Dr Dick’s response:

The main function of the rectum is to act as a passageway for faeces. Faeces are not normally stored in the rectum unless you are about to have a bowel movement. However, small amounts may remain in the rectum in between movements. There is also the risk of transmitting Hepatitis B if in contact with an infected partner.

If you are wanting to douche (squirt water in the anus using an enema bottle) then be sure to use a vinegar mixture (half a teaspoon of vinegar with 500ml luke warm water) and not a betadine douche. The betadine douche has been found to disrupt the mucosal barrier of the rectum and thus increase the risk of HIV infection. Be sure not to douche too frequently and also be sure to lie on your side when douching as this will reduce the likelihood of any injury. It is also through injury that one's risk of HIV transmission increases.

Other helpful tips include:
 

1. Ensure that you use condoms correctly and consistently with plenty of water-based lube when engaging in anal intercourse;
2. When rimming be sure to use either a dental dam/ non-microwavable cling wrap/ a cut open condom;
3. Purchase and use sterile wet wipes to use at the point of anal play;
4. Before and after anal intercourse be sure to clean the insertive partner's penis and the receptive partner's anus thoroughly (not vigorously); and
5. Rimming should be avoided if you have a cut or sore in your mouth or gums.

Dr Dick’s response:

Being a discordant couple does not mean that the relationship is doomed. There are a lot of very happy and 'safe' discordant couples out there. I usually tell people to find creative ways to keep each other fulfilled and safe. Oral sex is considered a low risk activity, but there is some risk nonetheless because of

• the presence of pre-cum (which has been found to contain small traces of HIV);
• the possibility of microscopic tears in your mouth (on your gums, between your teeth, under your tongue, at the back of your throat, or on the inside of your cheeks – which can act as an invitation for the infection to enter into your body); and
• the unpredictability of reaching orgasm (he may just cum without warning giving you little time to withdraw his penis from your mouth).

The decision is yours, but I would suggest using flavoured condoms or flavoured dental dams - which can be a lot of fun. Obviously anal intercourse carries a higher degree of risk. If your partner is a top and you a bottom, be sure that condoms are used correctly and consistently and that a water-based lube is used in order to minimise friction and breakage. And if he were to cut himself somehow I would suggest that without making too much of a fuss, minimise direct contact with that area or his blood. Keep gloves, disinfectant, plasters, bandages etc nearby just for in case. It is all about learning the facts, allaying your anxiety, and enjoying each other.
 

Dr Dick’s response:

To answer your question I need to tackle this from different sides:

1. Learn about the shape of your rectum. The depth of anus is not that straight forward. It is not as simple as saying 15cm because the whole alimentary canal consists of (in a southerly direction) rectum, anal canal, and then the anus. The rectum is not straight, after the short anal canal, the rectum tilts (sometimes as much as 90 degrees) toward the front of the body. Then, after a few centimetres, it curves towards the front of the body again. A useful tip here is to learn about the shape of your rectum by gently inserting your finger or a soft object (make sure that it is a safe object, like a dildo with a flared base - having a flared base will help to ensure that the dildo does not slip completely inside your rectum should you lose your grip) into your anus, and then explore your rectum by probing in different angles. Concentrate on how this feels. By exploring yourself, you will gain firsthand knowledge about what feels ok and what is not. For example, depending on the direction of the penis in the anus, shorter or deeper penetrations may be acceptable. As such, penetrating deeply in a direction towards the back of the body or straight up might not be advisable, given the shape of the rectum.
2. It is all in the technique. Many gay men think that pleasure is derived from hard thrusts or deep penetrations. But this is not necessarily true. The anal region and rectum has an abundance of nerve endings, with the highest concentration at the opening of the anus (a pleasure point). Thereafter, the anus responds mostly to feelings of pressure or fullness. Putting pressure on the ventral wall (towards the front of the body), a few centimetres in, will stimulate the prostate gland (a walnut shaped gland situated behind the pubic bone). Try to locate this spot by gently inserting your finger into your anus and then point your finger towards the front of your body. If stimulated, it should intensify your pleasure when climaxing. Thus, most of your pleasure will be derived from the opening of the anus and the prostate gland, which does not require any full thrusts or deep penetration.
3. Know about the risks. The main function of the rectum is to act as a passageway for faeces. Faeces is not normally stored in the rectum unless you are about to have a bowel movement. However, small amounts may be remain in the rectum in between movements. It is for this reason that it is recommended that we use condoms during anal intercourse (to minimise the risk of getting Hepatitis B for example). In addition, the lining in the rectum is very thin, not very elasticated, and can rip very easily. It is therefore VERY IMPORTANT that you 1) always practise safer sex using condoms correctly and consistently, and 2) limit the amount of stress placed on the rectum by taking it easy, cutting your fingernails short, and using plenty of water-based lubrication. Reckless or rough anal sex may result in serious damage: a tear in the lining of the rectum or an anal fissure. After repeated damage, the risk of fecal incontinence becomes significant.

Dr Dick’s response:

Having a ‘pornstar’ as a partner is the stuff of many a gay man’s fantasy! Perhaps try the following:

1. Purchase yourself a butt-plug. Preferably one that is large. The design of the butt-plug is such that your anus gradually widens the deeper you insert the butt-plug into your anus. In this way you should become accustomed to 'large' objects. Try 6 reps a day for at least two weeks. You can practice inserting it yourself or you can introduce it as a form of fore-play with your fiancé.
2. Try to reframe the sexual encounter. Gay men often put a lot of pressure on themselves and their sexual partners to perform anal sex. This is because anal sex has become synonymous with gay sex. Most gay men see anal sex as the only valid form of ‘real sex’ between men and therefore place a great deal of pressure on themselves and their sexual partners, directly and indirectly. So perhaps a suggestion could be to remove your focus off anal sex for a short period and agree instead to focus on other, equally exciting ways to experience desire and pleasure with one another. I am reminded here of a case I heard about where a guy had a particular fetish for being f*cked in the arm pit. It may sound bizarre for many but at least he was able to find alternative ways to experience pleasure. Thigh sex, which is very popular amongst straight adolescents, is another option. Be creative and have fun while you're at it.
3. It will only work if you really want it to. This may be a bit of an unsettling idea, but we need to explore all the alternatives. There is the idea that he can't enter you because you are feeling conflicted about something: perhaps anxiety, perhaps fear, or perhaps anger. Try and think (and hold back the laughter for just a moment) what his 'huge' penis may represent or mean for you? How does it make you feel? Now, how would you feel having it inside you? What could that mean? What are you achieving by not having him enter you? Does he use protection? These questions might sound strange but might be helpful to consider. Those in the know maintain that if you really want it (him inside you) then it will.