I started using meth a few years ago. At first, I was only using it about once a month when I would go out to party and hook up. Now I use it daily and can't hook up without it. My friends have no idea how much I'm using. The nicotine patch was a lifesaver when I quit smoking cigarettes. Are there any medications I can take that might help me stop meth?

Although many have been studied, at this time no medications have been approved by the FDA for treating methamphetamine addiction. There is ongoing research into the pharmacologic treatment of methamphetamine addiction, and so there is hope that a medication that helps with meth use will be found. In a small study looking at a medication called mirtazapine, men who have sex with men actively using meth who were in the counseling plus mirtazapine group had fewer positive urine tests for meth than those in the counseling-only arm.

If I have herpes, can I still have children?

Absolutely. Many people with herpes have healthy pregnancies and healthy deliveries. If you have herpes and you want to get pregnant with your partner, you can protect your partner by taking medication that will suppress your herpes while you are trying to get pregnant. If you have herpes and you are pregnant or want to become pregnant and not pass anything on to your baby, talk to your doctor, nurse practitioner or midwife about how to protect your baby.

Why do some guys have crooked penises? Is there a cure or a way to straighten a penis?

It is normal for some men to have a shape to their penis. The way the muscles, fascia and skin develop from birth to puberty shape the final result. No two penises are exactly the same, and that is part of the miracle of human diversity. Some partners report greater pleasure with different shaped and sized penises. I am sure that there is some surgeon out there who could convince someone with a very differently shaped penis to undergo cosmetic reconstructive surgery, but medically the treatment would be unnecessary and potentially very harmful.

Do I need to douche before or after sex?

It’s never necessary to douche. Vaginas are designed to be self-cleaning and douching can throw off the healthy environment, which can lead to increased risk for STIs or other vaginal infections. For this reason, vaginal douching is discouraged. Some people who have receptive anal sex (i.e "bottom" or have someone else's penis in their butt) douche before anal sex so that sex is not messy. Douching is a personal choice. It is most important to avoid injury to the anal/rectal tissue to reduce the risk of STIs.

Are there any vaccines I should get that could protect me from STIs?

Yes! There are several vaccines that can protect you from getting other STIs. All sexually active adults should be vaccinated against hepatitis B. All men and women < 26 yo should receive the vaccine against HPV (and anyone aged 26-45 should also consider it). The HPV vaccine can prevent genital warts, cervical cancer in women and anal cancer in men and women.

What are routine questions regarding gay men's health that I should be asking my physician during a regular examination?

We recommend that sexually active gay men and other men who have sex with men be tested for HIV and STIs (gonorrhea, chlamydia, and syphilis) every three months. Testing for syphilis usually involves a quick physical exam and a blood test. Testing for gonorrhea and chlamydia involves a urine sample if you perform insertive oral sex or anal sex (i.e. if you “top”), a swab of your throat if you perform oral sex on other guys, and a rectal swab if you practice receptive anal sex (i.e. if you “bottom”).  If you are not getting tested every three months ask your provider if you can be.

If you need to get checked for STIs, is there an age limit? Do your parents have to know?

In California, anyone age 12 years or older can get a medical check-up that is completely private and their parents do not need to know. However, if you use insurance, your parents may see the insurance bill. Planned Parenthood and most public clinics provide services to young patients and can bill you privately or provide care for free to protect your privacy.