Bryan Kutner is telling me how he got into studying butt<\/a> stuff over coffee. <\/p>\n \u201cSo,\u201d Kutner says, \u201cI was counseling cisgender men<\/a> and trans<\/a> folks in public sex<\/a> venues \u2014 bathhouses basically \u2014 for an HIV\/STI prevention project, and people would often share intimate details about their sex<\/a> lives.\u201d <\/p>\n One night, a guy<\/a> in his 50s commented, offhandedly, that bleeding after anal sex<\/a> was normal. This was the second guy<\/a> of the same age saying the same thing, and it baffled the public health worker. How could gay<\/a> men<\/a> in their 50s, he wondered, who\u2019ve been sexually active for 30 plus years, not know that bleeding is unnecessary. \u201cI thought, \u2018Wait a second. If bleeding is regular for these guys<\/a> then a medical provider needs to conduct an anal exam, to find and treat whatever is causing the bleeding.\u2019\u201d\u00a0 <\/p>\n It struck Kutner that we\u2019ve done a somewhat fair job of educating people about HIV. But could it be, he wondered, that that same public health effort inadvertently reinforced the notion that anal sex<\/a> is inherently harmful? Could we be conflating anal sex<\/a> with disease in such a way that we\u2019ve trained people to expect and accept other sexual health problems, like bleeding or pain, that are preventable? \u201cIt\u2019s almost like our HIV prevention campaigns have colluded with a taboo about anal sex<\/a>. Maybe that\u2019s inadvertent, like a natural consequence of repeated public health messaging, \u2018Hey, think about HIV when you have anal sex<\/a>.\u2019 But, in other cases, that conflation of anal sex<\/a> with harm is conspicuously informed by stigma toward anal sex<\/a>. Remember that \u2018It\u2019s Never Just HIV\u2019<\/a>campaign?\u201d<\/p>\n While Kutner pondered the ramifications of these bathhouse conversations, he received a call<\/a> from a friend as she walked down 8th Avenue after a gynecological visit. \u201cShe was in tears. She\u2019d been in the stirrups and the doctor was nearly done with the exam and my friend asked, \u201cWould you check a little lower? I think I felt a bump or something.\u201d <\/p>\n The doctor did look a little lower and saw a wart somewhere near her anus. The doctor\u2019s response was accusatory, \u201cAre you having anal sex<\/a>? You shouldn\u2019t be doing that. It\u2019s dangerous.\u201d<\/p>\n The doctor then froze the wart, one of a few options \u2014 and certainly a painful one given the location. \u201cIt struck me that my friend did the very thing we encourage people to do: \u2018When you have a medical question, ask your doctor,\u2019 right? But that resulted in a slap on her hand and an all-or-nothing message that she shouldn\u2019t be having anal sex<\/a>. It\u2019s the opposite of harm reduction. Just telling someone not to do something, expecting somehow that a warning alone is going to scare people into changing behavior. Well, my friend never saw that doctor again and it disrupted the continuity of her health care to boot. But she didn\u2019t stop having anal sex<\/a>. She just stopped talking about it with her doctor.\u201d<\/p>\n These two experiences got Kutner thinking that people, in general, may need basic information about anal health so they can advocate for themselves, and that providers specifically may need skills to broach this topic with their clients, to encourage disclosure by framing anal sexuality in terms of pleasure and health, rather than just harm. <\/p>\n Kutner had been a public health trainer in the harm reduction movement for several years, so he developed a new training curriculum and piloted it through the Harm Reduction Coalition. The training on physiology and health went so well that he added another day focused on how to communicate information. \u201cI based the training in motivational interviewing, one of the better researched interventions when it comes to helping me consider behavior change. With the help of all these public health workers who\u2019ve attended, we now have little mantras that embrace the diversity of people who have anal sex<\/a>. Like, \u2018Everyone has an ass<\/a>, so everyone has the capacity to enjoy anal sex<\/a>.\u2019 It\u2019s really beautiful the way people frame this not in terms of gender, but in terms of the diversity of human sexuality, in a sex<\/a>-positive way.\u201d<\/p>\n Kutner, eventually decided it was time to get more training himself, so went back to school, first for an MPH in epidemiology and then a PhD in clinical psychology. He says he landed on this topic for my dissertation, thinking it might be useful to understand more clearly the possible relationships between devaluation of anal sexuality, the concerns and questions people harbor, and how this might affect our HIV prevention efforts. <\/p>\n \u201cIn some ways, at least for queer men<\/a>, we\u2019ve placed anal sex<\/a> at the center of the HIV epidemic, but we know so little about how people think and feel about it, outside of the focus on HIV.