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What your gynecologist wishes you would do

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By Linda S. Mihalov, MD, FACOG

No matter a woman’s age or how comfortable she is with her gynecologist, she may still be unsure about a few things — like which symptoms are worth mentioning, how often to make an appointment and how to prepare for an exam.

Based on my 30 years of providing gynecologic care to women of all ages, I thought it would be helpful to provide a few tips about how to make the most of your care visits.

Keep track of your menstrual cycle

Dr. Linda Mihalov

Menstruation is a monthly recurrence in women’s lives from early adolescence until around the age of 51, when menopause occurs. Because of the routine nature of this biological process, it’s easy to become complacent about tracking your periods. Thankfully, there are numerous smartphone apps that help make tracking periods easy.

Keeping track of your period is important for numerous health-related reasons. A missed period is usually the first sign of pregnancy. Determining the due date of a pregnancy starts from the date of the last menstrual period. Most forms of birth control are not 100 percent effective, and an unplanned pregnancy is best recognized as soon as possible.

Conversely, women attempting to get pregnant can use period tracking to learn when they are most fertile, which may greatly increase the chances of conception.

In addition, a menstrual cycle change can indicate a gynecologic problem, such as polycystic ovarian syndrome, or even uterine cancer. It is also often the first obvious symptom of health issues that have no obvious connection to the reproductive organs. When a regular menstrual cycle becomes irregular, it may indicate a hormonal or thyroid issue, liver function problems, diabetes or a variety of other health conditions. Women also often miss periods — or experience menstrual changes — when adopting a new exercise routine, gaining or losing a lot of weight or experiencing stress.

One late, early or missed period is not necessarily reason for alarm. But if menstrual irregularity is accompanied by other symptoms, a woman should schedule an appointment with her gynecologic care provider.

Get the HPV vaccine

Human papillomavirus, or HPV, is a very common virus. According to the Centers for Disease Control and Prevention, nearly 80 million Americans — about one in four — are currently infected. About 14 million people, including teens, become infected with HPV each year. Most people who contract the virus will clear it from their systems without treatment, but some will go on to develop precancerous or even cancerous conditions from the infection.

The HPV vaccine is important because it protects against cancers caused by the infection. It can reduce the rate of cervical, vaginal and vulvar cancers in women; penile cancer in men; and anal cancer, cancer of the back of the throat (oropharynx), and genital warts in both women and men.

This vaccine has been thoroughly studied and is extremely safe. Also, scientific research has not shown that young people who receive the vaccine are more prone to be sexually active at an earlier age.

The HPV vaccine is recommended for preteen girls and boys at age 11 or 12 so they are protected before ever being exposed to the virus. HPV vaccine also produces a more robust immune response during the preteen years. If you or your teen have not gotten the vaccine yet, talk with your care provider about getting it as soon as possible.

The CDC now recommends that 11- to 12-year-old girls and boys receive two doses of HPV vaccine — rather than the previously recommended three doses — to protect against cancers caused by HPV. The second dose should be given six to 12 months after the first dose.

Teen girls and boys who did not start or finish the HPV vaccine series when they were younger, should get it now. People who received some doses in the past should only get doses that they missed. They do not need to start the series over again. Anyone older than 14 who is starting the HPV vaccine series needs the full three-dose regimen.

Young women can get the HPV vaccine through age 26, and young men can get vaccinated through age 21. Also, women who have been vaccinated should still have cervical cancer screenings (pap smears) according to the recommended schedule.

Do not put off having children

Fertility in women starts to decrease at age 32 and that decline becomes more rapid after age 37. Women become less fertile as they age because they begin life with a fixed number of eggs in their ovaries. This number decreases as they grow older. Eggs also are not as easily fertilized in older women as they are in younger women. In addition, problems that can affect fertility — such as endometriosis and uterine fibroids — become more common with increasing age.

Older women are more likely to have preexisting health problems that may affect their or their baby’s health during pregnancy. For example, high blood pressure and diabetes are more common in older women. If you are older than 35, you also are more likely to develop high blood pressure and related disorders for the first time during pregnancy. Miscarriages are more common in older pregnant women. Losing a pregnancy can be very distressing at any age, but perhaps even more so if it has been challenging to conceive.

