In public health, considerable attention has been placed on establishing a hierarchy of risk associated with STI and HIV transmission (see table below). The hierarchy ranges from minimal risk (abstinence) to highest risk (anal intercourse with internal ejaculation without a condom). This hierarchy is useful for establishing what your risk profile so that you can make informed choices on how to have fun safely and responsibly. 

Taking this hierarchy into account, safer sex can be achieved by:

• Using condoms correctly and consistently when fucking, when giving a blow job, and when sharing sex toys;
• Using a water-based lube (in combination with a condom or femidom) when fucking. Alternatively, use low fat plain yoghurt;
• Using dental dams or latex sheets correctly and consistently for rimming. Alternatively, use a flavoured condom cut along the side or non-microwavable cling wrap;
• Using finger cots correctly and consistently for finger-fucking. Alternatively, use a condom over your finger;
• Using non-powdered latex gloves for fisting or finger-fucking;
• Withdrawing and ejaculating outside your partner when engaging in oral sex;
• Withdrawing and ejaculating outside your partner when fucking;
• Avoiding an exchange in bodily fluids (e.g., semen coming into contact with an open sore).

Condoms

Condoms are available in a wide variety of colours, flavours, styles and sizes. Most condoms are made of latex or polyurethane. Latex condoms are the most common and inexpensive of the two types. Polyurethane condoms are an alternative for those allergic to latex.
Condoms, if used correctly and consistently, can reduce your risk of contracting HIV and STIs by up to 85%. Condoms can protect you during oral and anal sex.

Lube

Using lube makes sex smoother (because it decreases friction) and gives you added protection. Lube should be put on the outside of the condom (after it is on the penis of course). Using a water-based lube on the outside of the condom reduces friction and decreases the chances of breakage. A drop inside the tip of the condom can also greatly increase sensation. However, make sure it is only a drop as too much can cause the condom to slip off during sex. Lube should also be used around the anus (if planning on fucking) and can be re-applied during sex.
Only water-based lubricants should be used with latex condoms. These include KY Jelly and Assegai and an assortment of other brand names. Alternatively, you could use plain white low fat yoghurt. Oil-based lubricants such as butter, baby oil, Vaseline, Dawn or Aqueous Cream will break the latex down and make it fall apart – it will lose 70 percent effectiveness in 30 seconds!
Use un-lubricated condoms or flavoured condoms for oral sex – usual lubricant does not taste that good!
 

Why should I use condoms?

There are various reasons for you to use condoms. These include the following:

• Condoms prevent the spread of STIs and HIV, when used correctly and consistently.
• Condoms are available in various shapes, colours, flavours, textures and sizes – to increase the fun during sex. With practice they can also add to the enjoyment of sex.
• Condoms make sex less messy.
• Condoms can be part of foreplay and arousal.
• Condoms give the message “I care about myself, about you and about the gay community.”

Practical information on condoms:

Condoms can greatly reduce the risk of HIV and other STIs if you use them correctly and consistently. It is important that you remember the following:
 

• To keep condoms fresh, store them away from too much heat, cold, or friction.
• Always check the expiry date on the package. Do not use expired condoms.
• Do not open a condom package with your teeth.
• Be careful that your fingernails or jewellery do not tear the condom. Body jewellery in or around your penis may also tear a condom.
• Use a new condom every time you have anal or oral sex. Never use the same condom more than once, never ejaculate more than once in the same condom, or use a condom that has been used by someone else.
• Do not "double bag" (use two condoms at once) as friction between the condoms increases the chance of breakage.
• Throw used condoms away by wrapping them in paper – do not flush down the toilet as they can cause plumbing problems.

Using a condom:

• Check the packaging and expiry date on the condom. Open the package carefully.
• Make sure your (or your partner’s) penis is erect before attempting to put the condom on. Remember no penetration (oral or anal) until the condom is on. Many people start using a condom too late, after some initial penetration that may involve some pre-cum.
• If you are uncircumcised (uncut), pull back your foreskin before putting the condom on as this will allow your foreskin to move without breaking the condom.
• If you want, put a drop of water-based lubricant inside the tip of the condom. Be careful not to use too much as this may cause the condom to slip off during sex.
• Now gently squeeze the tip of the condom (to get rid of the trapped air) and place onto the tip of the penis.
• Start unrolling the condom now. Remember that a condom is like a sock – there is a right side and a wrong side. You can tell if you are on the right side if you are able to roll the condom down the penis with ease.
• If the condom is on the right way, proceed to roll the condom down the penis, all the way to the base of the penis.
• Put water-based lube on the outside of the condom and/or in your partner’s anus after the condom has been put on.
• Begin penetration. Check the condom during sex, especially if it feels strange. Make sure it is still in place and unbroken. Add more lube if necessary.
• After orgasm, hold the base of the condom and pull off before your penis gets soft. Remember to hold the condom tightly so as not to spill any semen. Only remove the condom after penetration is over.
• Tie your condom into a knot so as to ensure that not semen leaks out. Wrap the condom in paper and throw away. Don’t try and flush it as it may cause plumbing problems. 

