Note: refer to Gay Men’s Health & Why It’s On My Radar (Thoughts From a Holistic Practitioner, Part I) to connect with the background for this post.
Recently, I fretted to one of my patients about how very much I have to say about Chinese medicine and gay men’s health, and declared: “This is a whole topic…someone needs to write a book about it.” My patient gave me a meaningful look that said: “It should be you” and I flinched. I’m still recovering from book number one and I’m definitely not ready to write another. And yes, I may end up penning another tome but–for the moment–all I’m good for is this long blog post. I will try to keep this as concise and as useful to you, dear reader, as I can make it. Please be sure to read the endnotes, as they will contain valuable resources for your further edification.
The TL/DR: In my estimation, there are a few key topics that merit special attention. These include: your pelvic floor; your anus as a sexual organ; gut health; mental health; HIV drugs and their side effects; medical gaslighting; and–last but not least–cosmetic acupuncture. (It’s always good to end on a cheerful note, I think).
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So without further ado…
~~~You & Your Undercarriage~~~
Your pelvic floor:
Your pelvic floor cradles your bladder and bowels and plays an important role in your sexual function. Women’s pelvic floors get a lot more attention because they give birth; men, for their part, don’t usually think much about it until their prostate starts squawking or they develop intractable pain or erectile dysfunction.
When your pelvic floor is weak or overly-tight or in some way disrupted, signs of distress can present as far-reaching pain. You might feel the ache anywhere from your low back and tailbone to your abdomen and all stops in between. This could express as pain in your your groin, your anus, your testicles, and/or your penis. You could suffer from burning pain in your perineum or perhaps ejaculation brings on the misery. A guy with a problematic pelvic floor might experience issues going to the bathroom. This could mean weak urinary stream, difficulty starting, starting and stopping, and/or incomplete emptying of the bladder. It could present as bowel issues, such as constipation, diarrhea, and/or pain when defecating.
When a guy experiences any of the above, he may find himself shuttled from one specialist to the next, from PCP to urologist to gastroenterologist to physical therapist to psychotherapist, but nobody has good answers. When he then searches Dr. Google, he is left with the impression that pelvic floor dysfunction is a women’s issue and that there is little to no recourse for guys. This is incorrect, limiting, and detrimental to your overall wellbeing. In fact, men’s pelvic floor health is an important topic and there are resources for you (one of them being Chinese medicine).
Prevention is the best cure of all though, so do not wait until your pelvic floor gives you grief to learn about this crucial area of your body. Start educating yourself today.1 Meantime, your Chinese medicine practitioner can help you with either acupuncture or manual therapy, including tui na, cupping, and/or gua sha on surrounding areas, like your lower back, your legs, or your abdomen.
Your anus:
Anal sex is practiced by people of every gender.2 However, anyone who routinely and/or as an aspect of their sexual identity relies on their anus for pleasure needs to give contextualized attention to the health and wellbeing of this body part. That is a fact.
Nobody likes to have hemorrhoids or an itching anus or fissures (all of which can be the result of a tight pelvic floor, btw). But if, on top of the discomfort and embarrassment that these conditions bring, your sex life is utterly destroyed too, then that is a problem. My understanding, based on conversations with patients, is that not all MDs are comfortable discussing anal health in its function as a sexual organ.3 (Technically, the anus is part of the digestive tract and is categorized as a digestive organ; sexual ones, on the other hand, would be the reproductive parts. But if you use your anus as a sexual organ, then it is one, whether or not reproduction is its purpose. This, too, is a fact).
In my practice, I model frank, respectful discussion of the anus in its sexual function and have never needed to fall upon my fainting couch in response to anything any of my guy patients have told me. It’s your body and a part of your healthy sexual practice. I treat guys with erectile dysfunction too and have no problem discussing penises, so talking about anuses does not faze me. I’m not embarrassed and you shouldn’t be embarrassed. When you are at your healthcare provider’s office, you should be able to speak candidly and without shame, and you should expect that your questions are answered completely and with an understanding of your specific health needs.4
Bottom line? Your Chinese medicine practitioner can do wonders for you if you have hemorrhoids or other anorectal issues (we treat distally, so you do not have to worry about us poking around your undercarriage), but what really matters is the communication.
Dear reader, you deserve respectful practitioners who will speak candidly with you about your sexual health in relation to your anus. This, too, is a fact.
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~~~ Your Gut & Your Mind: One Speaks to the Other ~~~
Gut health:
Gentlemen, your gut health is your everything. Ever-y-thing. Your microbiome is the environment; the microbiota are the entities that live within it. The health of the whole picture affects everything from the obvious (digestion) to the far-reaching (mental health)5 and more.