So, women who are considering parenthood should not put off pursuing pregnancy for too long or it may become quite challenging.

See your gynecologist for an annual visit

For women to maintain good reproductive and sexual health, the American College of Obstetricians and Gynecologists recommends that they visit a gynecologist for an exam about once a year. Generally, women should have their first pap test at age 21, but there may be reasons to see a gynecologic care provider earlier than that if there is a need for birth control or periods are troublesome, for instance. Although pap tests are no longer recommended every year, women should still see their provider annually for a gynecologic health assessment. This may or may not involve a pelvic exam.

Other reasons to visit a gynecologist include seeking treatment for irregular periods, sexually transmitted diseases, vaginal infections and menopause. Women who are sexually active or considering it can also visit a gynecologist to learn more about contraceptives.

During each visit, the gynecologist usually asks about a woman’s sexual history and menstrual cycle. The gynecologist may also examine the woman’s breasts and genitals. Understandably, a visit like this can cause discomfort among some women. However, periodic gynecological exams are very important to sexual and reproductive health and should not be skipped. The patient’s anxiety can be significantly decreased if she knows what to expect from the visit. Prepared with the knowledge of what actually occurs during an annual exam, women often find it can be a straightforward, rewarding experience.

There are several things women should do to prepare for a gynecological exam, including:

  • Try to schedule your appointment between menstrual periods
  • Do not have intercourse for at least 24 hours before the exam
  • Prior to the appointment, prepare a list of questions and concerns for your gynecologist
  • Since the gynecologist will ask about your menstrual cycle, it will be helpful to know the date that your last period started and how long your periods usually last

The pelvic exam includes evaluation of the vulva, vagina, cervix and the internal organs including the uterus, fallopian tubes and ovaries. Appearance and function of the bowel and bladder will also be assessed.

The gynecologic provider will determine whether a pap test is indicated, and order other tests as necessary, including tests for sexually transmitted infections, mammograms and screening blood work or bone density studies. Even a woman who has previously undergone a hysterectomy and, as a result, no longer needs a pap test can still benefit from visiting her gynecologist.

Primary care providers, including family practitioners and nurse practitioners, internists and pediatricians can also provide gynecological care.

Menopause

Menopause can be a challenging time. Changes in your body can cause hot flashes, weight gain, difficulty sleeping and even memory loss. As you enter menopause, you may have many questions you want to discuss with your gynecologist. It is important that you trust your gynecologist so you can confide in them and ask them uncomfortable questions. The more open you are, the better they can guide you toward the right treatment.

Complete Article HERE!

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Cancer patients and survivors can have trouble with intimacy

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cancer-patients-and-survivors-can-have-trouble-with-intimacy

People who survive cancer treatment — a growing group now topping 5 million — often have trouble with intimacy afterward, both from the actual treatment and physical recovery and from the psychological damage of feeling so vulnerable.

People who survive cancer treatment — a growing group now topping 5 million — often have trouble with intimacy afterward, both from the actual treatment and physical recovery and from the psychological damage of feeling so vulnerable.(Photo: Getty Images/Comstock Images)

In the mirror, Kelly Shanahan looks normal, even to herself.

kelly-shanahan

Kelly Shanahan of South Lake Tahoe, Calif., has been battling breast cancer for eight years. She’s a big believer in doctors and their patients discussing sexual health.

But she does not feel like herself.

The breasts she had reconstructed eight years ago look real, the nipples convincing. But her breasts have no sensation. The only time she feels them at all is during the frigid winters of her South Lake Tahoe, Calif., home, when they get so cold, she has to put on an extra layer of clothing.

“For a lot of women, breast sensation is a huge part of sexual pleasure and foreplay. That is totally gone,” says Shanahan, 55, who has lived with advanced breast cancer for three years. “It can be a big blow to self-image, even though you may look normal.”
Kelly Shanahan of South Lake Tahoe, Calif., has been battling breast cancer for eight years. She’s a big believer in doctors and their patients discussing sexual health. (Photo: Kelly Shanahan)

Shanahan is part of a growing group of patients, advocates and doctors raising concerns about sexual health during and after cancer treatment.

