Today it is impossible to determine the answers to these questions, but if you live in Broward County that's about to change. This summer you will be able to participate in an online census for the gay, lesbian, and transgender community called "The Count." The collected data will finally give us a statistical presence that not only provides an awareness of our numbers but also assembles information that can be used for public policy and funding decisions. The census is a collaborative effort that includes the United Way, Sunserve, the GLCC, Broward House, and the Broward County Department of Health. This is the first effort to quantify and document information about our community.

Many of my psychotherapy clients express frustration about what they perceive to be a lack of community. This census is an important step in affirming that we are not only here, but that we will be seen, heard, and counted.

"The Count" will go live this summer, but you can register now on the site to be notified about updates. For details go to www.lgbtcensus.com and help spread the word.

The Gay Men's Health Agenda is a significant document which grew out of a grassroots effort within the gay men's health movement. After soliciting comments from gay men around the country, a draft was presented for feedback at the Gay Men's Health Summit in Seattle in October, 2008, and the final version has now been published.

The Agenda is significant because it urges policy makers to recognize that the health care needs of gay men extend far beyond HIV/AIDS, and include mental health, substance abuse, external and internalized homophobia, and a sometimes appalling lack of cultural competency of many health care providers in recognizing and appropriately treating the health of the gay, lesbian, and trans community.

Recommendations specific to gay men's health include funding and expanding social, behavioral, and biomedical research; developing and collecting data on sexual orientation and gender identity in federal research; funding campaigns to combat homophobia, biphobia, and transphobia; and eliminating bans on "promotion" of any type of sexual behavior, which impairs effective health campaigns. Other recommendations include creating strategies to combat health disparities, funding sexual health and wellness, and removing barriers to health care for transgender people.

Similar efforts for lesbian health include the Lesbian Health Fund of the Gay and Lesbian Medical Association. Health care disparities continue to grow for all of us in the LGBTQ community. These efforts are an important step in making our voices heard. Whether you participate by contributing to a similar document or by calling or emailing your representatives, be sure yours is among them!

The alert editors at Gaywisdom.org have found a video on Youtube that, while humorous and to a certain extent uncomfortable, is extremely important both for information and for overcoming the embarassment of this form of cancer. The video is of British origin. Unfortunately the level of prudishness and even homophobia in the US makes such a home-grown piece unlikely.

This clip is entertaining but vital. Watch it after the jump and go help a friend!

(Possibly NSFW)

Gaywisdom is the blog for the White Crane Institute, an important organization that publishes books and journals related to gay mens' health, art, and spirituality. They sponsor the Gay Men's Health Movement Leadership Academy (of which I am a proud graduate), the Queer Spirit conference, and other events such as the White Crane/ James White Poetry Prize for excellence in gay men's poetry.

New options for notifying sex partners couldn't come at a better time. Last week a CDC (Centers for Disease Control and Prevention) report announced that syphilis cases in the US were up a staggering 15.2% over the year before, and worse, gay and bisexual men (including a disproportionate number of African-American men) accounted for a whopping 65% of those cases. These numbers represent an unfortunate continuation of a seven year rising trend in syphilis rates.

Why are these numbers so high for gay and bisexual men?" The CDC speculates that we are suffering from prevention fatigue (certainly true) and being less vigilant with safer sex. Dr. John Douglas, head of STD Prevention for the CDC, also suspects that a rise in serosorting, the practice of choosing sex partners with the same HIV status, plays a role. Such unprotected sex leaves men exposed to other sexually transmitted diseases like syphilis.

I suspect an additional factor: substance abuse, particularly methamphetamine. Meth is the perfect storm for STDs: it increases risky sexual behavior, leads to multiple sexual partners, and eliminates cares about protected sex. The clients I see in the Meth and Men program at Sunserve (www.methandmen.org) bear this out: tina, out of control sex, and STDs go together.

No one wants to tell a friend or even a trick that you have exposed them to an STD. And realistically, you may not even know his name or phone number. But chances are that if you hooked up online you can find that profile and send him (or them!) an email that can be anonymous or personalized. In Florida, you can do this knowing that no governmental authority is involved, and that there will be no reporting or follow up by the health department.

Inspot provides six templates with sharp graphics and catchy phrases ("It's not what you brought to the party, it's what you left with"). If you wish you can add a personal message. The site also has links for information about sexually transmitted diseases and testing locations.

