Let's Talk About "Butt Stuff"

On Identity and Rectal Screening in MSM 

I mean if folx are asking about the ass and no one is willing to talk about it, then imagine the needs of those who do not talk about "butt stuff"...For example, those who engage is sexual practices like anal receptive sex but do not identify or do not disclosure their identity as gay, bi, or MSM. They are unlikely to talk about their asses in a clinical setting, and therefore unlikely to be offered prevention or treatment. 

A recent STI treatment experience once again reinforced the need to call attention to the lack of discussion about "butt stuff" among men who have sex with men (MSM), notwithstanding their identities. There is little focus on the needs of sexual minorities and the health issues associated with particular practices and sexual identities are even less established among relevant stakeholders; and for me, as a Bottom, I am particular bothered by the lack of care I receive from medical professionals in a variety of settings regarding my butt. Be it STI tests or preventive exams, there is little discussion about the butt, even when I am forthright about my sexual identity and practices involving my butt; it is seemingly ignored as an area of concern. There was a time where I went as far as asking for an anal pap. to test for cancer, after reading an article in Poz magazine about the prevalence of anal cancer in MSM with HIV; I thought it was readily needed, but the doctor didn't seem to agree. She responded that an anal exam of this kind was difficult to perform and unlikely to produce trustworthy results. Oh, and this was after she used her phone to Google the procedure, pulling up a video on YouTube about it. Needless to say, I have not thought about my butt in a medical way since this experience over two years ago, but then another health event came up and now I am curious again, for myself and others, about the relationship between culture health and sexuality in the specific context of access to anal screenings for STIs. 

I tested positive for STIs over a month ago, according to diagnostic screenings used in the clinical context at a local LGBT center; a self-administered rectal swab, urine sample, and throat swab performed by the nurse, were used in the examination, but I was not told which of these methods resulted in a positive outcome. Nonetheless, I was treated on-site and sent on my way that day. The next few days marked the relief from symptoms since treatment, and I assumed all was well with the situation; so, I put it out of my mind. An onslaught of symptoms manifested several weeks later, etiologically similar but more severe than before; but because of the knowledge that I was "cured" from treatment of previous STI, I had no reason to suspect this experience was associated with that one. Thus, I imagined a slew of sickness that could explain the symptoms I had, all of which were dealing with my butt. It wasn't until I read this article that I went to Urgent Care for treatment of STI. There I received more treatment, this time a shot and prescription for 7 days of antibiotics; whereas the clinic only offered me the shot. Again, the symptoms were gone in a few days, just in time for the Doctor at Urgent Care to phone me about the results of my STI screening at their office. Of course, she had the history of the event in mind as part of my intake. She proceeded to tell me that I tested negative for both gonorrhea and chlamydia from the urine sample screening. In this case, I rejected the rectal swab and exam because I already knew the situation; and the Doctor made a point to mention that it is common for folx to only use the urine sample diagnostics to determine STI incidence despite the fact that the rectal exam is more accurate and likely to result in more positive clinical outcomes. Considering this story, the article linked above, and the supporting words of Urgent Care Doctor, there is a lot to unpack about the impacts of this experience on the wider epidemiology of STIs; namely, the topicality of identity and disruptive innovation in the specific context of access to different diagnostic screen methods for clinical and non-clinical settings. 

The lack of sexual behavior disclosure may distort STI testing outcomes 

Link to Article in Question

Abstract

Background

Men who have sex with men (MSM) globally have a high burden of curable sexually transmitted infections (STIs). MSM do not frequently receive rectal STI testing because of several barriers, such as not being out (disclosure of sexual behavior). We evaluate whether Chinese MSM select an STI test (rectal vs urethral) appropriate for their sexual behavior (insertive and/or receptive), and the interactions with being out.

Methods

This was a secondary analysis of data from a cross sectional MSM survey conducted at a multisite randomized controlled trial (RCT) (December 2018 to January 2019) around uptake of gonorrhea and chlamydia testing among Chinese MSM (N = 431). We collected socio demographics, relevant medical and sexual history, and disclosure of sexual behavior (outness). We estimated the decision to test and test choice, and the extent to which disclosure plays a role in decision making.

Results

Among 431 MSM, mean age was 28 years (SD = 7.10) and 65% were out to someone. MSM who indicated versatile sexual behavior and were out to someone had a 26.8% (95%CI = 6.1, 47.5) increased likelihood for selecting the rectal test vs the ure thral test, compared to those versatile and not out. Versatile MSM out to their health provider outside of the study context had a 29.4% (95%CI = 6.3, 52.6) greater likelihood for selecting the rectal STI test vs the urethral test, compared to versatile MSM not out to their health provider.

Conclusions

Sexual behavior and outness may affect gonorrhea and chlamydia testing provision. Apart from clinicians, community based efforts may reduce stigma based barriers to testing.

Keywords: MSM, Sexual health, Sexual behavior disclosure, China