There I was, a deer in the fluorescent headlights, my feet in stirrups and my undercarriage catching the freshly methylated breeze of the clinic. I had finally gone to the doctor to address a discomfort I had in my “down there” area. (I had not yet made friends with Ms. J, my bujaina. I called her “down there”, “underneath”, or when I was feeling especially cold towards her, “anus”). I had spoken to my mother about this growing discomfort underneath and she had said it might be a heamorrhoid because “you sit down a lot” – I was a student at the time and sitting down was, indeed, one of my main responsibilities. I went to the clinic to get help.
After hushed explanations to the receptionist and a few minutes of sitting down and trying to touch absolutely nothing in the waiting area, my name was called and I consulted with a nurse. She asked me to take my pants off, sit at the edge of the table and put my feet in stirrups. (I had never done it that way before, but I went with it). There were a few minutes of silent and awkward prodding and wincing. Having found no malady after rudely poking at Ms. J, she opened the door, stepped out and called in a doctor to confirm that my case was confusing.
The doctor turned out to be one I did not particularly trust. On a previous occasion, he had awkwardly taken my sexual history without making eye-contact or introducing himself. He asked me a series of strange questions including “are you an MSM?” When I asked for my medical records (curious to see what sense he could have possibly made of the inane questions and reluctant answers), he asked me if it was perhaps because I was worried about what was going on against the gay community in Kenya. We were in the US, and nothing alarming was happening in Kenya as far as I knew. He explained that the records were confidential, except if an unknown suite in my insurance company wanted to see them. I explained how far South Africa (my home country) is from Kenya, punctuating my words with severely disparaging looks.
He walked in, asked the nurse some questions, and decided that I needed to see a specialist. They Googled for one on the computer inside the consultation room. In their eagerness, they had forgotten to allow me to veil Ms. J again while calling for reinforcements and Googling for help. So I remained spread-eagled on the table in a sea of fluorescent light. It was decidedly unpornographic. Ms. J saw more action in that hour than she had in the preceding 6 months. That thought made me sad.
Nurse and Doctor Stirrups referred me to a specialist in another part of town. I was not sure exactly his specialization – I was too busy being shocked by how much money someone was going to pay for my visit (fortunately, I had health insurance). After patiently waiting for my name to come up, I was led into his office. I took a surreptitious picture of a book lying on his cluttered desk: “The Ins and Outs of Gay Sex – A Medical Handbook for Men.” He finally came in and shook my hand, a kind faced 50-something year old whose heaviness gave the reassurance of a paper weight against the wind. He sat on the other side of his desk and I explained why I was there.
Dr: When was the last time you had sex?
Dr (*laughs): On the way here?
K (*mock outrage): “Excuse me! …Uhmm, a few months ago.”
Dr: “Did you top? Did you bottom?”
Dr: “When you bottomed, did you have any pain?”
K: “Only at first.”
Dr: “Any bleeding?”
He directed me to his table where he left me behind a screen to take off my pants so that he could come back and inspect my junk. Thankfully, there were no stirrups this time. He asked some banal questions while checking the outside and inside of Ms. J., making sure to announce everything he was going to do before doing it: “Where are you from?”, “Where is your family now?”, “I am about to insert a finger”, “What are you studying?”… I had never thought about my family while Ms. J was being visited. It was weird and unsettling, but I knew that he was trying to put me at ease, and I really appreciated that. He showed me some paper towels to use for cleanup and invited me back to his desk when I was ready. At his desk, this doctor (who I had just decided to name my Butt-Doctor) told me what he was screening for, and he told me ways to manage my discomfort while we wait for the results.
In organizing a series of webinars on Anal Health for the MSMGF, I have been reflecting on these contrasting experiences with healthcare providers, which both took place in very well-resourced settings, and neither of which were homophobic in the slightest. Even though Nurse and Doctor Stirrups may not have intended to have this effect, their ill-informed exploration of Ms. J and their lack of concern for my privacy were jarring. The environment they created was not conducive to an open exchange of information that would help us figure out what was happening with my body. Having already felt an ineptitude around the discussion of sex, I would not choose to go to Nurse and Doctor Stirrups if I had STI symptoms. Because I had that negative experience with them, I would be reluctant to go there even with flu symptoms.
My Butt-Doctor, on the other hand, not only made me feel comfortable enough to talk about my sex life in some detail, he had the skills and knowledge to investigate my problem and explain what he was doing and why he was doing it. His office felt safe from the moment I walked in. Seeing the book on his desk made me think that he knew what he was doing even before I started speaking with him. He was respectful of my body and of the way I have sex. After our consult, I felt like it would be almost as easy to tell him if I had warts on my dick as it would be to tell him if I had a persistent headache.
The aim of the MSMGF webinar series on Anal Health is to equip members of our global network of lay and professional healthcare workers with a certain level of knowledge, skills, and language to deliver the care that their clients deserve. This entails not only being non-judgmental about the ways that patients live their lives, but being skilled to deliver needed care and being understanding of the fullness of their sexual lives. It means that anal sex cannot only be conceived of in terms of the risk it poses for HIV and STI transmission; it must be understood as an expression, as a pleasure, as a source of confidence or insecurity, as a source of shame or pride. Anal sex has to be understood in the multiple and complicated ways that other kinds of sex are.
We attempt to expand the way that anal sex is discussed (in the field of public health, it is often discussed as a “problem” in and of itself), by beginning with the radical assumption that anal sex causes, first and foremost, pleasure. And pleasure is a good thing. The ways in which we seek and enjoy pleasure are related, both as cause and consequence, to numerous areas of concern to public health, including mental health, drug use, HIV, and other STIs. We do not all, however, go around with the sole objective of vanquishing HIV; we go around living and loving, playing, fucking, and licking, because it feels good. And because it is good to feel good.
We open the series today with a presentation on the physiology of anal sex and how it relates to pleasure. We hope that there will be much discussion in the question and answer session immediately following the presentation, and we have opened up the MSMGF Blog to continue the discussion online. Today’s presenter, Bryan Kutner, has kindly agreed to respond to comments and questions in this Blog space that were not raised during the webinar. Please feel free to engage on this topic below, and keep an eye out for forthcoming webinars in the series.
Keletso Makofane is a South African Fulbright Scholar and a graduate of the Columbia University Mailman School of Public Health. The first webinar in the MSMGF’s series on Anal Health took place today, January 21st, at 7AM PST - a recording of the webinar is available here. An interactive discussion with the presenter will take place here MSMGF Blog during and after the webinar.