Getting tested for HIV and other sexually transmitted diseases is essential. Most infections occur not because people lie (although some do) but because they don't know their status. When you get bad news don't let embarrassment keep you from notifying someone you might have infected. Use these Inspot notification emails to help stop this cycle and keep our community healthy.

For more information visit Inspot at http://inspot.org/florida.

The list of gay labels is long and ever-changing, but provides us with a common lexicon by which to classify ourselves and each other: bears, daddies, boys, twinks, tops, bottoms, barebackers, clubkids...even labels related to drug culture such as PNPers and slammers. Some categories are broad and general, and some are more obsessively developed such as the bear codes, which cleverly quantify characteristics such as furriness, the grope factor, and even the slut factor.

Are these useful? They certainly make finding a compatible sex partner as easy as finding a great shirt on the sale rack at Macy's. But such labels are also valuable helping gay men forge an identity in the relatively hostile environment that we call gay life. Labels provide guidelines for many men both during the coming out process and beyond, laying out a rich menu of sub-cultures which provide both identity and a sense of belonging.

I don't mean to imply that people are simply slaves to whatever category they have adopted, or that they are confined to just one label, or even that what we call ourselves doesn't change as we age. I do feel, however, that too often we are complicit in oversimplifying the identity we express to the world which reinforces the stereotypes about our community such as hypersexuality and superficiality.

Another downside of labels is their power to polarize. Too often they reinforce what keeps us separate instead of allowing us to experience what we all share in common. It is as if we have created our own little ghettos by which we limit ourselves from recognizing our strength as a gay community. We can find unity, however, as evidenced recently by the turnout at rallies against Proposition 2. It was truly moving to see a diverse group of gay men and woman as well as our allies coming together as one community to express our unified voice.

Do labels reflect who you want to be? Next time you consider how you fit in or how you are perceived by others, don't be limited by pre-packaged descriptions. Customize your identity and express yourself in a way that reflects who you really are, inside and out.

Interested in finding out more about this topic and others related to how we connect with other gay men both socially and sexually? Check out my "Connections" group as well as two other groups, "Becoming Mr. Right" and "Finding your Inner Artist," beginning in January at Fusion Wilton Manors.

So how can we achieve an attitude of gratitude? Or should we, as one client of mine pointed out, "save it for the greeting card companies?" No, I don't think so. Gratitude, the practice of being grateful, is increasingly being recognized not as a cliché or as something to be cynically ridiculed, but as a powerful tool that can actually change our outlook and our moods.

Most simply ask, "why?" The reason is because it not only makes you feel better, it may even change the world (more on that in a minute). The shift in personal consciousness created by the act of identifying gratitude can move us from a state of need and resistance to one of acceptance and healing. I recognize this is sometimes easier said than done. In the past year I have experienced sadness and pain around the declining health of a parent. I certainly haven't yet found a way to be grateful for that situation, but even on the worst days I can be grateful for a ground orchid in my yard, or my dog's relentless playfulness, or the steady support of my partner. Taking a few minutes to consciously acknowledge those things somehow breaks a spell and brings me back into balance.

While many spiritual traditions have long recognized the wisdom of gratitude, its power is now being increasingly documented in scientific literature. For example, one study by Emmons and McCullough in the Journal of Personality and Social Psychology used a double blind study to demonstrate that a conscious focus on blessings has empirical emotional and interpersonal benefits. Many other studies link gratitude with numerous positive effects ranging from well-being to goal attainment.

Even if being grateful can help us feel better, can our personal expression of gratitude have an impact on the world? Increasingly, many people think so. A number of metaphysical traditions (as well as quantum physics) acknowledge the power of our thoughts to change our very cells and even our reality. Today there is a heightened awareness about the potential of shifting human consciousness based on what we as individuals think about and what we do.

The internet is increasingly being used to facilitate such shifts. I recently learned of one free site (www.gogratitude.com) which is attempting to create a wave of gratitude that will sweep the globe. One can sign up to receive 42 brief, daily messages that help develop such awareness. To date, over one million people have signed up.

Thanksgiving and the other holidays can be inherently stressful, but we do have the power to choose where we lavish our attention. Personally, I feel a lot better if I can find at least something to be grateful for.

And when I can't, there is help - here comes my dog with a toy in his mouth.