“None of us would be here if it weren’t for sex. I don’t understand why we have such a difficult time talking about it,” she says.

Though virtually all cancer diagnoses and treatments affect how patients feel and what they think about their bodies, sex remains an uncomfortable medical topic.

Shanahan, an obstetrician herself, says that until her current doctor, none of the specialists who treated her cancer discussed her sex life.

“My former oncologist would rather fall through the floor than talk about sex,” she says.

Major cancer centers now include centers addressing sexuality, but most community hospitals still do not. The topic rarely is discussed unless the patient is particularly bold or the doctor has made a special commitment.

There’s no question that cancer can dampen people’s sex lives.

Hormone deprivation, a common therapy for breast and prostate cancer, can destroy libido, interfere with erections, and make sex extremely painful. Weight gain or loss can affect how sexy people feel. Fatigue is unending during treatment. Body image can be transformed by surgeries and the idea that your own cells are trying to kill you. The constant specter of death is a sexual downer, as are the decidedly unsexy aspects of cancer care, like carrying around a colostomy bag. Then, there are the healthy partners, feeling guilty and terrified of causing pain.

And once people start to associate sex with pain, that can add apprehension and muscle tightness, which makes intercourse harder to achieve, says Andrea Milbourne, a gynecologist at the University of Texas MD Anderson Cancer Center in Houston.

There’s almost never a medical reason cancer patients or survivors shouldn’t be having sex, says Karen Syrjala, a clinical psychologist and co-director of the survivorship program at the Fred Hutchinson Cancer Research Center in Seattle. Even if there is reason to avoid intercourse, physical closeness and intimacy are possible, she says, noting that the sooner people address sexual issues the less serious those issues will be.

“Bodies need to be used and touched,” she says said. “Tissues need to be kept active.” Syrjala recommends hugging, romantic dinners, simple touching, “maybe just holding each other naked at night.”

There are ways to improve sexual problems, starting with doctors talking to their patients about sex. Milbourne and others say it’s their responsibility, not the patients’, to bring up the topic.

Hormone deprivation, a common therapy for breast and prostate cancer, can destroy libido, interfere with erections, and make sex extremely painful. Lubricants can help smooth the way.

Hormone deprivation, a common therapy for breast and prostate cancer, can destroy libido, interfere with erections, and make sex extremely painful. Lubricants can help smooth the way.

Communication between partners also is essential. “A lot of times, it’s unclear, at least in the mind of the other partner who doesn’t have a cancer, what has happened. ‘Why does this hurt? Why don’t you want to do anything?’ ” Milbourne says.

For women who have pain during sex, Milbourne says one study found benefit to using lidocaine gel to numb vaginal tissue.

Jeanne Carter, head of the female sexual medicine and women’s health program at Memorial Sloan Kettering Cancer Center in New York City, recommends women do three minutes of Kegel exercises daily to strengthen their pelvic floor muscles and improve vaginal tone, and to help reconnect to their bodies.

For women sent abruptly into menopause, moisturizing creams can help soften tissue that has become brittle and taut. Carter says she’s conducted research showing that women with breast or endometrial cancers who use moisturizers three to five times a week in the vagina and on the vulva have fewer symptoms and less pain than those who don’t. Lubricants can help smooth the way, too.

“We’ve got to make sure we get the tissue quality and pain under control or that will just undermine the whole process,” Carter says.

Sex toys also take on a different meaning after cancer treatment. Specialized stores often can offer useful advice and the ability to examine a product before buying. Rings and other equipment, in addition to medications such as Viagra, can help men regain erections.

Doctors and well-meaning friends also need to stop telling cancer patients that they should simply be glad to be alive, Shanahan says. Of course she is, but eight years after her initial diagnosis and three years after her disease advanced, Shanahan wants to make good use of the time she has left.

And that, she says, includes having a warm, intimate relationship with her husband of 21 years.

Complete Article HERE!

