Aaron Lawrence is a 24 year old escort and porn star from New Jersey. He's also got a college degree in Psychology and is the author of The Male Escort's Handbook just published in the USA and Suburban Hustler available here in the UK. Every fortnight in OutUK he answers your questions on being gay, sex and relationships. And any other stuff you might want to ask. He says "My advice is based on my experiences in the sex industry, academia, and life. In no way am I a medical doctor, licensed psychologist, trained sex therapist, or God. Please read my advice with those limitations in mind".

Aaron 'sez: It is extremely important to know what to look for when checking your client for STDs. The list below is not an exhaustive list of symptoms, nor is it meant to provide a formal diagnosis. This is simply a list of warning signs. If you have any concerns that your partner may have an STD, you should politely recommend he see his physician and excuse yourself from the situation. Before you leave, you should thoroughly wash your hands and any part of your body that came into contact with your client.

What to Worry About:

Sores and Ulcers

A red open sore on the shaft of his penis near the head. There may be more than one. (Possibly syphilis)
A cluster of small, pink sores that may be crusted-over on the head or shaft of his penis, under his foreskin, or near his anus. (Possibly herpes)
One or more small (pimple to pea-sized) sores filled with a white slime on his thighs, anus, dick, balls, or stomach. Occasionally on his arms, back, or face. (Possibly molluscum contagiosum)

Discharge

A green or yellow discharge from his penis. (Possibly gonorrhea)
A reddish streak in the seat of his underwear from anal discharge. (Possibly syphilis, gonorrhea, or herpes)
A faint stain on the front of his underwear. (Possibly urethritis)
A yellow-green streak on the inside front of his under-wear from penile discharge. (Possibly gonorrhea)
Excessive amounts of a clear or white fluid that emerges before the client has an erection. It may appear similar to precum. (Possibly urethritis)

Warts, Blisters, and Other Marks

One or more small warts on his dick, anus, balls, thighs, or butt. They may look like tiny cauliflowers, or like dark skin blemishes. (Possibly genital warts)
A cluster of small, clear blisters on the shaft or head of his penis, under his foreskin, or near his anus. (Possibly herpes)
Dark purple blotches found anywhere on his body. (Possibly Kaposi's sarcoma from HIV infection)

Other Symptoms

Small brownish-red dots at the base of his pubic hair. (Possibly crab lice)
Abnormal lines on his hands, especially between his fingers. Also found on arms, stomach, and genitals. (Possibly scabies)
A yellowish color to his eyes. (Possibly hepatitis)

What Not to Worry About:

A clear substance emerging from his penis after he be-comes aroused. (Probably precum)
Small, fleshy, half-inch "tags" near his anus. (Probably skin tags or hemorrhoids)
Tiny red bumps at the base of his pubic hair where he has shaved. (Probably folliculitus, a minor skin irritation from shaving)

Question: My problem is on the "gory" side. I've been ejaculating blood in my semen. It only happens sporadically. I've been to my own personal physician who I am completely open with and knows all about my active sex life, and a urologist, and the only answer they can come up with is that it happens some times. It's causing me anxiety over having sex (I'm unattached and quite sexually active. I've been checked out for STD's, HIV - I'm all neg. It's only happened once with another person and he was quite understandably freaked. I also wear a cock ring usually but it's not too tight if that makes a difference. The thing is when it does happen it's the most intense orgasm, it seems to be two separate orgasms. The first one is a thin clear fluid that flies, then it gets real intense and the second "load" is bloody (not just specks but gruesomely gross). Have you ever heard of this?

Aaron 'sez: If there is blood in your cum, it is usually from a broken blood vessel in the prostate. That can happen as a result of the force of ejaculation, but can also be the result of an infection, or even possibly a tumour. If you suddenly finding yourself cumming on a regular basis with a lot of blood in it, see your doctor to make sure that it isn't something serious. If your urologist gives you a clean bill of health, then you don't have to worry. At least not from a medical perspective. Of course being medically safe doesn't eliminating the stress of a bloody cumshot! There are a few things you can try. For starters, anytime you have a real whammy of a blood orgasm, give your prostate a couple of days to heal back up. The blood vessel will likely heal quickly, but for the next few days you might have more blood in your orgasms. Definitely avoid filming any porn movies in the meantime. You may also want to consider having if the way you were having sex has anything to do with the broken blood vessel. Does it only happen when you bottom? If you haven't cum in a week? Engage in SM? If you find a common factor, experiment to see if you can alleviate the problem. For example, if you only have bloody orgasms if you get fucked after not cumming for a week, having a small jackoff session every few days may solve the problem for you. In the case of frottage, it is possible that the urethra is becoming irritated and is bleeding somewhat. Try using lubricant next time you rub up against your partner, and see if that helps alleviate the problem. If not, by all means see your urologist for an examination.

