A disgusting creature takes up residence in a human body, grows unnoticed and wipes everyone out until it is finally destroyed. This is how the horror classic "Alien" can be summarised. Something similar often takes place in the arses of gay men. However, the aliens are then called genital warts, chlamydia and gonorrhoea. The horror would soon be over if passive - but also active - guys regularly took their bums to the proctologist, urologist or dermatologist.
Malte* is 24, outrageously well-built and even prettier when he blushes. Like the moment he talks about the "cauliflower". A guy asked him a few months ago during sex: "Tell me, do you know that you've got really weird bumps on your rosette?" - "Gnubbel???" - "Yes, it looks like cauliflower." Malte admits that he ran to his GP rather than going. Diagnosis: genital warts. Referral: proctology. "I felt really dirty on the way there and could have cried with shame."
Legs wide for diagnosis
Proctologists are doctors who treat diseases of the anus. They examine their patients on a chair that looks similar to the one used by a gynaecologist. Dr Andreas Bellmunt knows how reluctant patients are to spread their legs on it. In his HIV-focussed practice in Dortmund, he often examines gay men for sexually transmitted diseases in their buttocks and first has to convince some of them. "I explain objectively why we need an exact diagnosis - just like with other parts of the body."
In addition to papilloma viruses, which can cause genital warts, gay men often have chlamydia and gonorrhoea. A few years ago, for example, an American study of supposedly healthy gay and bi men found that almost one in ten had chlamydia in their arse. The fact that these men were surprised by the infection is not unusual: the bacteria are nowhere near as noticeable in the bum as they are in the urethra. Some patients with chlamydia or gonorrhoea only complain of a "funny feeling". In others, mucus sticks to the faeces or there is a little bleeding.
The beasts must go
But no matter what the symptoms are: Chlamydia and gonorrhoea are intruders that the body defends itself against. "Sooner or later, this leads to inflammation, which makes the tissue more vulnerable and more susceptible to further infections," explains Bellmunt. So the nasties have to go. The same applies to papilloma viruses, of which there are numerous types. Genital warts are caused by rather harmless viruses. But they can occur with relatives that cause cancer.
Genital warts can usually be treated well with an ointment. In Malte's case, however, they had time to proliferate. His proctologist therefore had to burn them off with a laser - in several sessions, each time under local anaesthetic. "The more warts that need to be removed, the more serious the procedure," confirms Dr Bellmunt. For some patients, a general anaesthetic is even necessary to cut away entire colonies. One possible consequence: the skin becomes scarred and less sensitive.
Going to the loo normally before an appointment
Although the wound took a few weeks to heal, Malte can already smile about his first visit to the bum doctor. "When I was lying in the examination chair, the first thing the proctologist asked me was whether I had flushed my bowels. I actually had, because otherwise I would have felt dirty." The doctor asked him to go to the loo normally before his next visit. This was important because the bowel secretes mucus after flushing and you can therefore recognise less. "Then he winked at me and said that he already knew what he was getting himself into."
Arse in your trousers? Off to the inspection!
Chlamydia, gonorrhoea and papilloma viruses have an easy time of it, especially during unsafe sex. But you can also get infected when you finger yourself. Dr Andreas Bellmunt therefore advises passive men to have regular proctological examinations. It's up to each man to decide how often. If you always use condoms, an annual check-up may be enough. Those who change sexual partners frequently, on the other hand, are better off making an appointment every six months. "Some of my patients even come every three months of their own accord," reports the Dortmund doctor. "They probably know why ..."
*Name changed
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