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How I Spent My Summer Vacation

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Hey sex fans!

I’ve been away. Did ya miss me? Yeah, I’ll bet.

Last Sunday, 07/24, I woke up feeling a bit wonky. Couldn’t quite put my finger on why I was feelin’ out of sorts; I just was. But I had a swell outing planned for the day, so I couldn’t flake. A couple of friends and I were planning on taking the ferry to Bainbridge Island for lunch. The weather was perfect for our little cruise across Puget Sound.

Bainbridge ferry

My friends and I met at Pikes Market, a famous landmark here in The Emerald City, and we walked to the ferry from there. I walk about four miles every day so the 15-minute walk should have been a breeze for me. But something was wrong. I felt lethargic and winded.

pikes market

The 35-minute ferry ride was magical, as always, but upon disembarking and walking to the restaurant I began to really hurt. Not one to spoil the fun I marshaled my resources and made it to lunch.

The walk back to the ferry was excruciating. I was lightheaded, slightly nauseous, and completely winded. My heart was pounding like it wanted out of my chest. My companions became as worried as I was.

Once we docked in Seattle I had to once again disembark then walk to public transportation and to home. I was in a panic. The crush of the crowd around added to my distress. I thought for sure I was gonna faint, or barf, or worse. I was certain that my lungs were gonna give out on me. After many stops to catch my breath and buckets of sweat from the effort I finally made it home.

I’ve been monitoring my blood pressure for several months. (Ya gotta do this when you’re old, like me.) So once at home, I took a reading. My blood pressure was normal, but my pulse was unusually low, a reading of 49 to be precise. A couple of hours later it was 45. This was odd. I had never experienced anything like that before.  Mostly my pulse rate hovers in the upper 70s and low 80s.

I felt much better on Monday. But come Tuesday, I was a total wreck. The least bit of exertion left me exhausted and prostrate. I knew it; my lungs were finally giving out. I put in a call to my doctor and got an expedited appointment for the very next day.

Tuesday’s blood pressure readings were slightly elevated, which was great, but my pulse was way down. I took several readings and each was in the mid 30s never over 40. I still didn’t get it. (This is probably why I’m not a brain surgeon.)

Wednesday turned out to be a nightmare. Unbeknownst to me I was about to began a headlong descent into the maw of the medical industry.

My doctor’s appointment was at 10:30am. The doc took one look at me and ordered an electrocardiogram (EKG). “HOLY SHIT!” She exclaimed. (Or something to that effect.) “How is it that you’re still standing?”

Needless to say, this got my attention right quick. “What?” I inquired. “Although you are not having a heart attack you are this close to the pearly gates. Your pulse is about to flat line, you monkey!” My doctor stuttered. (Ok, maybe she didn’t mention the pearly gates, or call me a monkey, but that was her drift for damn sure.)

Maybe it was the stress or shock of it, but I started to laugh. My doctor asked; “What’s so funny?” I said; “Did you ever see the movie, Death Becomes Her? Remember the scene in the emergency room?”

She gave a faint smile and said; “Yeah, I get it, but this is no laughing matter. Get thee to the Emergency Room ASAP!”

Off I went.

I got to Swedish Hospital (First Hill) Emergency Reception just before noon. The guy behind the desk asked what was wrong with me. I said; “Basically, I’m having a heart attack.” Apparently those are the magic words because the team swung into action. I was admitted immediately, blood was drawn, another EKG, x-rays were taken, and I was hooked up to a heart monitor. Diagnosis: Bradycardia with second-degree heart block.

You need a pacemaker IMMEDIATELY!

We’ll get you a room on the cardiac ward at our Cherry Hill campus, which is just a mile away, as soon as one is available.”

“Oh, OK, I guess,” said I as the severity of the situation finally began to dawn on me. As you can see, I’m not the sharpest pencil in the box.

The fact is, I’m more versed in facing my mortality than the average person, what with the decades of death and dying work that I have done. But let me tell you, staring into the abyss is still daunting.