Aaron 'sez: Viagra hasn't been around so long that there are many long-term studies of people using it, so some of its effects may be unknown. It is known that it will have a decreased effect in older men as their arteries harden. Perhaps your body is changing, which in turn is affecting how Viagra works on you. Alternatively, perhaps you're becoming a bit jaded with your sex life? A bit of contemplation and renewal may be in order. Being hard is often a matter of the mind. Viagra does help, but it is rarely necessary for most men. As for poppers, the two contain some of the same chemicals, but they are very different in their effects. And yes, both Viagra and poppers dilate blood vessels allowing more blood to reach your dick. But the wearing-off effect of poppers hasn't been studied in Viagra yet.

Aaron 'sez: You may have a bleeding haemorrhoid, which would certainly explain your troubles. Give your doc a call and set up an appointment for an examination. If you're not out to your doc about being gay, you can mention you have found traces of blood in your underwear. He'll know to take a look inside you. Alternately, you may want to try a few new things in the anal sex department. For example, try a new lubricant. One that doesn't have nonoxynol-9 in it. Ask around and see what your friends suggest. Also, try being fucked in different positions. Doc Goldstone suggests lying on your stomach while you are fucked, saying that other positions can promote more swelling and bleeding. I'd say experiment around though and see if you can find a good one for you. And be sure to talk to your doc!

Aaron 'sez: Sounds to me like you're a lucky man! Why you can cum without touching your cock is probably a lot of things. You're probably very excited for your partner, and very comfortable having sex with him. He's probably fucking you and gently stimulating your prostate. And I'll bet that if you think about it, you'll realize his belly is rubbing up against your cock and balls. That is often that extra bit of stimulation that someone needs in order to cum without touching themselves. Either way, have fun with it!

Aaron 'sez: Have you ever heard of the Darwin awards? It's a silly set of awards that floats around the Internet, congratulating stupid people on killing themselves in a ridiculous fashion, thereby conveniently removing their DNA from the gene pool. Well, I have news for you. If you decide to drink kerosene in lieu of following your doctor's advice, you're likely to wind up on next year's list. I mean think of it - don't you think that if it's a safe and effective way of killing parasites that doctors would be prescribing it already? No, my friend. I think your solutions wind down a different path. For starters, I'd suggest getting a second opinion next time you have your troubles. A second opinion is always useful, and I find it extremely unlikely that you're having parasitic infections from just giving oral sex. My best is that your doc is either failing to rid you of your parasites, or that there may be another problem altogether. Failing that, may I suggest finding some new cruising spots?

Question: I have Peyronie's Disease, which results in a slightly dented dick at best and a greatly shortened one at worst. The latter case applies to me; I went from a true 7 x 6.5 to a 4 x 4 in six months time. I have managed with a sense of humor and feel lucky that it still works, as some guys lose their potency from the condition. I have read in a reputable medical journal about successful surgery followed by dedicated vacuum-pumping in order to restore the "lost" inches. The doctor who wrote the article will not respond to my queries. Have you heard of the procedure or any places doing it with success? I will admit to a desire to regain what I once had! Thanks for any input.

Aaron 'sez: Okay, folks. It's time for the bent penis talk. The condition you guys have been mangling through bad spelling is called "Peyronie's Disease". It's not a disease in the traditional sense, in that you won't be passing it on to your partner, and you don't have to wear a condom to avoid it. But it is a medical condition, and left uncorrected it can lead to discomfort, pain, or even impotence. Here's the scoop. Having a slightly curved dick is totally normal. I've got one, as does at least one of my brothers, and a host of my clients. If your dick has had a slight curve to it, don't worry. Peyronie's Disease (slang: Bent Penis Syndrome) is when your dick starts curving over a period of several months. It may start subtly, but may develop a major bend to it, as much as 90 degrees or more. It is caused by a lump of plaque or scar tissue inside your dick that causes your dick to start bending around it. It may form on its own, or may be the result of a mild sports or sex injury that you may not be aware of. If your dick has suddenly changed in shape, give your urologist a call and set up an appointment. He'll feel your dick for any sort of bumps and lumps, both the ones that may be causing the curvature, as well as any you may not be aware of. Assuming he decides you have Peryonie's Disease, he may opt to treat it in any of a number of ways. The least invasive way is to wait it out. Many men with Bent Dick Syndrome find that their dicks return to normal. He may give your dick an injection to break up the scar tissue, or may opt for oral or topical vitamin therapy. In more serious cases the doctor may even use medications, radiation therapy, or even surgery to correct the problem. Obviously these are considerably more serious, and are not to be taken lightly. Which option is right for the three of you is not for me to say. If your dick isn't returning to normal on your own, give your doc a call to discuss the matter with him. Alternately, find another urologist and go get yourself a second opinion.