Making condoms less of a burden and more fun:

Some men feel that using a condom “ruins the mood”. Many feel that condoms decrease pleasure and are a burden. While this may be true to some extent, the bottom line is that there is no other way to protect yourself from HIV and from STIs during sex. So, it is a trade-off but certainly the benefits of using a condom greatly outweigh the disadvantages.

You can try making condoms less of a burden by trying the following:

• Practice putting on a condom when you are on your own or while with a partner or friend? Practice makes perfect.
• You can also try different sizes, flavours and textures to see what you like, and what feels, the best.
• Try putting the lube on the inside and then masturbate with the condom on. See how it feels and what you like.
• Accessorise!

Availability of condoms:

Some men do not feel comfortable carrying condoms when they go out because they feel that they will be judged as being easy or looking to score. OUT’s research showed that one of the main reasons that men do not use condoms is that they do not have them available when they need them. Therefore, it is best to be prepared. Carry condoms and keep condoms at hand (e.g., by your bed, in your pocket etc) so you are not in a situation where you need one and do not have one. Also keep lube handy – in a large tub by your bed so you do not have to fiddle with small packages. Keep an eye out for OUT’s fun Safer Sex Packs (including condoms, strawberry lube, and funky messaging) the next time you are in a club or visiting the Prism Lifestyle Centre.
 

Remember, carrying a condom and being prepared does not mean that you are looking to score or that you are easy. What it does mean is that you are responsible and have thought about your health and the health of your potential sex partner. So, try developing the following attitude (and behaviour):

• Carrying condoms is positive;
• Carrying condoms means you are prepared;
• Carrying condoms means you are in control;
• Carrying condoms is part of your preparation for feeling sexy; and,
• Carrying condoms means you are prepared for when you meet that fabulous guy!

"But I’ve fucked without a condom already!?"

Even if you have already had risky sex, or are having it now, this does not mean that all is lost – it is never too late to start over. It is clear that some people may become HIV positive after one encounter but this is not always the case. You might still be HIV negative and this is worth finding out and protecting. Establish your HIV status by going for an HIV test (this should be done regularly, approximately every 6 months).
 

It is sometimes difficult to remain true to your contract with yourself on protected sex especially if you are caught up in the heat of the moment, if condoms are not accessible and/or if you are using alcohol and drugs. However, you can try to minimise these situations by:

• Making condoms and lube accessible
• having the discussion on condom use with your sex partner before you are caught up in the heat of the moment
• knowing your reaction when you are under the influence of alcohol and drugs.

What is clear is that an overriding determination always to have protected sex does not always translate into action but it is important to keep trying!

Communicating about condoms and lube

A guy might find it difficult to bring up the subject of condoms with his sexual partner(s). He may feel embarrassed or shy or worry about rejection. Or if he is already in a sexual relationship, he may worry that by bringing it up, his partner will assume that he has been unfaithful or is distrusting.

It is definitely easier to raise the issue of condom usage before you have sex for the first time. You can emphasise that this is your policy and that you always have sex with a condom to protect yourself and your partners. It may lead to some uncomfortable situations, such as rejection, but it is better to be safe than sorry. In most cases, if he is as concerned about his health as you are, he will have no problem with it.
 

It may be difficult, but it is not impossible, to discuss condom use any time during a sexual relationship. Emphasise that it is not only a question of trust, but precisely that you love him that you want to ensure that he is protected. The discussion may be undertaken in a larger context, if you are ready and willing, of negotiated safety. Thus it will include a discussion about going for an HIV test, what the results will mean for the relationship, and also issues about sex outside of your primary relationship.
 

