Dear Dr Laura,
I’m 22 and I think my sex life is out of control. I can’t stop going on to Grindr, BBRT and apps like that to find sex. I have up to 10 encounters a week. I’m a bottom and I’m on PrEP but I know this amount of casual bareback sex is putting me at real risk of others things, what can I do?
Thank you for your question and I’m sorry you’re worried about the sex you’re having. My first question to you is whether this sex is completely consensual – it sounds that way from your letter but if, in any way, you are feeling pressurised into having condomless sex, or sex at all for that matter, please speak to a sexual health service.
My next question is whether you are enjoying the sex you have? If you’re having fun but are worried about the risk of sexually transmitted infections (STI) that’s a different issue to finding yourself in a spiral of apps and hook-ups that you then feel bad about.
Let’s deal with STIs first – you are on PrEP, which if taken as recommended, is highly effective at preventing HIV. I-base have just produced an updated leaflet on how to take PrEP which I recommend. Anyone who has been taking medication for a while can slip into the habit of missing doses or taking them late so, even if you’re a confident PrEP user, it’s worth reminding yourself of how best to use it.
We recommend you get an HIV test every 3 months if you are using PrEP – it’s important to diagnose HIV promptly in PrEP users to reduce the risk of developing resistance to HIV medication if you do acquire it. For other STIs we do recommend condoms but these are not 100% effective (especially against syphilis, herpes and warts which can be passed on through skin-to-skin contact) and many people don’t like using them – especially for oral sex, which is a particularly important route of gonorrhoea transmission. Whether you’re using condoms or not we’d recommend regular STI checks – every 3 months or sooner if you get any symptoms, and talk to the clinic about making sure you’ve had all the relevant vaccinations (hepatitis A, hepatitis B and HPV).
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Next is the more physical element of bottom sex…. are you fisting? Using toys? Having group sex? All of these increase your risk of hepatitis C (there’s no vaccine for this and all gay men having condomless anal sex, especially with multiple partners, should have regular hep C testing as part of their STI checks) and also increase the risk of physical trauma. If sex is painful then you should ask your GP or sexual health clinic for advice – fissures (small tears in the anus) can be very painful and take a long time to heal.
You’ve not mentioned drugs – having multiple sexual partners often overlaps with chem sex and this is a sexual merry-go-round that can be hard to jump off. If your sex is not sober, and you’d rather it was, it can be very challenging to cut down, or stop using chems altogether. Avoiding triggers to chems use, such as particular friends or venues, can be tough as can finding the confidence to have sex without chemical crutches. But lots of people manage it and there’s a lot of support out there – speak to your local clinic (many offer support from health advisors and some have access to specialist psychologists) or check out one of these websites: thehavelockclinic.com/chemsex-sober-sex; dean.st/chemsex-support or fridaymonday.org.uk/breaking-the-cycle/getting-help
Ultimately, if your sex life makes you happy, and you are in control, you should enjoy it! Make sure you’ve had the vaccines we recommend, get regular STI checks, and ask your partners to do the same – being in control of your sexual health is sexy after all!
The Boyz Doc is Dr Laura Waters, an HIV and sexual health consultant at the Mortimer Market Centre in central London. Dr Laura answers your questions every week in Boyz. If you have a question for Dr Laura please email her at email@example.com