With these words Eric Rofes, the late gay health activist, began an article on the gay men's health movement in the White Crane Journal just three years ago. Are these words still true? Were they true then? Today we are bombarded by grim statistics on rising HIV rates, alarming amounts of syphilis and other sexually transmitted diseases, the lives of partners and friends ruined by meth and other substances, and a disquieting acceptance that its okay not to talk about our health status with our sex partners.

Are we healthy, happy, and life affirming? I admit that one can easily get discouraged. After twenty plus years of AIDS crisis mode, much of the celebration of gay life and gay sex that began after Stonewall has been diminished. Gay sex today is often seen as something to be feared, contained and controlled. Many gay men are viewed by society at large (and unfortunately by some other gay men) simply as vectors of disease who are hypersexual, tweaked-out, and potentially destructive to themselves and anyone around them. Society views many of us as complacent at best- and pathetic at worst.

What about Tina's rampage? I probably have worked with more individuals caught in the vortex of crystal meth than anyone in this community, yet of all the men I have been privileged to know, not one planned to venture into the darker realms they experienced on meth. Like most of us, these men sought to increase their confidence, feel sexually desirable, overcome their inhibitions, or experience increased sexual intensity. Sound familiar? Pretty normal? It's not the person who is bad or shameful; it's a very nasty drug that hijacks sexual desire and clear thinking, often with disastrous personal consequences.

There is, of course, a need for responsibility and accountability. Both personal and community health and wellness are something that each of us must create. Solutions can't be found in avoidance or demonizing. As a community we experience way too much divisiveness: negative versus positive; older versus younger; those who "party-and-play" versus those who don't. By identifying what unites us as gay men, what we all share, we can generate strength and healing.

Are gay men really creative, strong, and resilient? Absolutely, yes. Can we think outside the box? Of course. Many of us have witnessed such resilience in other times and places and it's happening here again. Gay men, our allies, agencies, churches, and a host of other organizations are actively working together to create a healthier and stronger community. I'll be writing about some of these challenges and solutions in the months to come and I invite you to join us in creating personal lives and communities that are not only satisfying and fulfilling, but in Eric Rofe's words, healthy, happy, and life affirming.

The proclamation comes on the eve of the Seventh Southeast Regional Gay Men's Health Summit which will begin at noon on Friday, November 7, and end on Sunday, November 9. It will be held at the Embassy Suites Hotel on 17th Street Causeway in Fort Lauderdale. The goal of the Summit is to promote the well being of gay, bisexual, and transgender men living in the southeast United States through educational programs that enhance physical, spiritual, and mental health, in a nurturing environment conducive to learning and building community. Over 150 men from around the country will convene for a weekend of educational workshops, plenary sessions with nationally-known speakers, and opportunities to socialize and network.

This year's keynote speakers include Chris Bates (Acting Director of the U.S. Office of AIDS Policy, Department of Health and Human Services) and Cornelius Baker (National Black Gay Men's Advocacy Coalition). Several meals are incorporated into the agenda, as are twenty-eight workshops, including a series provided by Sunserve's Gay Male Empowerment Project on relationships. Other seminars will be presented on a variety of other topics including spirituality, methamphetamine recovery, sexual healing, physical health, aging in the gay community, HIV among black gay men, a forum on what's hot for younger gay men, and several other workshops on topics related to HIV/AIDS and other sexually transmitted diseases. Throughout the weekend there will plenty of opportunity for socializing and networking.

The Summit has received significant support from both the Florida and Broward County Departments of Health, South Florida Pride, and pharmaceutical companies such as Abbott, Gilead, and Tibotec. Because of this support many scholarships have been available and registration fees continue to be significantly reduced. More details can be found at the Summit website (www.gaymenssummit.com).

The Summit is a great opportunity to learn about the health challenges
facing gay men in the new millennium, create collaboration, form new friendships, and create new strategies to enhance positive self-regard and overall health improvement.

We hope to see you there!

My friend is Bill Jesdale, with whom I have worked on issues pertaining to gay men's health. He currently teaches at San Francisco State University. His research was published in the Journal of the Gay and Lesbian Medical Association (Volume 6, Number 2, June 2002 , pp. 61-69) in an article called "Enactment of Gay Rights Laws in U.S. States and Trends in Adolescent Suicide: An Investigation of Non-Hispanic White Boys." The objective of his work was to estimate the decline in adolescent suicide rates in relation to enactment of state laws offering protection from discrimination against sexual minorities.