Back in the emergency room I was laying on a gurney with electrodes and wires sprouting from my chest and back. I lay there for hours listening to the cries, screams, and moans of my fellow emergency patients. Codes blue and grey are being called with regularity and I can just imagine the human misery that surrounds me.

At 5:00pm one of the emergency nurses tells me that a room at the cardiac ward will be available at 7:00pm. “But, 7:00pm is the changing of the shift. So the soonest we could get you there is 7:30pm.”

7:30pm comes and goes. “What’s up?” I ask. “We’re trying to locate transport for you.” Was their retort. “But the Cherry Hill campus is just a mile away. I could walk there from here.” I countered. “But you need a special ambulance, one with a nurse on board, one that can monitor your heart in transit.” “You gotta be kidding!” Said I. “Not at all. You could flat line on the way to Cherry Hill and we’d be liable. Don’t worry, Richard, we will surely have the transport by 10:00pm.”

AMR

The transport didn’t actually arrive till 12:30am. That was twelve and a half hours on a gurney in the ER! And the fun is just beginning.

I finally get to the Cherry Hill campus at 1:00am. I am ushered into a room where I am then interrogated for 45 minutes. (Are you now, or have you ever been…) They called it an intake, but a rose by any other name. I haven’t eaten since breakfast at 5:00am the previous day with only water to drink. Now, even the water was being withheld. I guess they anticipated I would have my procedure later that (Thursday) morning.

swedish cherry hill

Not so fast there buckaroo!

Thursday dawns, but nothing happens. I’m confined to my bed (the second worse bed in the world. The first being the ER gurney I left yesterday) and am attached to a heart monitor. I am faint from hunger and more than a little dehydrated. By noon they decide they need to feed me lest the hunger and dehydration kill me before the arrhythmia.

I scarfed down my lunch like a dying man…mostly because I was.

Allow me to pause my narration for a moment and comment on the cardiac nursing staff. They are superb! And even that superlative leaves me wanting. These women are freakin’ rock stars in my book. One in particular, Nurse Jen, totally got me. We both had the same gallows humor. She is my hero.

Eric Williams

Eric Williams, MD, FHRS

Late Thursday afternoon Dr. Williams, a cardiac electrophysiologist, saunters into my room. He’s gonna be doing the cutting on me. He is a tall handsome black man with the most unassuming manner. He looks me in the eye and talks to me like I’m a human. I’m super impressed with his bedside manner. He tells me my blood work and enzymes are excellent. My x-rays show that my heart isn’t enlarged. (But wait! Every one tells me I have a huge heart.) And there’s no sign that I had a heart attack. We talk about the pacemaker and the procedure. He tells me it’s about the size of a silver dollar. (When I actually see the blasted thing the next day, just before they shove into my chest, I have to wonder where Dr. Williams gets his silver dollars.) The procedure is very routine; he tells me. “Yeah sure, for you maybe.” It’ll last approximately 45 minutes, during which I will be enjoying twilight anesthesia. “Twilight anesthesia, huh? That sounds delightful.” Better living through chemistry, I always say.

I get a sedative Thursday night to help me sleep in my little bed of torture. And nothing by mouth after midnight. (Oh no! Not that again.)

Friday morning my nurses prep me for surgery. First, they have to shave my manly chest, don’t cha know. Nurse Jen takes the lead with a maniacal gleam in her eye.  This is more than a little awkward and also maybe a wee bit kinky.

Finally the fateful hour arrives. I get a second IV stent, because apparently one is not enough for these folks. Then I’m wheeled down to the bowels of the building where I disappear into one of the surgery suits.

1pacemaker0129

Does this look like the size of a silver dollar? I don’t think so.

Two hours later I’m back in my room dopey as all get-out, but still kickin’.

I’m home now, i’m happy to report. They liberated me on Saturday, 07/30, afternoon. And I am only slightly worse for the wear. I have a very distinctive slash across my left pectoral. There’s an unsightly bulge just below it.  It looks like i’m growing a third breast. And a nasty purple and brown bruise that runs from my shoulder to my sternum and from my collarbone to my nipple. I sound like a real attractive guy, huh?