In any case, do not wait until you are in bed or about to have sex to have the discussion about condom use. It might be helpful to have the conversation at a low-key moment, such as over dinner or over the phone. Tell him that it is not because you do not trust him, but that you are just concerned about health – yours and his.
 

It is important that you set ground rules for yourself with respect to condom use. Make it a practice to always use condoms, whoever you are having sex with – whether it is casual sex or a steady boyfriend, unless you have negotiated unprotected sex with your boyfriend.

Negotiating safety if already in a relationship:

OUT research has shown that it is very difficult for men in sexual relationships, to begin using condoms and practice safer sex, especially if they have not already done so. In this case, negotiated safety may be more practical. When negotiating safety, you should:

• Talk openly and honestly about your relationship. This includes talking about the state of your relationship as well as what each of you can expect from the other.
• Ascertain (through HIV testing) what your HIV status is. Don’t just talk about going for a test, but actually do it. You might have to do some internet research on the advantages and disadvantages of testing, where the nearest gay-friendly HIV clinic is, and what treatment might involve should either of you be HIV positive. If you have friends who are living with HIV, ask them how hey coped with the test result, and about living positively.  The process of testing together can be a challenge for your relationship – but it can also strengthen it. Most test sites will allow you to test as a couple because this gets around the challenge of disclosure of your HIV test result.
• Reintroduce safer sex into your relationship or agree that unprotected sex is limited to your relationship. Irrespective of your HIV status, you should agree on certain ground rules that will govern your relationship. In this negotiation, each of you should state clearly what each of you expect and agree upon. During this process you can choose to introduce (or reintroduce) safer sex into your relationship. You may at this point mention that despite your trust in him and the relationship, it is your growing understanding of HIV and STIs that makes you want to ensure that you are both safe. Reintroducing safer sex into your relationship becomes especially important when either or both of you tests HIV positive. However, you may feel that safer sex is not necessary for your relationship. If this is the case, it is important that you are both clear about the risk that this decision carries, and how best to deal with casual sexual encounters outside the relationship should they occur.
• Agree to use condoms if having casual sex outside your primary sexual relationship. You will need to discuss whether you are in an open or closed relationship. You should agree on what kinds of sex are or aren’t allowed outside the relationship. You should agree that condoms are used in every casual encounter. You should also discuss whether or not it will be necessary for both of you to disclose your casual sexual encounter whether allowed or not.
• Agree to warn their steady (primary) partner in cases of non-compliance. This is another important area of discussion. Think about what might happen if either of you are not able to stick to what it is that you agreed upon. Will you disclose this to one another. Will you inform each other so as to protect each other.
• Re-evaluate the agreement. After a predetermined time, you can agree to sit down and honestly share how each of you feel about the arrangement. It may become clear that, no matter what rules you have agreed upon (e.g., not have casual sex outside the steady relationship, not have unprotected casual sex, or to warn each other about non-compliance), your agreement is not a viable option and that a new agreement needs to be made. Or you might find that the agreement needs to be reinforced, with only fine tuning here or there.

So, negotiated safety is a way to engage in safer sex and although it still carries some level of risk, it may be more practical for men already in a steady sexual relationship.

Negotiated safety if not in a relationship:

If you are not in a relationship it is a good time now to think about your limits and put it in practice for your next casual encounter or your next steady relationship. Decide how much risk you are willing to take. What is and is not acceptable to you. And consider how important it is that you know your status in order to protect yourself and your future casual or steady partner(s).
 

Now is the time for you to think about the following:

• When in a relationship, what would you feel comfortable with in terms of sex outside of the primary relationship?
• Will you want to know, or feel comfortable telling him, about sex outside of your primary relationship?
• How will you discuss this with your partner?
• What will you do if he wants to have unprotected sex with you?
• Make a plan to go for regular HIV tests.

What is important is that you take the time to think about yourself – while you are not in a relationship – and your limits and requirements. What makes you feel good? What do you like to do and how? What risks are you willing to take? After that, you need to make an agreement with yourself that says that, no matter what, you will always try to honour your agreement.

At the beginning of your relationship, you need to have an open and honest discussion with your partner. As the relationship progresses, you may feel ready to have unprotected anal sex with him. If so, ensure that you both go for HIV tests and agree to the ground rules that you set for the relationship. Revisit this arrangement every so often.