Relevant blog posts:
“Gut & Digestive Health: Three Reasons Why It Matters & How Chinese Medicine Can Improve Yours“
&
“How’s Your Digestion? Two Hearts Wellness Gives You The Straight Poop on … Well, You Know“
If your pelvic floor is weak or tight or otherwise not functioning as it should AND you’re dealing with an overgrowth of bacteria in your small intestine, for instance, PLUS you have anal fissures and you’re a nervous wreck, it’s not going to help you if all you do is go to pelvic floor physical therapy and a proctologist.6 You need to address the full spectrum of your big picture. For most practitioners of Chinese medicine, helping you with a scenario like this one would mean starting with your gut health.
If you are crushed by anxiety and unable to sleep, you bloat up after eating, you break out in hives or rashes at strange intervals, and your bowel movements are a mess, this can be a gut health issue. If you want to lose weight but cannot, or your blood sugar is problematic, then once again, this may well be a gut health issue. When you heal your gut, you are healing your whole self, and of all the things that Chinese medicine is great for, gut health is one of our crown jewels of amazingness.
Take care of your gut and your gut will take care of you.
Mental health:
There is a whole lot of beauty and joy and wonderfulness to your identity as a gay man. Any stress or distress you feel today may well have nothing to do with being gay and everything to do with having a disrupted gut microbiome or current work-related issues or lingering trauma from that car accident you had two years ago. And yet…cultural competency and good listening skills are not too much to ask of your practitioner.
Relevant blog posts:
“Emotional Scars Tell a Story (But You Can Change the Narrative)”
&
“Chronic Stress: Ways to Protect Your Mind, Body, and Spirit for the Long Haul”
A practitioner of Chinese medicine is not a psychotherapist, and one who purports to step into that role is skirting the boundaries of their scope of practice. What we can do, however–as discussed in the blog posts that I’ve linked, above–relates more to your overall wellbeing. If you can’t sleep or your digestion is a problem or you find that you are crying or angry more than you would wish, we have acupuncture points and herbal formulas and lifestyle guidance to support moving away from your current patterns.
But what if the root cause of your distress is part and parcel of your experience as a gay man? How important is your unique personal experience to your wellness-focused clinical experience? In other words, how significant is collective and cultural history to you when you go for your acupuncture appointment?
What goes on in your mind and heart is part of your whole-self health, and fortunately for you, dear reader, Chinese medicine has many options for you.
In my first career, I was a Spanish professor. My area specialty was national trauma and how it filters through literature and art. Meaning: big picture, collective trauma (namely: civil war, dictatorship, genocide, and torture). Today, I see the effects of collective trauma (the COVID pandemic being one) in my clinical practice in a range of patients, whether gay or straight or anything in between. Some traumas are more contextual than others though, as you surely already recognize. Gay men may carry LGBTQ-specific trauma from being old enough to remember when AIDS was a death sentence, to cite one example, while younger persons might experience a sense of communal injury related to current political trends. In sum: everyone has their personal experience, and groups (cultural, ethnic, national) have their collective scars.7
In terms of your mental health, this might present as chronic anxiety or grief, repetitive acts that are unhealthy (stress eating, drinking too much, and so forth), and/or aches and pains that come from a deep place that is not easily accessed without professional support. Your psychotherapist will help you to make meaning of these symptoms but it’s your acupuncturist who can ease you towards a more stable, healthy container as you work through your cultural injuries. And no, you do not need to parse out every why and wherefore of your trauma with an acupuncturist (again, that’s not what we are here for) but you should expect that your practitioner understands and respects that you have both a personal history and a collective history.
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~~~ Challenges & Opportunities for Healing~~~
HIV medication long-term health:
If you are on HIV medication (aka anti-retroviral therapy, or ART), then you know that this is a life-saver and that things are much better all around due to the existence of these meds. We can all be extremely grateful for ART at the same time that we feel some ambivalence. It is ok to multi-task when it comes to the subject of HIV management. What is not ok? Being gaslit by your HIV management doctor or not being given the kind of information that makes your regimen effective and as healthy for you as possible.
Has your doctor discussed HIV meds in the context of diabetes, cardiovascular problems, and/or rare adverse events? If not, why not? Do you know about the links between ART and diabetes or cardiovascular disease? Do you want to know more about these topics? Take a look at the endnote at the conclusion of this sentence for resources for you, should you wish to follow up on these topics (you should follow up on these topics).8
But what, you might be asking, does any of this have to do with Chinese medicine? The short answer is: a lot. Not all practitioners know much about HIV medication but we are fantastic with chronic inflammation. Western medicine tends to see a problem and want to get rid of it. Chinese medicine prefers to resolve the body’s imbalances so the body repairs itself. As the the articles linked in the footnote clarifies, the line from ART to diabetes and/or cardiovascular disease isn’t entirely clear, and scientists posit that it’s related to longevity and/or chronic inflammation rather than the drugs. Be as that may, getting any lingering inflammation under control is one of Chinese medicine’s super-powers.