\u201d<\/p>\n As he prepared to train others, to his surprise, Kutner found there was so much to learn and convey in trainings. \u201cIf you gently stroke the top of your hand with your finger, see what sensations you notice,\u201d he says, \u201cNow flip your hand over and gently stroke your palm. You naturally feel a difference.\u201d <\/p>\n That Kutner says is an easy way to communicate the sensitivity of the anus, the opening before the anal canal. \u201cIt\u2019s a part of the body with lots of nerve endings packed into a small area. That may be a hard concept to communicate as a health worker, but it\u2019s a little easier with visuals and little tricks of the trade people share in trainings.\u201d<\/p>\n There\u2019s also the prostate, \u201cContractions around the prostate produce a sensation of orgasm, and typically these contractions contribute to ejaculation. But pressure internally from a toy, object, penis<\/a>, or hand, or pressure externally against the perineum \u2014 aka the \u2018taint\u2019\u2014 can also produce this orgasmic sensation, even without ejaculation.\u201d <\/p>\n He adds,\u00a0 \u201cPelvic floor muscle exercises, like Kegel exercises, may also aid discovering this sensation, by building the ability to stay in the plateau phase of the sexual response cycle, riding the rise of orgasm without ejaculating \u2014 basically a multiorgasmic experience. It\u2019s the p-spot in \u2018male<\/a>\u2019 anatomy, akin to the g-spot in people with \u2018female<\/a>\u2019 anatomy.\u201d Kutner recommends a few books on the subject\u00a0Multiorgasmic Man<\/em>\u00a0and another\u00a0The Ultimate Guide to Prostate Pleasure.<\/em>\u201d <\/p>\n And then of course, there\u2019s\u00a0\u00a0Anal Pleasure and Health\u00a0<\/em><\/a>by Jack Morin which is a go to source because it\u2019s so comprehensive.\u201d<\/p>\n Kutner continues, \u201cWhen I first started, people thought the training was all about men<\/a>\u2019s anal sexuality. But at a population level, there aren\u2019t that many men<\/a> who have sex<\/a> with men<\/a>, maybe 2-4 percent. Women make up a much bigger part of the world\u2019s population, so if even a minority of women<\/a> are having anal sex<\/a>, it\u2019s likely to outnumber men<\/a> who have anal sex<\/a> with other men<\/a>. This is a woman<\/a>\u2019s health issue too \u2013 or, really more to the point, a health issue that isn\u2019t about gender binaries but about the diversity of how human beings have sex<\/a>.\u201d <\/p>\n At first, Kutner struggled to find accurate, science-based information about anal sexuality beyond men<\/a>\u2019s sexuality. \u201cThere was very little written about physiological sources of anal pleasure in relation to the clitoris. I kept searching online and one day in 2009 found an\u00a0obscure blog post<\/a>and\u00a0YouTube video\u00a0<\/a>from the Museum of Sex. I didn\u2019t know the clitoris had legs \u2014 and,\u00a0apparently, we didn\u2019t discover that until 2009!\u201d There\u2019s a lot more information out there than there used to be. \u201cStill, there\u2019s very little I\u2019ve seen about lesbian<\/a> and transgender anal sexuality \u2013 they\u2019re both a very neglected area of research, I think. Most of what I\u2019ve found, in general, is from a cisgender perspective, and mostly about penetration, which is just one aspect of sexual activity.\u201d<\/p>\n On that note, Kutner shares some more of what surprised him as he learned more. The legs of the clitoris extend into the pelvic floor musculature and seem in part to be responsible for pleasure and possibly orgasm through anal stimulation, even when the visible clitoris is not directly stimulated.\u201d Kutner notes, \u201cThe clitoris has legs and bulbs that extend deeper into the body than just the visible part under the hood.\u201d<\/p>\n Kutner recounts how a trans<\/a> man<\/a> once described how hormone therapy enhanced his experience of anal sex<\/a>, bestowing him with a sensation that he remarked, wassimilar to the way\u00a0 cisgender men<\/a> describe satsifcation from prostate stimulation.<\/p>\n \u201cThere\u2019s so much to learn,\u201d Kutner says seriously as this is generally an understudied area of sex<\/a> research. \u201cI\u2019m not exactly a sex<\/a> researcher myself \u2014 as in I\u2019m researching sociobehavioral phenomenon but not conducting direct experimental or observation studies of physiology and sexual response. This is all just stuff I\u2019ve picked up by reading and talking with health providers and educators.\u201d<\/p>\n Kutner\u2019s been surprised by a lot since embarking on this field of study. Since early 2016, he\u2019s been conducting his dissertation, a mixed-methods study on anal pleasure and health. \u201cOne thing I\u2019d never considered is just how the omission of basic information about anal sexuality can affect people,\u201d he says, \u201cI interviewed cisgender guys<\/a> as a lead up to developing quantitative measures for the online survey.\u201d <\/p>\n Guys asked him questions he\u2019d never considered, \u201clike whether someone can ejaculate directly from the ass<\/a> \u2014 as in literally cum or ejaculate sexual fluid from the ass<\/a>.