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Portland, oregon. Jamie scott, rn, ran into a patient at ryan white's clinic where she operates in richmond, va. When he mentioned that he "drenched" before sex.
The word stopped her, but scott kept moving. Her hiv training taught her something you can't even blink an eye,” when patients say nuances that surprise you. But she needed to know more.
"I asked, "are you using a summer's eve type product or are you using a fleet [enema]?" She said. "I just posted it. If they dare to tell me , then i dare to ask.”
According to data presented at the nurses association at the aids care 2019 conference, half of black gay and bisexual men in the south used an enema—or “rectal douche,” as the community calls it, — although it's not clear what they use in the shower.
For men who are receptive partners, it's even more common, and so despite the conventional wisdom about which one should not continuously use enemas, unless there is a neurological disease such as multiple sclerosis or spinal cord injury that warrants it.
Evidence also suggests that enemas, along with other sexual hygiene practices, can increase the risk of hiv transmission and other sexually transmitted infections (and ppp). But there are formulations that are the most proven, and drug research continues.
Increased risk of hiv and stis
This is where healthcare professionals come in, says derek dangerfield , phd, from the johns hopkins school of nursing in baltimore. They will help men who are going to douche anyway, to do it in a way that is less damaging to the microbiome and the fragile rectal mucosa.
"A lot of guys learn to do it alone. Or they learn through pornography," said dangerfield: "what users need are strategies to reduce the damage to this phenomenon."
Most clinicians see the rectum as just another side of the colorectal system, but for certain patients it's much more, he said. Jonathan baker, pa-c, from the laser surgery center in new york.
"Over 30% of the population considers anus and rectum to be pussies. One applies to my community as well," said baker , who is gay, citing the results of the survey.
Baker, known by his @rectalrockstar handle on instagram, refers to his patients because the gynecologist will be able to meet comprehensive sexual health. , Pass anal second pap smear for high-risk human papillomavirus (hpv), gonorrhea, and chlamydia. He explained that hpv testing is especially invaluable to the health of people living with hiv, as the incidence of hpv-related anal cancer is elevated in this population, he explained.
Furthermore, baker said he advises your pets on how to take care of the delicate rectal mucosa, which consists of only one layer of cells, and not like the vaginal mucosa, which consists of several layers.
"It's a fragile mucosa, and with it, this material is easily damaged," he said. "It's probably damaged by more things than we even realize."
The rectum really has its own line of defense, and a visitor only needs to look through a microscope to see the service, craig hendrix said. , Md, of the johns hopkins school of medicine in baltimore.
There you'll find a "lush and rich" lining, a row of protective epithelial cells that also make a protective mucin, said hendrix, who studies pharmacokinetics in developing formulations and is currently thinking about medicated douching to protect against hiv transmission.
The key is to keep that protective sheath in place. Some formulations do this, one of which is the normosol-r electrolyte and water injection that hendrix's team used to test the safety of douching.
But many agents used as enemas or anal douches, including one of the popular, no. And with a pad only one layer thick, there is almost no room for error.
For example, the process of injecting hyperosmolar water into the rectum means that fluid is pushed through the membrane more easily and quickly. And the lush epithelial layer “literally disappears,” hendrix notes. "All the epithelial cells are gone and the mucin is gone."
The first step to sexual health is to protect that epithelial layer and the mucin, he explained.
Patients and healthcare providers usually don't know how to do this, baker said. And this will lead to layers of risk when patients, unaware of the effects of hyperosmolar drugs, impose one on another.
Take lubricants, for example. Lubricants can reduce friction during sex, preventing tears that can lead to the transmission of hiv and stis. The latest evidence suggests that they further reduce the risk of slipping and breaking condoms.
But many lubricants, some of which include ky jelly, astroglide, and wet original, are themselves hyperosmolar, as is spermicide nonoxynol-9, according to a 2007 study in which hendrix participated. That hyperosmolar lubricants "bare" the cell wall.
However, according to one small study, isoosmolar lubricants exist, in particular good clean love and pré.
now add to enema equation and rectal douching.
Like lubricants, not a complete list of enema benefits are the same. And researchers don't really know what patients mean when they say "douche," dangerfield said. Reporting on the types of douches they knew their patients were using, including commercially available sodium phosphate enemas similar to those sold under the brand name fleet; homemade tonics made from water or "soap" and slurs and available devices that attach to the heart and fill the rectum with water.
There are also other feminine hygiene products, one of which is summer's eve containing vinegar, says maureen scahill, np, rn. , From the university of rochester in new york. “I have never had people who would tell me that they actually use them, but this question is worth studying.”
And this is silent about laxatives, suppositories and exploitation of a dozen once. Time," baker added.