Aaron 'sez: Nope, it's not. At least not generally. This doesn't mean you're a bad person, but it may be indicative of a more serious medical problem. According to Dr. Goldstone, something probably happened to your other testicle. It may have never formed properly, or may have twisted and died. Alternately, your testicle may actually still be inside your body, and have never descended as your body developed many years ago. In that case the matter is somewhat serious - undescended testicles are at an increased risk for cancer. So go see a urologist and let him check you out. Ask him all of the questions that are stressing you, and have your medical situation checked out.

Aaron 'sez: What you are referring to is a retrograde ejaculation. In order for cum to emerge from your body during orgasm, a small muscle closes around the entrance to your bladder. After prostate surgery, many men lose some or all control of this muscle. As a result, your cum shoots into your bladder instead of out the urethra. It's not a serious condition, but it is permanent. There are no real treatments for retrograde ejaculations. One long-shot though, is that some medications and/or illegal drugs can cause your problem. It's highly doubtful those are causing your condition, but you may want to bring them up with your doctor down the line. In the meantime, count your blessings. You surgery has hopefully maintained your health. And a lot of people emerge from those surgeries with even less pleasant side effects than you have. You can at least have a traditional sex life, albeit a dry one. Not everyone receives that chance.

Aaron 'sez: Why does it always work this way? I sit down to write this advice column while munching on some crackers with sliced gouda on the top, and now I get a question about eating dickcheese. Now I'm going to just have to sit here hungry for the next hour. Although I may be suffering, you fortunately don't have to worry too much. At least not directly. Dickcheese consists primarily of dead skin cells and sweat. As long as the guy doesn't have any sort of infection, you should be relatively safe. Be on the lookout for any redness, soreness, or a really bad smell. That's a sign he has a hygiene problem "down there." And if you like smegma, you may run into those infections from time to time. What you do have to worry about is all the traditional STDs you can catch from giving oral sex. Those include herpes, gonorrhea, and syphilis. If you are looking for guys who don't have a lot of penile hygiene, chances are you're going to run into those, too.

Aaron 'sez: For better or for worse, HIV doesn't have any obvious physical symptoms. Those "grapes" could be haemorrhoids, anal warts, or something else altogether. Play safe in the meantime, as you never know when your partner has HIV.

Aaron 'sez: I can't give you a set number on your risk (ie; a 1 in 10 chance of catching XYZ), but you could have been exposed to a number of STDs. These include herpes, gonorrhea, syphilis, genital warts, HIV, and others. If you are concerned about your health, go make an appointment with your doc for an STD screening. You may also want to avoid the local glory holes in the future, and make a point of staying in enough control of the situation so that you can always play safe.

Aaron 'sez: Funny that you should consider that a problem. A LOT of guys like a guy's dick with bulging veins in it. Besides the fact that surgery on one's dick is a serious matter that can have a lot of unforeseen consequences, it's also unnecessary. There are plenty of guys out there that would be glad to demonstrate their love for your cock, veins and all. Stop worrying about your dick and begin living life a bit more.

Aaron 'sez: You may have balanitis, a fungal infection. It isn't a sexually transmitted disease (although it can be), and is common in uncircumcised men. Similarly, it can affect those men (like you and I) that have a lot of excess skin on our dicks. Your local pharmacy will have several over-the-counter anti-fungal creams. Go pick one up and use it for a few days. If the problem doesn't get any better, visit your doc. Hoping it will go away can turn your minor condition into a major one. For future reference, keep your dick a bit more dry and clean. After you take a shower, thoroughly air dry your dick before you put it in your shorts. And don't feel nervous about discussing it with your wife or your doctor. It's not a "gay thing", and could have happened anytime.

Aaron 'sez: According to Dr. Goldstone, it sounds like you may have "hemangiomas". They are not from itching, and just "happen to happen." They can become a serious problem if they become infected. So go see a urologist (not the one you saw before), and get a second opinion. Hopefully he can help you clear up your problem.