\u201d Kutner knows that\u2019s not happening from an internal physiological process, \u201cas far as I can tell: it\u2019s lube, precum or semen from someone\u2019s penis<\/a>, not from the rectum.\u201d\u00a0 <\/p>\n But that\u2019s not what his study participants said. <\/p>\n \u201cThey encouraged me to look online for \u201ccreaming\u201d videos<\/a> because it\u2019s a thing.\u201d He laughs at his own naivete, \u201cI didn\u2019t know it was a thing AT ALL. And that\u2019s amazing in itself. Here we are, 35 years into an epidemic spread in large part through anal sex<\/a>, and people still haven\u2019t been given accurate, specific responses to their questions about anal sex<\/a>. And, at least in my case, I didn\u2019t even know some of the questions they had!\u201d <\/p>\n If there\u2019s shame in learning any of this, Kutner believes it lies, \u201cin our neglect of such an obvious area of study.\u201d<\/p>\n Another preliminary finding from the qualitative interviews Kutner found, is just how woven together experiences of devaluation are. \u201cIt\u2019s not just that people stigmatize anal sexuality, all on its own. It\u2019s racism, xenophobia, sexism, and other forms of human devaluation intersecting with people\u2019s experiences of anal sex<\/a>.\u201d <\/p>\n This in and of itself did not surprise Kutner, but, people shared quite painful experiences. Kutner pauses, \u201cSome of these guys<\/a> grew up thinking all gay<\/a> men<\/a> were supposed to enjoy anal sex<\/a>, so syllogistically as they came of age desiring other men<\/a> they thought they should bottom even if they didn\u2019t like it, even if it was painful and not pleasurable.\u201d <\/p>\n It didn\u2019t occur to them that they could decline anal sex<\/a>. They also didn\u2019t know how they could learn how to find pleasure in it. Which to Kutner, \u201cSounds awfully similar to women<\/a>\u2019s sexual experiences catering to men<\/a>\u2019s desires rather than holistically to their own desires too.\u201d<\/p>\n Kutner was also struck by how, at least for the men<\/a> he interviewed, anal sex<\/a> is intimately associated with experiences of racism and sexism. For example, one black man<\/a> shared that even though a white sex<\/a> partner would never consider himself to be racist, once in bed it became quickly apparent that his fantasies about anal sex<\/a> were indeed\u00a0racialized \u2014 and in ways that were not mutually pleasurable. Men of color, in particular, experienced being objectified by their race in ways that seemed to potentiate a partner\u2019s pleasure even while it inhibited their own pleasure and, at times, lead to physical and psychological discomfort. Kutner says, \u201cIt\u2019s a strange paradox that anal sex<\/a> is obviously pleasurable to many people, but how it\u2019s practiced is still mediated by social processes that make it less enjoyable and, at times, appear to increase psychological and physiologicalharm \u2014 and that appears to be experienced by men<\/a> of color in very different ways than white men<\/a>.\u201d<\/p>\n Even with these painful experiences shared in research interviews, for the most part the people he\u2019s surveyed are interested in hearing more about the positive aspects of anal pleasure. \u201cThey\u2019re hungry to have their questions answered, and to hear more directly about anal sex<\/a>.\u201d <\/p>\n That is what Kutner hopes to finally understand upon completing his dissertation, how to leverage these interests in anal sex<\/a> to promote more engagement in HIV services. \u201cThat\u2019s one of the problems we have with the epidemic in the U.S. We have all these interventions\u00a0 \u00a0available \u2014 ARVs, PrEP, PEP, behavioral interventions \u2014 but can we find new ways to engage people?\u201d<\/p>\n Bryan Kutner has worked in public health for over 15 years, first helping to launch the Harm Reduction Coalition\u2019s Oakland training calendar, then offering case management services for people living in supportive housing. In 2001, he began training for the University of California San Francisco AIDS Health Project, traveling throughout the state to facilitate workshops for HIV service providers and to collaborate with the California Department of Public Health on policies and procedures related to HIV counseling and testing. Bryan continues to consult with a handful of domestic and global NGOs to develop training programs for mental health, supportive housing, sexual health, and HIV prevention projects. He earned an MPH in Epidemiology from Columbia University, is nearing completion of a PhD in Clinical Psychology from the University of Washington, and is a member of the Motivational Interviewing Network of Trainers, a group dedicated to the dissemination and implementation of evidence-based practice. <\/em><\/p>\n This story originally appeared on HIVPlus dot com<\/a>.<\/a><\/em> Reprinted by permission of the author<\/a>.<\/a><\/em><\/p>\n The post Everything You Think You Know About Butts Is Wrong<\/a> appeared first on Towleroad Gay News<\/a>.<\/p>\n