• Students who have been harassed or attacked at school because of their gender are more than twice as likely as non-harassed peers to report having attempted suicide in the past year (13.4% vs. 5.2%).

• Students who have been harassed or attacked at school because of their race are more than twice as likely as their peers to report having attempted suicide in the past year (12.4% vs.5.9%).

• Almost a quarter of students who have been harassed or attacked at school because someone perceived them to be gay or lesbian report having attempted suicide in the past year - more than three times the rate their peers report (23.2% vs. 7.1%).

Laws and public policy that are anti-discriminatory can make a huge difference. With the research I mentioned earlier, my friend Bill and his colleague compared rates of suicide among non-Hispanic White boys aged 11-18 years before and after enactment of laws prohibiting discrimination on sexual orientation. Between 1990 and 1999, 9,639 such boys committed suicide in the United States. Bill found that states that enacted antidiscrimination laws had a significant reduction of suicides of gay youth relative to states that never enacted these laws. Even in the same states that enacted protective laws, there was a reduction of suicides after they took effect.

The research results are deadly serious: efforts to reduce heterosexual societal prejudice statistically affect the health and well-being of gays and lesbians.

Efforts such as Amendment 2 have a significant impact on the physical and emotional health of every member of the LGBT community. Even if you never intend to exercise your right to marry, it is important to remember that the social climate set by exclusionary laws and policies (and conversely, by anti-harassment and protective laws and policies) have a life and death impact that is reflected not only in suicide rates of gay youth but in potential physical and emotional violence against all of us, as well as increased rates of mood disorders and addiction.

We can save a life: vote no on Amendment 2.

Men who have sex with men accounted for 53% of these new cases, and African Americans, while only 13% of the U.S. population, accounted for 45% of the cases. These statistics represent a discouraging trend for both populations, especially for gay men who for many years saw a steady decline in new rates of infection.

Abstract numbers are difficult to personalize and it's extremely easy to disconnect our daily routines from this deadly trend. But every gay man needs to ask himself "what do these numbers mean for me?" Here are some things to consider...

A significant number of new infections occur because men who are HIV positive (but don't know it) inadvertently infect others. Having unprotected sex with someone who claims to be negative is foolish. Many men don't get tested because they don't want to know. Others may have not yet converted or worse, they're not being honest. Take charge of your health - get tested.

2. Do I engage in safer sex?

Practicing safer sex takes a little more thought and effort, but doesn't necessarily rule out an erotic experience. It is important to be informed about specific high risk behaviors, and with a little creativity something like putting on a condom can turn into a two-man operation that enhances the mood. Use your imagination!

3. Do I party a little too much?

A major factor behind the rise in HIV rates among gay men is substance abuse, particularly methamphetamine. Meth increases sexual desire while, ironically, causing erectile dysfunction. It also results in less impulse control and inhibition which translates to risky sexual behavior. There are many men who first used "Tina" and ended up with HIV. If you think you might have a problem, check out Crystal Meth Anonymous or Meth and Men South Florida.

4. What's the big deal?

Life with HIV isn't always as thrilling as it appears to be for the guy doing the rock climbing in that medication ad. While living with the virus has changed dramatically over the years, it remains a life-threatening illness that cannot be cured. The medications themselves can cause serious physical problems, including long term damage to the heart, liver, and kidneys. People continue to die from AIDS. It is a big deal.

5. So what can I do about it?

Make HIV your business, whether you are negative or positive or not sure. HIV/AIDS affects us all. Whether it's advocating for better public policy, or giving service to the community, or being sexually responsible, every one of us needs to get active. Let's make it the community norm to stay involved with the issue of HIV. This is life and death, and we have the power to make a difference.

The poor guy was in the throes of an anxiety disorder called Trichotillomania (use that in a sentence and impress your friends!), an irresistible urge to pull one's hair. And he wasn't the only one with symptoms of anxiety. We were all traveling on a recent day when yet another financial giant had collapsed, there was a general mood of uneasiness, and it seemed that we were all being pulled helplessly into very frightening territory. At the airport the mood was somber, people were unusually quiet, and many stood around watching the television monitors broadcasting endless bad news and dire warnings.