A dental dam is a rectangular latex sheet that can be used for rimming (annilingus). It can be used to protect against the transmission of sexually transmitted infections. Placed over the anus, it allows for oral-anal stimulation without any exchange of bodily fluids. Dental dams are quite pricey and are not readily available. In the absence of a dental dam, a great alternative is to use non-microwavable cling wrap (available at most grocery shops) or a cut flavoured condom. The cut condom is achieved by cutting alongside the shaft of the condom. This is then opened and placed flat over the anus.

A finger cot is a latex device resembling a condom, but designed specifically to fit over the finger. This is ideal for finger fucking and offers protection against the transmission of most sexually transmitted infections, including Herpes and the Human Papilloma Virus (HPV). These are not readily available. Non-powdered latex gloves are more commonly used, especially for fisting, and are more readily available.

Risk reduction is a personal strategy that you can develop and follow in order to your risk profile. This is only possible once you:

• Have gained insight into your own risk behaviour and current health status; and
• Have a clear understanding of the available tools you could draw on to reduce your risks.

A personalized risk reduction is only effective when:

• You are completely honest with yourself. It is only when you are completely honest with yourself that you are able to identify what you can and cannot do in terms of reducing your risk;
• You do what is possible and realistic first. You are more likely to stick to choices and changes that are possible and realistic; and
• You start small. Smaller changes at first are usually easier and are likely to motivate you to move on to more difficult changes later on.
• You are clear on the steps and goals. By being absolutely clear on the steps involved in each area of change and by allotting a time frame to it, you are less likely to get side-tracked and lose momentum.

Below is a link to a pdf document, which contains a useful risk reduction template you can use to develop your own risk reduction strategy – a useful starting point to being committed to your own health and wellbeing. Remember to action what is personally achievable.

Please see our Risk Reduction Template HERE

While focusing on HIV, other STIs are often overlooked. And this can have serious health consequences for you if left untreated. Such as, increasing your chances of HIV infection, especially if you are fucking without protection and have certain physical conditions (such as open sores) that make it is easier for HIV to be transmitted.

The Advantages of Testing for STI's:

• By having regular STI screening, you are taking control of your life and your health. You can get treated and protect your sexual partners from becoming infected.
• Most STIs can be treated. If caught early enough, diagnosed and treated correctly, long term and permanent health complications can be avoided.

Having an STI makes HIV infection more likely. Thus, treating any STI is recommended in order to decrease your chances of HIV infection.

A few points to consider when testing for an STI:

• If you test positive for an STI, your partner might accuse you of having unprotected sex outside the relationship. However, several STIs do not have symptoms and therefore it might not be clear when you actually got the STI – it could have been before the relationship even started.
• Finding out you have one of the incurable STIs, such as herpes, may lead to depression, anxiety and loss of libido.
• Once you know you have an STI you may feel an extra responsibility to disclose this and face rejection from a potential, or past, sexual partner.

Testing for STIs – What to expect?

As a guideline, you should test for STIs if you have any symptoms, if you are having unprotected sex, if you feel prepared and motivated, or simply decide to get into the habit of being screened at least once a year.

The following are used to test for STIs:

• A urine test is very common and involves urinating into a cup and taking the urine to the relevant health care worker, who then inserts a “dipstick” into the urine it to check for various infections. The results from the urine test are given immediately and the health care worker can suggest a course of treatment if needed.
• A blood test usually involves drawing a vial (5 ml) of blood and sending it to the lab to check for various STIs such as syphilis and hepatitis B, C and D.
• Although not commonly used, a throat swab or scraping may be taken if treatment (involving antibiotics) for an existing sore throat has not been effective. This swab or scraping is then sent to the lab for analysis.
• A rectal swab is not a very common procedure, but may be necessary if an abscess or some other infection in the rectum is not responding to antibiotics. A rectal swab, involves a swab of the infected area, and does not usually involve inserting the swab into the rectum.
• A colonoscopy is uncommon and is limited to cases of suspected abnormal cells. A small camera is inserted into the rectum and threaded up to the colon and the cells are investigated. If the cells are thought to be problematic, a biopsy is taken – a small sample of the cells – and sent to the lab for analysis. In gay men, there is usually scar tissue around the rectum, but this does not necessarily mean that there is something wrong; however, if you are unsure, you should ask your medical practitioner.

HIV stands for Human Immunodeficiency Virus.

Going for an HIV test can be intimidating and very scary. This is completely normal. So it is very important that you are fully prepared when you go for the test. Try this: think about the possible consequences of having both positive and negative results. Also, think about who you would tell, if anybody, if you were HIV positive – in other words, who you would be able to count on for support.