Aaron 'sez: I know sex far more than I know drugs, but isn't opium completely different from cocaine? Either way, there have understandably been no studies on the effects of drinking piss on drug testing. So while it does seem somewhat logical that you may have traces of cocaine, I don't think anyone can say for sure if that's where it came from.

Aaron 'sez: There are no guidelines as to the safety of using refrigerated cum as a salad dressing, nor are there any basic standards for when it is safe to use as a lubricant. There's a reason why hospitals dispose of sharps rather than reuse them after several weeks - it's because you just can't be sure they're clean. The same goes with cum. Letting cum sit around for a few weeks is not an acceptable substitute for safe sex. I will grant you that some of the virus will die, as will some of the other STDs that may be in the cum. But the safety of the cum remains highly questionable. Exposing the cum to your skin may possibly infect you with STDs, even if there isn't a sore involved. I know you want a specific set of safety guidelines, but I can't give one to you. Cum on the skin is safe as far as HIV is concerned unless you have a cut or sore, but other STDs can be transmitted more easily. As for your partner spewing fresh cum on your face, I agree that is very hot. But it's also potentially dangerous. Gonorrhea can infected your eyes, just as it can infect other parts of your body. Be especially careful when your partner cums on your face. The STDs that you may contract from cum on your face (but not in your mouth) aren't fatal, but they may be seriously annoying.

Aaron 'sez: This is an advice column. You never have to apologize for not knowing the answer to your question. Unless you ask something really stupid, of course. And I mean not just run-of-the-mill stupid, but something REEEEEALY stupid. Anyway, you want to know how fast modern medicine can determine whether you are positive. The answer is "pretty fast, but it takes a while." A standard HIV-antibody test will not be particularly accurate unless six weeks or so go by. Your doctor can do a viral load test. It takes less than six weeks to give an accurate reading, but is a more expensive test. In your situation, you'd want to immeeeeeeeeeediately talk to your doctor. As in, go into your doctor's office and demand to see him. If you receive treatment within 48-72 hours of exposure, they can give you a sort of "morning after" treatment for HIV. It's a month-long series of medications, but it is designed to give your immune system a big burst against HIV. It's what doctors use if they are accidently exposed to HIV-infected blood, and it may just work for you. Once you've started on your medication, your doctor will want to give you an immediate test. It won't help with your new exposure, but it will determine if you had HIV before-the-fact. Assuming that is negative, then you will want to be tested after six weeks, three months, and again at six months.

Aaron 'sez: It sounds like you may have folliculitis, a common minor infection of the hair follicles. Try using antibiotic wipes to clean the area during an outbreak. If the problem persists, see your doctor or a dermatologist when you have an outbreak. He may give you an ointment or oral medication to help clear up the problem. And you're right, shaving can make it worse. If you have to shave there for some reason (which you don't), use a disposable razor and change the blades after every use.

Aaron 'sez: While lice-killing shampoo is not cancer-causing, it's hardly the sort of chemical you want to be using regularly. I'm not sure what you read, but everything I found suggests that lice-killing shampoo is only harmful to lice. Or perhaps people if you decide to drink the stuff. It's not a good idea to use it unless you definitely have symptoms of an infestation, but I don't know of any immediate risks to yourself.

Aaron 'sez: So far there have been no controlled studies of the "natural" alternatives to Viagra. That means the companies can make all sorts of claims about their product, but have no factual evidence to back them up. A few may be slightly helpful, but most are probably useless. Furthermore, herbal supplements are outside the FDA area of regulation right now, which means they can have potentially dangerous side effects. As for medications, I have not heard of any other FDA-approved drugs similar to Viagra. So for now Viagra remains your only real medicinal solution. You may want to consider investing in a nice leather cockring though. It's not for everyone, but some men find that it does give them an edge when it comes to staying hard. And it's a heck of a lot cheaper!

Aaron sez: I receive many submissions of questions I have already answered. Aaron's Advice is published every couple of weeks in OutUK and you can see my past OutUK columns in the OutBack archive.

Bedtime Reading

Aaron's bestseller which graphically reveals his businesslike approach to the world's oldest profession. Available at Amazon.

Aaron sez :
For more information about gay health, check out Dr. Goldstone's book, The Ins and Outs of Gay Sex.

Suburban Hustler - Memoirs Of A HiTech Callboy is Aaron's first bestseller which has sold more than 200,000 copies at AmazonUK alone. Available here.