It seemed that Mel Brook's joke about the very, very nervous really captured what we were all experiencing and it reminded me of some basic skills I teach patients to help them deal with anxiety. I thought it would be useful to list a few of them here...

A great deal of energy gets consumed compulsively worrying about things in the past, things in the future, and generally things over which we have no control. This is frustrating as well as emotionally and physically harmful. It is very useful to determine where you actually have some influence over any given situation. It may be that choices are truly limited, but there is usually something we can do to assert a sense of empowerment. Even the act of making lists to organize our plans can help us regain a sense of control.

2. Take action, then let go of the results

Once you determine where you can be effective take deliberate action. Don't shoot from the hip, but also be wary of becoming paralyzed, a trap experienced by many people experiencing anxiety. Remember that doing nothing is in fact an action, and the results may not be in your best interest. Once you've done what you can do, monitor the results and re-evaluate where you go from there. Twelve step programs utilize the Serenity Prayer which captures this beautifully:

God grant me the serenity
to accept the things I cannot change;
courage to change the things I can;
and wisdom to know the difference.

3. Identify your safe place

Think of this as your "safe word" when life's scenes gets a little too intense. Select a place you can imagine in your mind that is soothing, calming, and comforting. It can be the beach, or the woods, or a mountaintop - whatever works for you. Anchor this spot in your imagination with as many specifics as you can: What time of day is it? What is the season and the temperature? Is there a breeze? What colors do you see? Are there sounds? Can you smell grass, or leaves, or the sea? Once you have determined your safe place, practice going there until it becomes effortless. It works because your mind can only focus on one thing at a time and it's easily distracted. Spending a few seconds there can have remarkable physiological and emotional effects, actually calming nerves, reducing blood pressure, even averting panic attacks. I use this when working with patients who have experienced trauma - it's powerful.

Like it or not, anxious situations seem here to stay. The more tools we have to deal with them, the more we'll be able to move through life with some sense of serenity, not to mention (at least for some) a full head of hair.

Such visuals, at one time widely used in drug prevention campaigns, may have had some value. For one thing, they certainly got our attention. Until recently, many gay men in our area were naïve about meth's downside and its potent and destructive addictive power. Florida arrived late at the meth party and we were able to learn a great deal about the epidemic and what to expect from gay communities on the west coast. But even treatment professionals were unprepared and uninformed about meth's unique properties.

These grisly illustrations, however, also had unintended consequences. Men struggling with meth took one look and went deeper underground. The images did little to assist them in stopping the drug, but did a lot toward increasing their shame about using it. Others in the community who never tried meth were appalled that anyone would use a drug that could do that, and a rift opened resulting in further polarization.

Now, no one can claim they are unaware of meth's inherent risks. But knowledge itself, unfortunately, is ineffective at fighting dopamine-fueled drug cravings. Scary skull pictures do little except remind users about the harm they are causing for themselves. While self-help groups have become increasingly available, south Florida has needed additional meth resources, and fast.

Enter Meth and Men South Florida (M&M), a new program of Sunserve (www.methandmen.org) that grew out of the South Florida Meth Task Force. M&M is dedicated to the support of men in our community struggling with the crystal meth epidemic. Their website already lists resources in south Florida, and will soon grow to include other informational pages. M&M is dedicated to filling gaps in services and in the near future will begin a therapy group focused on sexual issues in meth recovery, sliding-scale individual counseling, and a variety of other events like town hall meetings.

Save the creepy pictures for Halloween. With groups like METH 911 we can face a really scary problem together and discover that action and community trump fear every time.

While Steve's comments are based on a narrow view of sex appeal and contain more than a little self-pity and rationalization, the notion of invisibility and aging is shared by many gay men. It is true that both straight and gay culture value physical beauty and youth. Observing change in our bodies as we grow older can be difficult if we rigidly define ourselves by our looks alone. Steve spent a lifetime classifying himself based entirely on externals such as physical appearance and his career. Throughout his adult life they buffered him from shame and other uncomfortable feelings and when those became less effective he used drugs and alcohol to push discomfort aside. With time, however, nothing really numbed his fear that he was no longer valued and he found himself in a growing crisis of identity and self worth.