The Advantages of Testing for HIV:

• If you test positive, you can learn more about HIV and decide how to take care of your health. Early diagnosis and treatment can help you stay healthier for a longer period of time.
• By taking the test you are taking control of your life and your health.
• Taking the test takes away the anxiety of not knowing. Sometimes it is worse not to know, which can cause ongoing unnecessary stress.
• The longer HIV and STIs are left undiagnosed and untreated, the more serious health problems they can cause.
• If you know your status, you can better protect yourself and your sexual partners.

Free treatment is available in the public health sector and all medical aids must now provide treatment for people living with HIV.

A few points to consider when testing for HIV:

• If you test HIV positive, your partner might blame and reject you. If you were both negative at the beginning of your relationship, it means that one of you has had unprotected sex outside of the relationship. This may cause a great deal of distrust and anger.
• There is still a lot of fear, shame and blame around HIV. Stigmatising attitudes can spill over into actual discrimination.
• Sometimes internal stigma can lead to low self esteem and social withdrawal in people living with HIV.
• Testing positive may mean disclosing to others and this can be stressful as the outcome is mostly uncertain.
• It is not always easy to tell potential sexual partners you are HIV positive.
• Getting good treatment is not always a simple matter.
• Depression and anxiety can affect your quality of life.

What’s the point? I’m sure I’m HIV positive already!

Even if you have had unprotected sex previously or are currently engaging in risky casual sex, or if you are in a “monogamous” relationship where you have had unprotected sex once or several times over the last few months, it does not mean that all is lost! It is never too late to start afresh and to have an HIV test to kick-start your own determination. Remember that there is no accurate way of knowing your status unless you go for an HIV test.

Many guys think that:

• The test is too complicated;
• The tests are not accurate;
• They will not cope with the result;
• A positive result will be the end; or
• They are already positive "so what’s the point?"

Open your mind to the possibility that you could be HIV negative and make a decision to find out what your HIV status is. If you are already in a relationship, make a plan to go for a test together. Remember that there is no way of knowing your status, as individuals or as a couple, unless you go for a test. You could both still be lucky and be negative. If you do test positive this will be hard but at least you are in a position to make some good decisions.

Testing for HIV - What to expect?

Informed consent

It is a legal and ethical requirement that all HIV testing be accompanied by informed consent. Consent has two parts to it – information and permission. With an HIV test, a person must know what the test is, why it is being done and what the result will mean before agreeing to go ahead with the test. A person may not be forced or tricked into consenting to testing or treatment.
Your right to confidentiality

Ethical and legal rules say that doctors, nurses and other health care workers must keep all patient information confidential. This means that any information about your test, any illness or treatment, or HIV status, can only be given to another person with your consent. Therefore, a health care worker cannot tell your family, employers, friends, other health care workers, or sexual partner of your HIV positive status.
 

There are only very few exceptions where this does not hold true, and where the health care worker is allowed to tell someone else without your permission. In such cases you will be counselled extensively beforehand. If you still did not want to disclose, you would be notified by the health care worker of their intent to disclose your status even without your permission. But the health care worker needs valid reasons for doing so. An example of this would be when you refuse to tell your regular partner you are HIV positive and there is a chance he is not yet HIV positive.

In some medical settings, such as a hospital ward, or an ARV treatment site, all people treating you will know your HIV status. This is called shared confidentiality and it ensures that you are getting the best possible treatment. This should be explained to you when you first enter that medical setting (although this does not always happen).

In South Africa, a health care worker is not required to tell the health care authorities (the government) that you have tested positive for HIV or have AIDS.

Pre- and post-test counselling

Every HIV test should be accompanied by pre-test counselling. This is where you have a discussion with a trained counsellor about the nature of the test, the reasons why it is being done and how the result, whether positive or negative, could affect you. Following this, you are asked for your informed consent, which means having all the necessary information to give permission to go ahead with the test. Pre-test counselling is a legal and ethical requirement and no one can force you to have a test against your will. Pre-test counselling should never be rushed or done in a routine way – the HIV test result can have an important impact on your future, whether you test HIV positive or HIV negative.
 