Even better is if you can find a practitioner who is well-versed in ART, because then that practitioner can intentionally help you to live your very best, healthy life while taking your medications. In my practice, for instance, I have helped patients to clarify their symptoms in a way that made their MD take their concerns more seriously and change their prescription. I have also helped guys to assess relative risk for diabetes, heart disease, lactic acidosis, and liver health (among other issues) and shift their nutrition and other self-care strategies as a result.
The bottom line? If your MD isn’t talking to you about the pitfalls of ART and how to bolster your health against them, or the MD isn’t taking your concerns about adverse events seriously (and this goes for PrEP, too), then it might help you to work with an acupuncturist. There is a lot of information out there (the endnotes I share are useful), and having someone to guide your reading of them and subsequent health practices can be invaluable.
Everyone should be grateful for HIV medications. However, being on them for a lifetime requires a little extra ingenuity to maintain health, and knowledge is power. You deserve more than just avoiding a detectable viral load. You deserve to THRIVE, and by strategizing, you can.
Yes, you can!
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Medical PTSD:
One of my primary areas of expertise is Ehlers Danlos syndrome and the usual accompanying range of comorbid conditions. This is a complicated, incurable disorder and one that can take years to diagnose. The comorbid conditions are wide-ranging, life-altering, and also a challenge to diagnose, much less actually treat. I have a lot of familiarity with patients who have no choice but to engage with a medical system that may well end up killing them anyway.
When we live with chronic conditions, especially if they are complicated, we survive by learning how to engage with the biomedical industrial complex. This is a learned skill, and a necessary one.
This relevant blog post:
“Medical PTSD and Chronic Illness: Root Causes and Strategies for Survival”
was written with my EDS patients in mind, but it’s a must-read for anyone who lives with a chronic condition that requires ongoing interactions with potentially damaging medical systems.
The above-linked blog post aside, I will say this much: you deserve to be treated with respect by everyone at your doctor’s office. The doctor isn’t doing you some incredible favor and saving your life. You are saving your own life by showing up at the doctor’s office. You are saving your own life by educating yourself and by taking care of your health the best possible way you can. One thing is to be appreciative of medical care providers who work hard on your behalf and who treat you well. Quite another is to feel as though you must always be grateful and never question things and remain silent even when you have concerns. You have every right to question your doctor and to expect a certain level of respect from them.
Remember that.
~~~ Some Fun For You ~~~
And in conclusion…cosmetic acupuncture:
One thing that kind of bugs me about gay men’s health, at least when I research online, is that it does tend to focus on the negative. If you look for material on anal health, for instance, there are a lot of warnings about anal cancer and warts but not much that focuses on efficacy and wellness. The narratives do lean towards the problematic. Considering issues like ART pitfalls or medical PTSD, as I do here, does little to change the dynamic. Personally (and professionally) I like to find some joy whenever possible (without falling into toxic positivity, which is just as awful as being unrelentingly negative).
Consequently, I am unable to conclude this blog post without adding something fun and a little frivolous to it, and that would be cosmetic acupuncture.
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Yes, gentlemen, cosmetic acupuncture is for you, too.
Relevant blog posts:
“Microneedling and More: Holistic Treatments That You Will LOVE“
&
“Facelift With no Downtime? (With Needles or Without, Traditional Chinese Medicine Can Make it Happen)“
There is nothing superficial about wanting to look your marvelous best, and it can even help your mood to do something about deep-set wrinkles. If you’ve never tried it, you are totally missing out.
Do you want to miss out on the marvel that is cosmetic acupuncture?
No, no you do not.
~~~In conclusion~~~
Have you ever heard of the organization Free Mom Hugs? This is an organization founded by a mother who initially rejected her son because he is gay. Eventually, she realized her error and, among other things, started attending Pride parades and giving “mom hugs” to anyone who needed or wanted one. Now it has become a nationwide effort with chapters of volunteers who want to give hugs and allyship to persons of the LGBTQ+ community. Every time I’ve read about this, I am touched by how sweet and dear they are, and how heartfelt is their work.
Personally, I think that everyone needs a Spanish professor, and in my clinical work, I am still a Spanish professor. If you had a favorite profesora who was on your side, who wasn’t going to accept less than your best, and who encouraged you when you needed support, then you know what I mean when I say that I am here for you. If you never had that, well. You’re getting it now. I’m not here to give mom hugs but I am definitely here to be your Spanish professor, thus imbuing you an added layer of self-confidence and personal efficacy.
Either way? Dear reader, I hope that this essay has inspired you to try Chinese medicine. I hope that it has brought together some valuable information for you. I hope that you are that much more excited about your health and wellbeing and enthusiastic about strategizing your own version of what it means to be a healthy gay man.
You deserve all this, and more. And yes, I will consider writing a book for you.