The Moral Of The Story
Life-is-not-a-dress-rehearsal
My friends, life is short! Ought we not live every day like it’s our last? I think so. I have decided that I will try to be more kind to myself and those around me. Because, ya know what?  In a twinkling of an eye, it can and most assuredly be over.

wake up and live

The End

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Doctors urged to advise patients about risks of abstinence-centric sex education

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American Academy of Pediatricians’ new report is the clearest denouncement of the failures of not talking about STIs and pregnancy prevention

Across the US only 50% of high school students receive sex education that meets the recommendations of the federal Centers for Disease Control and Prevention.

Across the US only 50% of high school students receive sex education that meets the recommendations of the federal Centers for Disease Control and Prevention.

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The country’s largest organization of pediatricians entered fraught political territory on Monday, with a call for doctors to use their time with patients to combat the potential health consequences of abstinence-centric sex education.

In a new report, the American Academy of Pediatricians (AAP) issued its clearest denunciation yet of sex education programs that fail to offer comprehensive information on topics such as sexually transmitted infections (STIs) and pregnancy prevention.

“This is the mothership telling pediatricians that talking about sex is part of your charge to keep children and adolescents safe,” said Dr Cora Breuner, a professor and pediatrician at Seattle Children’s research hospital and the report’s lead author.

“These guidelines give pediatricians in communities where people might say, ‘We don’t want you talking to our kids about this stuff,’ permission to say, ‘No, I can talk about this, I should talk about this, I need to talk about this.’”

The report is broadly a call for pediatricians to help fill in the gaps left by the country’s patchwork sex education programs. It urges pediatricians to teach not only contraception and the benefits of delaying sexual activity, but to cover topics such as sexual consent, sexual orientation and gender identity with school-aged children who may not receive any information in the classroom and involve their parents.

But the authors single out abstinence-heavy education, which sometimes excludes information about contraceptives, as a key concern for doctors looking to help adolescent patients avoid sexually transmitted infections and unintended pregnancy. As a result, it is likely to fuel an already contentious debate.

Groups that have advocated for sex education to emphasize abstinence instantly found fault with the new guidelines.

“A health organization like the AAP should not be affirming a behavior that can compromise the health of youth,” said Valerie Huber, the president of Ascend, a group that promotes abstinence-centric sex education and advocates for federal funding. The group was formerly known as the formerly the National Abstinence Education Association.

“They recommend ‘responsible sex’ for young adolescents. Exactly what is responsible sexual activity for adolescents? … The science is clear that teens are healthier when they avoid all sexual activity.”

Moreover, Huber said, programs that “normalize teen sex” are unpopular with many parents.

“Most communities do not support the type of sex education they recommend,” she said.

Still, others embraced the report as bringing the AAP’s recommendations more in line with the reality.

“This is a fantastic move,” said Chitra Panjabi, the president of the Sexuality Information and Education Council of the United States (SIECUS), a research group that supports comprehensive sex education. “It’s really important that our medical providers are standing up and saying, hey, the youth in our communities are coming to us because they’re not getting the information they need. And so we need to step in.”

The US does not enforce national standards for sex education and schools in many states are not required to teach it. Across the country, SIECUS estimates, only 50% of high school students receive sex education that meets the recommendations of the federal Centers for Disease Control and Prevention. The other half of students receive anything from an incomplete sex education, to education that emphasizes abstinence, to abstinence-only education, with a focus on delaying sex until heterosexual marriage.

In February, Barack Obama proposed a budget for 2017 that eliminated the $10m the department of health and human services spends on abstinence-only programs every year. But funding continues to flow to those programs from other sources. Title V, an abstinence-only program, allocates $75m a year to abstinence-only programs, money that states match by 75%.

In the last quarter-century, programs emphasizing abstinence as the optimal way to avoid pregnancy and STIs have received more than $2bn in funding from the federal government. Comprehensive sex education, by contrast, has no dedicated federal funding stream.

“It’s a political climate where people don’t want to talk about these issues,” said Breuner. “But it makes our job so much harder when we cannot coordinate our efforts with the schools. It takes time away from the other safety issues we need to be discussing. Don’t smoke weed. Don’t text and drive.”