Once the test has been completed it is important that you also have post-test counselling. At the post-test session, the results of the test will be presented to you and the counsellor will discuss the meaning of the results and provide you with information on the way forward. Post-test counselling is required even if your test result is negative, in which case the counsellor will discuss with you how best you can stay negative. If your test result is positive, the counsellor will discuss the way forward, in terms of health and treatment issues, disclosure and support. A positive result may feel like the end of the world but in time most people make an adjustment to being HIV positive and learn to integrate this into their lifestyle.

Types of tests

There are a number of different types of tests for HIV. Most look for the presence of antibodies for HIV in the blood. Antibodies are special protein complexes that are produced by the immune system that attack and neutralise specific disease-causing organisms. The antibodies, which the body creates in response to HIV, are unfortunately powerless to protect against the long-term destructive effects of HIV on the human body.

The most common HIV test is a blood test. The following blood tests can be used to diagnose HIV:

• Rapid test – results are available within 10 minutes after a sample is taken (this test is most commonly used in the public health sector as a screening test).
• ELISA – looks for antibodies against HIV.
• Western Blot – to confirm a positive ELISA test.
• P24 Antigen test – measure the proteins of the virus.
• PCR – detects viral genetic material.
• Saliva test – tests saliva rather than blood (normally used as a screening test).

The ELISA test is commonly used as a screening test (especially in the private sector) but the new “rapid test”, based on the ELISA test, is the most common test in the public sector. The P24 Antigen test and PCR are not widely used in South Africa because they are more expensive than the other two. The saliva test is a non-blood test which works on the same principles as the rapid tests, i.e. it is antibody based.
 

A positive result for any HIV test should be confirmed with a second test. Antibody test results for HIV are accurate more than 99 percent of the time.

Test Results

Image: Test Results - Negative:

Image: Test Results - Positive:

Image: Test Invalid:

Now is the time for you to think about the following:

• Make a plan to go for regular HIV tests.
• Think about your safer sex options and try incorporating these into your sex life.
• Set your limits beforehand and stick to them.
• Get an adequate supply of lube and condoms and make sure they are easy to find when you need them.
• Talk to your partner(s) in advance so that they know your limits.
• Never make the dangerous assumption that you can tell if a current or potential sex partner has an STI or HIV just by looking at him.
• Don’t let alcohol or drugs cloud your judgement. Don’t kid yourself by thinking that it won’t. You should have some idea how you react when you are under the influence of drugs or alcohol. It is perhaps a good idea to put certain plans in place in case your judgement does become impaired  (for example, go clubbing with a friend you trust and tell him to make sure you go home alone, or that he carries condoms and lube and gives them to you if you leave with someone else).
• Don’t give up if you had an unsafe encounter – it’s never too late to start over.

What if I test HIV Positive?

It may not be the test that is daunting for you but the consequences of a positive result. Here we start to look at some of the challenging aspects that you may find difficult to think about.
Your right to disclose

You can choose who, when and how to disclose your HIV status. Think carefully about who you would tell if you tested positive and why you would tell them – this is one of the things that will be discussed with you during your pre and post-test counselling – as you will most probably only want supportive friends and family to know your results.
 

There are various advantages and challenges to disclosing your HIV status. The advantages of disclosing include:

• It can help you accept your HIV positive status and reduce the stress of coping on your own.
• You can get necessary emotional and other support - You will have supportive family and friends (those who you have chosen to tell) who will help you deal with HIV and AIDS and you won’t be on your own.
• If you disclose to your sexual partner(s), he/they can also go to test to determine their status. You can engage in safer sex every time to ensure that the risk of infection or re-infection is minimised.

The challenges may include:

• You may be rejected because the stigma associated with HIV is still so prevalent.
• While your friends and family (whoever you have chosen to disclose to) may try to be supportive, they may start to change in the way they treat you. This may lead to a change in your relationship.
• Your sexual partner(s) may reject you because of their fears and prejudices.

Your psychological reaction to a positive test result may vary.

Personal hygiene is described as the principle of ensuring and maintaining cleanliness and care of the external body.
 

The benefits of good hygiene:

• Increased self-esteem and confidence;
• Projecting a positive body image;
• Helps reduce unpleasant body odours;
• Helps reduce the risks of infection and pain.