Un abrazo muy fuerte,
Profesora Bruno
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Dr. Paula Bruno, Ph.D., L.Ac., is a licensed acupuncturist and herbalist, an AOBTA-CP traditional Chinese bodywork therapist, a health coach, and an author. She maintains an active and growing practice at her Austin, TX office. Dr. Bruno is also available for distance appointments for wellness consultation or coaching.
In her first career, she was a Spanish professor.
Dr. Bruno’s specialties as a Chinese medicine practitioner include: • Musculoskeletal health (acute or chronic pain relief; Ehlers Danlos syndrome & hypermobility support) • Digestive support, gut health, and weight loss • Aesthetic treatment, including scar revision • Men’s health • General preventative care and wellness support for all persons.
She is the author of Chinese Medicine and the Management of Hypermobile Ehlers Danlos Syndrome: A Practitioner’s Guide. Dr. Bruno also maintains a second website, holistichealthandheds.com, with resources and information curated specifically for people with hEDS and HSD.
When you are ready to discover what traditional medicine plus a vibrant and engaged approach to holistic health can do for you, either contact Dr. Bruno or book an appointment online.
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Two Hearts Wellness does not accept paid advertising on this website
Note: Material on this web site site is not intended to diagnose, prevent, treat, or cure any disease, illness, or ailment. A Chinese medicine practitioner in Texas identifies syndrome patterns but does not diagnose illness. Material on this web site does not purport to identify syndrome patterns.
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- A fantastic resource is R. Louis Schultz’s Out in the Open, Revised Edition: The Complete Male Pelvis. It was written by an esteemed and knowledgable Rolfer and educator and the photographs of male undercarriages are very instructive. I truly love the author’s frank, personable, and wise attitude towards the human body. This is a marvelous book. ↩︎
- A nice history of anal sex can be perused in the Oxford Classical Dictionary‘s entry, “Sex, anal.” Obviously, the focus here is on Greece and Rome. Though heteronormative, Men’s Health has an interesting article on lube, “A Brief History of Lube, From 350 BCE Onward,” that includes discussion of Asian history and anal sex. ↩︎
- Your acupuncturist is not going to be the one to examine your anus or give you a swab but you should be able to discuss your concerns with her, him, or them. This is good practice for you so that you become more confident and able to speak with your biomedicine providers. You’re not alone if you feel uncomfortable. As “Gay and Bisexual Men Who Report Anal Sex Stigma Alongside Discomfort Discussing Anal Sex with Health Workers Are Less Likely to Have Ever Received an Anal Examination or Anal Swab” outlines, stigma and shame get in the way of appropriate healthcare. If you’re still not persuaded, take a look at “Better conversations about our butts.” It’s an older article (from 2018) but, based on my clinical experience, it is certainly still relevant. What do you think about its message? Does anything in it resonate with you and with your experience at the doctor’s office? ↩︎
- “Looking after your assets: everything you need to know about maintaining a happy, healthy ass” is a useful resource that includes a helpful graphic of the anatomy and mentions nutrition, which–as I discuss–is quite important for your sexual health in this context. ↩︎
- See “Depression, Serotonin, and the Gut” for current research into the microbiome and anti-depressant medication. I also link some interesting material regarding gut and digestive health in the blog post on gut health that I link in the “relevant blog post” section. Do look!. ↩︎
- However, for great tips and education, I highly recommend Your Friendly Proctologist on YouTube. He is so jolly and enthusiastic and his information is useful for anyone who wants to learn more about colorectal health. Do check him out! ↩︎
- For further discussion, refer to “Historical and Collective Trauma Among LGBTQ+ People: How hate, violence, and oppression negatively affect LGBTQ+ communities.” Whether or not collective trauma is a central aspect of why you are seeking treatment, you absolutely deserve a practitioner who respects your cultural affiliation and any scars contained therein. A helpful resource for finding practitioners near you is OutCare, where you can plug in “acupuncture” as your keyword. ↩︎
- For a very clear outline of potential side effects of ART meds, refer to “Side Effects of HIV and AIDS Drugs.” It can be somewhat alarming to see the list of what might go wrong, yes. However, if you strategize your wellbeing, you take good care of your liver, and you maintain control of your blood sugar and any inflammation, then you can indeed live quite well on your meds. It just takes self-knowledge and strategy, and you can do it! “What to Know About HIV and Diabetes” is also comprehensive and useful. “Cardiovascular toxicity of contemporary antiretroviral therapy” is helpful to understand the effects of some of the older ART drugs on heart health. Another worthy post, “Coronary heart disease and HIV” discusses inflammation and heart disease in HIV+ populations and provides a clear outline of cause, effect, and ways to prevent it. For clear explanations of potential side effects of PrEP, refer to “Six Side Effects of PrEP” and “Pre-Exposure Prophylaxis (PrEP).” ↩︎
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