Despite some progress over the years, people still aren’t recognizing anal sex as a legitimate sexual act. In Leo Bersani’s 1987 essay “Is the Rectum a Grave?” he thinks of anal sex as signifying two deaths. The first is the death of the rigid masculine ideal. The second is the literal, biological death that is the potential result of AIDS. The latter death, he argues, “reinforced the heterosexual association of anal sex with self-annihilation.”
Our view of anal sex has certainly evolved since the ’80s, and now we know that AIDS is no longer something exclusive to the gay community. Neither is anal sex, for that matter. And many a sexual activity can lead to the transmission of STIs without contraception.
The vision of sexual tolerance we must adopt is one where everyday people acknowledge differences in sexual relations while promoting public health provisions that accommodate our sexual diversity. We need a sexually tolerant healthcare system that accounts for the various kinds of activities that occur in our sexual lives.
And although anal sex is here to stay, it seems that people who practice anal sex, both occasionally or exclusively do not have access to the same kinds of care as people who practice vaginal sex.
This is partially because men have no national guidelines for their sexual and reproductive health care, meaning their care is done at the discretion of the physician or physician’s assistant. When considering women, despite the fact that women have considerably more guidelines, they simply aren’t asked about their anal sex practices. As such, regardless of gender, care for people who practice anal sex will only happen if a patient volunteers information.
This is odd, considering the prevalence of anal sex. The latest data released in 2002 by the National Survey of Family Growth showed that 34 percent of heterosexual men and 30 percent of heterosexual women have had anal sex at least once.
And while all gay men do not practice anal sex, many are particularly hampered when providers do not take them into account. To further explore the healthcare disparities, consider this story. I spoke with a male LSA senior who asked for anonymity to protect the identity of his partner. After developing an anal wart, it took him four months to actually receive adequate care. He noticed a small bump on his rectum one night during anal sex but thought nothing of it.
When he and his monogamous partner decided to stop using condoms, he went to University Health Services to get tested. He explained to a physician’s assistant that he was a gay man who was a receptive partner for anal sex. The PA conducted a visual inspection of his penis, took a urine sample and called him a few days later saying, “Everything came back negative.”
But soon after, the bump started to itch, and upon a second look, his partner recognized it as a wart. He drove an hour and fifteen minutes to his family’s physician, only to receive no rectal exam and a referral to a colon and rectal surgeon. On his third appointment, he received a full examination and fulguration — the most effective way to treat warts so they don’t return.
While the LSA student did not feel personally mistreated by the UHS PA, he did have this to say: “At the minimum, if the PA at UHS had given my anus a visual inspection, he may have identified that the alleged bump was instead a wart, a symptom of human papillomavirus (HPV).”
UHS medical director Dr. Robert Ernst supplements this viewpoint. When asked about the standard testing protocol for someone who was practicing anal sex, he replied, “There are no national health guidelines for men, regardless of sexual orientation, and further, there is no standard protocol for anal sex.”
Anal warts are a symptom of HPV and, as I mentioned in previous columns, men can’t get tested for HPV. But there are more thorough visual inspections available at UHS to confirm if one has anal warts. The main procedure is the digital rectal exam or an anoscopy, where the physician inserts a small tube in order to better visualize the anus with the naked eye.
So why didn’t our anonymous man receive this when asking for an STI test? Dr. Ernst explained that rectal exams “are not otherwise done unless they are prompted by a concern or an irregularity.” The take home point is that if you are practicing anal sex and want a rectal examination along with your testing, you have to ask for it.
Women aren’t that much better off. During annual Pap smears, UHS doesn’t specifically ask whether they are engaging in anal sex. Although there are guidelines for looking for changes on the cervix, there are no such guidelines for changes in the anal area. As such, the main circumstance under which women would be checked for anal warts is when they are positive for HPV, have confirmed symptoms or cervical changes that have taken place as a result of HPV or have volunteered information confirming that they practice anal sex.
It’s important to note that the major differences between the way men and women receive sexual health care exacerbate the situation. It’s true that women have significantly more regimented sexual health care than men. National health guidelines assert that three years after women become sexually active or by age 21, they should be tested annually. While socioeconomic factors prevent some women from accessing sexual health care, the institution of annual Pap smears means that women have their risk assessed annually and other STI testing can take place.
Considering that there are no sexual health guidelines for men, their testing is done entirely on a voluntary basis. It’s also important to mention that heterosexual men can rely on their female partners’ annual Pap smears to get a rough sense of their HPV status. This is a luxury gay men don’t enjoy, since they are usually diagnosed after warts — or worse, cancer — appear.
To UHS’s credit, Dr. Ernst informed me that representatives from UHS will soon be attending a health forum where medical colleagues will explore what guidelines should be considered for anal Pap smears, which involve culturing the anal area to detect cancer. Still, I have recommendations on improving the sexual healthcare system here at the University. First, in the absence of sexual health guidelines for heterosexual men, the University has set their own informal guidelines to account for the male population. In previous columns, I have noted that UHS administrators have recommended that heterosexual men who are regularly sexually active should get tested annually for chlamydia, gonorrhea and HIV. As such, the University should consult with experts in the field of gay men’s sexual health and create guidelines for gay men like visual inspections of the anal area for men who are the recipients of anal sex.
Secondly, UHS should support student efforts to advocate for clear national guidelines for gay men, men in general and for non-vaginal sex activities. More printed materials should be made available in UHS on anal sex health care. Women and people who seek STI testing should be asked if they are having anal sex during their annual examinations and provided information accordingly.
I have already started writing grants for a campus organization that will conduct educational programs that reflect sexual tolerance and inclusion, and I am now constructing my leadership team. E-mail me if you want to join.
Rose Afriyie is the Daily’s sex and relationships columnist. She can be reached at firstname.lastname@example.org.