The Risks of Poor Hygiene:

• Social embarrassment;
• Rejection and isolation;
• Increased risk of getting an infection or an illness

Hand Hygiene:

• Hand washing is vital. This should be carried out after using the toilet, after handling anything potentially hazardous, before preparing food, before eating, and before and after having sex.
• When washing your hands try using warm water and a good soap. Wet your hands thoroughly and apply soap and work into a soapy lather. With a repetitive motion continue hand washing (over the back of your hands, across your palms, in between your fingers, around your nails, and even around your wrists) until you are thoroughly satisfied they are clean (which is usually the duration of singing ‘Happy Birthday to you’ in your head). Rinse and dry thoroughly using a clean dry towel.
• Keep your nails short and clean.
• Treat any cuts or open sores immediately.
• A latex glove is very handy when engaging in any sexual activity (e.g., finger fucking).
• In cases where water is not readily available consider using a anti-bacterial wet wipe.

Oral Hygiene:

• Bad breath (or halitosis) is most commonly caused from poor dental hygiene (e.g., wrong technique used to brush teeth, don’t floss, irregular visits to the dentist etc). Bad breath can also be caused by eating highly aromatic foods such as onions and garlic or in cases where food intake has been severely restricted. Dehydration can cause bad breath, while drinking alcohol can lead to bad breath and body odour. And lastly, smoking, chronic sinus problems and gum disease may also lead to bad breath. Resolving any of these causes is likely to result in a dramatic improvement.
• In general, teeth should be brushed at least twice a day, followed by some flossing. You could also floss after every meal. Remember to also brush your tongue as this will remove any buildup of bacteria and/or dead cells.
• You should avoid brushing your teeth before or after engaging in any oral sexual activity as this may cause the gums to bleed, increasing your risk of infection. Rinse with a mouth wash or chew some gum instead.
• Replace your toothbrush approximately every three months.
• Keep well hydrated, by drinking at least 6 – 8 glasses of water per day, which is actually good for your overall health.
• Go to your oral hygienist/dentist for a check-up and clean-up at least twice a year.
   

Genital Hygiene:

• The penis and scrotal area should only need proper washing once a day.
• No attempt should be made to clean the inside of the urethra (e.g., using an earbud). Cleaning is only concentrated on the outside of the penis.
• Uncircumcised men should take special care to clean the head of the penis, by gently pulling back the foreskin and rinsing the head. Failure to do so may result in buildup of smegma (aka cheese), causing bad odours and an increased risk of infection. If your foreskin is too tight to retract then it is important that you consult your doctor.
• Circumcised men can simply rinse the head as normal.
• Gentle genital cleaning should also be done after sex, even if a condom was used. This is to prevent bacterial buildup and unpleasant smells arising.
• Wearing loose fitting cotton underwear can reduce the possibility of perspiration buildup and subsequent aromas.
• Do not apply aftershaves and /or deodorants directly to the genital area.

Anal Hygiene:

• The anus should only need proper washing once a day and then appropriate cleaning after every bowel movement.
• Not cleaning after defecation (aka shitting or taking a dump) can lead to irritation of the surrounding skin, bad odour, the transmission of a wide range of STIs (e.g., Hepatitis A etc). 
• Although hygiene is very important, over-cleaning (using harsh internal cleansing products) and over-wiping (using course toilet paper) is not desirable as this may lead to irritation and in some cases bleeding.
• When cleaning use a soft ‘two-ply’ toilet paper, or if possible, use a pre-moistened, non-perfumed adult wipe.
• Anal douching is the practice of introducing water slowly and gently into the anus in order to clean out the rectum. This has been suggested as a possible method but there are associated risks to this practice: it can lead to damage of the rectum and can actually increase the risk of contracting an STI. 
• When sex toys are used, these should be cleaned in between uses, even if new condoms are used each time. This is especially important if sex toys are shared.

Body Odour:

• Body odour develops from a buildup of perspiration generally in the groin, armpit and feet. Exercising and hot weather can contribute to this. Perspiration is not preventable but body odour can be controlled.
• Frequent washing can help reduce the development of body odour. For most, one wash a day may be adequate. For others, two to three washes a day may be required. Ensure that you dry yourself thoroughly to avoid reservoirs for bacteria to breed in.
• Wearing clean underwear, socks and clothes every day can also help reduce body odour and reduce risks of infection and soreness.
• The moderate use of anti-perspirant deodorants can help reduce odours developing in the armpits. The key here is moderate, as you don’t want to appear to have been doused in chemicals as this is also unappealing.
• The removal of excess hair can help reduce the area on which bacteria can breed and odours developing.
• In cases of severe perspiration, medical treatment may be sought (e.g., trans-thoracic sympathectomy or botox injections into the armpit).