Hepatitis A. This is a major route of transmission. The risk can be reduced pretty drastically by washing the area, but a lot of people who like rimming like the natural smells of the area. They don't want it squeaky-soapy clean; that's a turn-off. So, that's a tough one. What I try to do with people who feel that way is for them to become more discriminating in whom they do it with. Don't do it casually, certainly, and do it with people whom you know long enough to have some hints about what's going on health-wise with them. But you don't really know, necessarily, who's carrying parasites around, or Hepatitis A.

Oh, and don't share toys without cleaning them...

Audience: I don't want to open up the whole issues of fissures, but what about the health issues - the chances of getting torn by long fingernails?

Oh, I'm really glad you brought this up. It's not a sidetrack at all; I just neglected to mention it. Any time a finger is going in there (one's own, or one's partner's), there has to be consciousness about trimming the fingernail, and smoothing them to be sure there are no rough edges. This is especially important in fisting.

Audience: Shouldn't fisters be wearing gloves anyway?

Well, that's what they say, but as a practical matter most fisters don't wear gloves. Actually, I think fisting - in and of itself - is a very low-risk activity if it's done via relaxation. The problem is when people are fisted and then someone fucks them, which you're not supposed to do, because you're really going to the max in terms of expanding the tissue. There's a chance of microscopic tears you might not know about, or surface abrasions, that would provide entry points for semen, and HIV that might be in semen, if you got fucked afterwards.

Audience: Wouldn't you be using a condom?

That would help, of course. In general, the fisting enthusiasts who are really thoughtful about it also recommend that after a fisting session you give your anus and rectum a break for a few days; just take really good care of it.

Audience: What kind of injuries happen, and what can you do about them?

The injuries, fundamentally, that happen are fissures: scrapes or tears. I don't know what the frequency is, it's not as great as you might think, but they do happen. Mostly they happen with rough, vigorous, intercourse where the receiver is ignoring strong pain signals. For people who have the no-pain-ever commitment and don't let anything happen that hurts, injury is very rare.

When injuries occur, they tend not to occur in the rectum. Generally they occur in the anal canal or around the anal opening - the entryway, which is about an inch long - or at the juncture between the anal canal and the rectal tissue. There's a seam there, and that can tear. Or, if they have hemorrhoids, it can irritate their hemorrhoids. But if people do it without pain, and gently, it can actually help the hemorrhoids.

Any final comment before we wrap up?

I hope there's something here that's been useful to you; thank you all very much!

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