Top Five Questions Every Gay Man Should Be Asking His Doctor but Isn’t

Gay, straight, bi, or trans, men of all sexual preferences sometimes feel embarrassed talking to their doctors about sex. Unless their physician directly addresses the issue, some men may avoid it, even when a serious problem may be present.

Here are five key issues that gay men in particular should be talking about with their doctors.

1. I’m considering taking an oral erectile dysfunction medication. How will that medication interact with others drugs I’m taking?

Before taking any of the oral erectile dysfunction drugs (such as Viagra), you should consult your doctor and discuss any potential complications with other medications you’re taking.

Unfortunately, use of erectile dysfunction drugs in the gay community is often associated with the abuse of narcotics, especially at sex parties that include the use of crystal methamphetamine, cocaine, ecstasy, or ketamine. The combination of these drugs can and does result in serious cardiac or neurological problems, or both, and is also associated with the spread of sexually transmitted diseases, including HIV and AIDS.

Men taking medication for HIV infections not only are more likely to suffer from erectile dysfunction but also are much more sensitive to the effects of the oral medication. Certain protease inhibitors, the mainstay of treatment for HIV-positive patients, can markedly increase the blood concentration of oral erectile dysfunction drugs and may result in the magnification of both the effectiveness of these drugs and their potential side effects. Therefore, in HIV patients taking these drugs, the smallest possible dose of the PDE5 inhibitors must be used to achieve adequate performance levels and safety margins that are acceptable.

2. As a gay man, do I need to worry about HPV?

Human papilloma virus (HPV) is the most common sexually transmitted virus in the United States. About seventy-nine million people in the country are currently infected, and about fourteen million more get infected each year.

Evidence is mounting that HPV can cause cervical, vaginal, and vulvar cancer in women. Presently, an FDA-approved vaccine called Gardasil is recommended for females between the ages of eleven or twelve and twenty-six. While Gardasil has predominantly been promoted as an important vaccine for females, the vaccine has benefits for males as well.

In the gay community, HPV has been associated with anal cancer. It is incumbent upon any responsible man to be treated promptly and make his partner aware of his condition should he acquire HPV.

3. If my partner has passed an AIDS test, is it all right for us to have unprotected sex?

Knowing that your partner has passed an AIDS test is not always enough, as the virus can be transmitted before it shows up in a test. When in doubt, you should heed the usual advice about using condoms or avoiding intercourse. Condoms may cramp your style, and, yes, sex feels a lot better without them. But your life is at stake. You can love sex even with latex. You can still exercise your sexual power to your heart’s content. You just have to do it with discernment, caution, and care.

All studies indicate that a primary mode of transmission of HIV/AIDS is through anal sex. The anus is particularly vulnerable to tears in the delicate tissue membrane, which expose the perianal blood vessels as a port of entry for the deadly retrovirus.

Remember that the entire template of a partner’s prior sexual experience will be permanently tattooed upon you. Those cultures or subcultures that encourage multiple sexual partners greatly facilitate the spread of HIV. The connection between AIDS and anal sex has classically been implicated as the primary route of spread (excluding contaminated needles and blood products). Fellatio by itself can transmit HIV, though the risk is much lower. The deadly virus can, in fact, find its way into your bloodstream through any minor break or crack, either in your skin or in the mucous membranes lining any body cavity.

Since there is no cure, extreme caution in both your choice of sexual partners and your sexual menu becomes your only defense.

4. Is everything normal down there?

Though all men wonder at some point about whether their anatomy is normal in size, shape, or functionality, they don’t always feel comfortable telling their doctor that. Some men may even invent an imaginary friend with a sexual disorder to indirectly express their concerns.  Usually, the conversation starts with some equivalent of the phrase “Doc, my friend has this problem.” Now, we both know who this “friend” really is.

You don’t need to hide your questions behind a fake friend. If you find yourself wondering, “What’s wrong with it?” or “Why can’t it be bigger and harder?” know that, more than likely, your apparatus is perfectly normal. But if you do have concerns, see a qualified urologist, and don’t be afraid to get personal and ask questions.

When a male patient comes into my office and reluctantly admits that he is having problems, I first try to make him feel comfortable and safe so that we can speak openly and honestly about his situation, and any good urologist will do the same.

5. Should I have a PSA?

One issue that is blind to sexual orientation is prostate cancer. Prostate cancer is one of the most serious health problems in the global community. An estimated 174,650 cases were detected in 2019 in the United States alone.

The best way to beat prostate cancer is with an early diagnosis, and the key to early diagnosis is a yearly digital rectal examination by a qualified examiner, a PSA (prostate-specific antigen) blood test, and an ultrasonic-guided prostate biopsy, if needed.

The PSA blood test is the male equivalent of the Pap smear and mammogram in women. This is a routine, painless way to potentially detect cancer in time to treat it effectively. Men over forty should discuss their medical and family history with their doctor to determine whether a yearly PSA screening is right for them. Published data has shown that screening using the PSA doubles the detection rate of early prostate cancer compared to a standard, digital rectal examination alone.

Though bringing up cancer can feel scary, asking for a PSA screening is one of the best ways you can protect yourself from the threat of prostate cancer.

If any of the above questions—or any others—have been on your mind, don’t wait for your doctor to bring them up. By asking the right questions, you can take charge of your sexual health.

Dudley Seth Danoff, MD, FACS, is president and founder of the Cedars-Sinai Medical Center Tower Urology Group in Los Angeles, a Diplomate of the American Board of Urology, a Fellow of the American College of Surgeons, and author of The Ultimate Guide to Male Sexual Health.