Recently, two major surveys of existing research on sex education concluded that there was no evidence or inconclusive evidence to show that abstinence-centric programs succeeded in delaying sexual activity. One of the surveys found that comprehensive sex education was actually more effective than abstinence education at delaying sexual activity in teens. (Ascend points to select studies which show the opposite.)

A long-term study found that teens receiving abstinence-only programs were less likely to use contraceptives or be screened for STIs, although rates of infections were not elevated.

The studies helped compel the AAP to issue its first major guidance on sex education since 2001.

“It’s important for pediatricians to have the backing to say, ‘Look, I can’t support telling this stuff to children,’” Breuner said. “I have to deal with the aftermath, which is a 15-year-old who’s pregnant, or a 16-year-old who has a sexually transmitted infection he’s going to have for the rest of his life.”

Breuner said a number of her patients have suffered consequences from abstinence-only education. Many of them are pregnant teenagers and girls who, in the absence of accurate information, came to believe in common myths about pregnancy prevention.

“They’ll say, ‘I thought you couldn’t get pregnant when you were having your period,’ or, ‘I thought it took two or three years after you get your period to be able get pregnant.’ It’s heartbreaking, because I know with education, this could have been prevented.”

Complete Article HERE!

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I am slightly paranoid about being a clean bottom

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Name: Carl
Gender: Male
Age: 45
Location: Seattle
I am a 45 year-old gay man who has not bottomed in over 15 years (which included a 10 year monogamous relationship). I am interested in doing bottoming again. However, I am worried about my cleanliness and smell. As a top, it never bothered me that much with my bottom partners, and it was rarely a problem. I never asked them if they prepared ahead of time.

I am slightly paranoid about being clean as a bottom. Should I use an enema, and if so, with what liquid? How does diet help? I am basically vegetarian, although will occasionally eat meat if it’s served to me (no pun intended). Obviously, this apprehension will not help when the time comes because I’ll likely just tighten up. I know this based on past experience.
I could go on with other details but will stop here and see about your reply.

Thanks!

Hey Carl,

Worrying about stuff is just about the best way to mess up a sexual experience of any kind. But I’m sure that you know that already, huh? This is particularly true for someone reacquainting himself with the pleasures of being a bottom.

I’ve written and spoken extensively about this very thing. I’d like to direct your attention to the CATEGORIES section in the sidebar of my site. It’s a pull-down menu. You will notice that the second category is ANAL. Under this is a whole bunch of subcategories. Click on any one of those you will be taken to all the posting I’ve made on that particular subject. Of particular interest to you would probably be my tutorial for being a good bottom: Liberating The B.O.B. Within.

In terms of douching, warm water is all you need. Never use soap. Some people add lemon juice or vinegar (1-2 Tbs per quart) of the warm water. Others dissolve (2 Tbs) of baking soda in a quart of warm water.Ergo Speed Douche

Stay away from commercially produced douches, most contain harmful and irritating chemicals. And trust me, you don’t want that. Besides, commercial douches are expensive and all that packaging is definitely not Eco-friendly. And we all want to be green sodomites, don’t we?

Finally there is always the ever-versatile shower or bath bidet option. You can find one model, the Ergo Speed Douche, in My Stockroom. Look for the Dr Dick’s Stockroom banner in the sidebar of my site.  (Everyone here at Dr Dick Sex Advice is a big fan of the Perfect Fit Brand line of adult products.)  Look for our review of the Ergo Speed Douche HERE.

I also know that a vigorous fucking will introduce more air into a bottom’s rectum expanding it and making for that “OMG, I gotta take a dump” feeling. So take it easy the first few times you get back into the saddle, so to speak, as it were.

Diet can indeed make a difference in the composition of your shit and how you and it smell. But, that being said, you have to realize your bowels are working properly when they eliminate waste from your body, so don’t try and mess with that. And just so you know, there are often some unpleasant side effects to rootin’ around in someone’s hole, regardless how fastidious the bottom is about his hygiene. So why not just relax and if there’s a little mess, clean it up with some soap and water. Its not the end of the world.

Good luck

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