"I've heard from all sorts of behaviors - from laxatives to imodium, suppositories, enemas, showerheads and high-end heated bidets - although i fully support bidets," said he. "People sometimes add them, like lemon juice or vinegar, which are called acidic and can lead to even more damage to the mucous membranes." Have been associated with intestinal electrolyte dysregulation, hyperphosphatemia, severe metabolic disorders, kidney damage, and even death. These types of hyperosmolar drugs are also harmful to the rectal mucosa in a douche-like manner as they are in the form of a lubricant.
It is therefore not surprising that rectal douching is associated with an increased risk of hiv transmission. And the acquisition of stis such as chlamydia and gonorrhea. One study found that users who used enemas once a week were 3 to 5 times more likely to already have a rectal infection than those who never ignored enemas (odds ratio [or], 3.57; p = 0.001), and almost four times more. Likelihood of contracting a rectal infection during the study (or 3.87; p = 0.001).
In each case, repeated cleaning of the rectal cavity increases inflammation, may interfere with vitamin absorption, and is associated with an increased risk of hiv infection (or, 2.8) and stis (or, 2.5).
This is where dangerfield, a trained sociologist, comes into play. Transparent: we understand the importance of delicacy and non-disclosure of details in biology; i wonder who they are.”
So dangerfield partnered with demark hickson, ph.D. Principal investigator of the environmental study of sexual behavior and hiv/stis among african-american men who have sex with men in the southeast usa (mari study), in order to find out who these particular gay and bisexual men are and how they use the anal douche. Ing.
While studies have shown that up to 88% of gay and bisexual men have taken anal showers, and what a beneficial thing up to 64% are now doing, there is little information about black gay men and black women -transgender people are in the deep south, the people dangerfield is interested in.
Sex, sexuality and stigma
"Overall research most whites sample or are conducted in a european context "- he said. But we all know that black guys who have sex with men are disproportionately affected by hiv. And what a useful thing it is, more than half of trans women living with hiv are black."
Hickson found that in a cohort of 386 black participants (5.5% of whom were transgender girls from jackson, mississippi and atlanta, 52.9% had used a rectal douche at some time: 30.8% for at least six years, and 28.3% from three up to 5 times.For his part, dangerfield asked all sorts of demographic questions: age, recent history of stis, hiv status, income, education level, number of sexual partners, and condom use.
When he analyzed this information for the lack of associations with douching, there were none. The only thing that influenced the likelihood of douching was the role that the internet visitor played during sex. In the parlance of the gay community, being "universal" or "bottom" while fucking means sometimes or always being a receptive partner during sex, and being "top" means always being a compulsive partner.
People, who said the models were versatile were 2.46 times more likely to use rectal douche than men who identified as the best. The lower ones were 2.36 times more likely to seek rectal douching than the upper ones. Has a 50-50 chance of acquiring hiv.There are structural reasons for qualified hiv among black americans, such as lack of insurance, unfair use of pre-exposure prophylaxis for hiv, and available rates of viral suppression.
Then add that they're inferior or universal.
Then add the re-discoveries that show that gay blacks are more likely to use condoms than their white counterparts, and a lack of rectal mucus. Such a move would be due to sex without enough lubrication or using the wrong lube.
And then throw in the wrong rectal douche and you'll be provided with a fertile environment that hiv is ready to exploit.
+>"This is the most elegant and useful question," he said. “This risk behavior occurs in people who may be in the high-risk community. And this creates a complex high risk factor for stis and hiv.”
The point is not to cause alarm. Or tell men they can't shower or tire themselves out with anal sex; "it wouldn't be a cultural response," dangerfield said. And that probably won't work.
Culturally sensitive care
Dangerfield's study of men who reported douching found that among the reasons why the cartoons that did were the following: they were asked by a partner and that they say it can increase joy and that douching after sex can prevent the transmission of stis.
More than that, baker had patients who were blacklisted. Out of their little sex nets for having an accident during sex.
"It can become very stigmatizing," he explained. "".
In baker's office, he begins an erotic plot with all this in mind. He asks about sexual positions, the use of lubrication and the shower. When his patients present the opinion that these drugs are "preparing for porn", he asks them how, according to the indicated words.
Although he is willing to tell them that rectal douching is especially often not worth it, he takes the conversation as a learning moment.He recommends not using fleet's enemas as well , instead offers simple water enemas using a syringe with a bulb or an empty fleet enema bag.
If the patient uses the shower head to inject water into the rectum, he encourages them. , Or rather, adjust the water so that it begins to separate knee and roll at that point, and at the end gently insert the nozzle.
"We try to apply the same amount of liquid as if we were using a syringe with a bulb," he said. Moreover, water pressure itself can cause damage.
Baker also recommends water-soluble or silicone lubricants for citizens who use condoms, and oils on an oily cloth for anyone who does not use them.But his favorite conversation product, which he squeezes out in the end, is fiber. Under all circumstances, he recommends a diet rich in fiber, but also recommends taking fiber supplements at 1% or twice a day. For many patients, this is probably not realistic,” he said. “It's all about harm reduction.”
These kinds of conversations can be signed in minutes,” dangerfield said. And these girlfriends can improve patients' sexual health.
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