It is critical at any age to define yourself more broadly than by outward appearance alone. Otherwise, you miss the inner spirit that truly defines who you are. Self image can be enhanced in many ways. Practice developing an awareness of your unique skills, personal gifts and talents. Get in the habit of identifying positive personality traits as well as positive physical characteristics (not just what you dislike about your body --for some that is a real challenge). Develop gratitude on a daily basis and remember to nurture all of you: body, mind, and spirit.

Connecting to the community in a variety of ways is vital to this process. You are not alone. SAGE (Senior Action in a Gay Environment - www.sagewebsite.org) has many activities and supports. The GLCC (www.glccsf.org) hosts a variety of groups that provide social interaction outside of bars and clubs, as do many organizations in the faith community. It may take a little research, but many alternatives exist.

Once free of drugs, Steve took a hard look at his core beliefs and sense of self. To his surprise, he found that the wisdom he had gained through a successful career and a variety of friendships and relationships was eagerly sought by a community hungry for role models and elders. Once he began to value himself more, Steve felt more confident both socially and sexually. By valuing more than just his physical appearance, Steve not only became visible but liked what he saw.

The gay men's health movement grew out of resistance to a national trend of increasing moralistic condemnation of gay men and lesbians. This was further compounded by an unintended consequence of the AIDS crisis: a persistent reframing of gay men, their sex, and their lives in negative, pathological terms. This negativity pervaded even well-meaning efforts, such as HIV prevention programs, which were often based on fear and control, and which, ironically, have been rejected by many gay men resulting in a rapid increase of high risk sexual behavior.

The gay community certainly has serious problems ranging from addiction to epidemics of sexually transmitted diseases, but portraying us and everything we do as pathological, or at best sadly pitiful, is increasingly destructive. The LGBTQ community has an amazing gift for healing both ourselves and our communities. The gay men's health movement seeks solutions grounded in affirmative concepts of health and wellness.

At the closing in Boulder back in 1999, a call went out to continue these gatherings both at a national and regional level. The call was heeded and now the seventh Southeast Regional Gay Men's Health Summit will take place in Fort Lauderdale from November 7-9.

Nearly 200 men from around the southeastern United States are expected to converge for networking, workshops, and a lot of fun during this exciting weekend.

These are gay and bisexual men of diverse backgrounds, who share a common interest in promoting better physical, spiritual and mental health. Participants will represent urban, suburban, and rural areas from throughout the southeast. Men of color, gay youth, and gay men who have never before participated in formal health promotion efforts are especially invited to join the Summit.

The program will include plenary sessions, workshops, and social activities designed to increase health awareness and a greater sense of community. Break out sessions will be organized around four conference tracks: health and prevention, community building, relationships, and personal development. Workshop topics range from serious to light, including as sex and intimacy in crystal meth recovery, living with HIV, spirituality and the gay community, and one called "You call that a swimmer's build?" about "creativity" in Internet profiles. There will be several plenary dinners with nationally-known speakers, including Chris Bates, Director of Health and Human Services Office of HIV/AIDS Policy in Washington, D.C.

Would you like to participate? Workshop proposals can be submitted online until September 22 at www.gaymenssummit.com. There are a number of scholarships available to make the Summit affordable to everyone. See the website for registration and scholarship details.

In my practice I hear a nearly-universal complaint about a lack of community outside bars and clubs. Here is an opportunity to have a great time and experience other gay men in an affirmative and powerful weekend. Join us!

Southeast Regional Gay Men's Health Summit
November 7-9, 2008
Embassy Suites Hotel
1100 Southeast 17th Street
Fort Lauderdale, Florida 33316

www.gaymenssummit.com

There are many situations where this can be a problem. Couples (gay or straight) often have trouble speaking frankly about their sexual needs or concerns in their relationship. Revealing serostatus to a date or sex partner is a big concern for many gay men. And others, even after seeking out a gay physician, are reluctant to talk about their sexual practices honestly with them, which jeopardizes their health. I have had clients who prefer to get tested and treated for STDs at an anonymous clinic rather than at the office of their gay doctor. This is not for insurance reasons but because they are embarrassed about their sexual behavior.

How is your sexual competence? Here are some tips for speaking up about sex:

1. Respect yourself. Gay men and women need to work at self love even harder than society at large simply because we are consistently bombarded with negative messages, both overt and covert. You have a right to your feelings, a right to speak up and be heard, and a right to have your sexual limits honored.

2. Minimize embarrassment or shame when speaking about your sexual needs, concerns, or problems. You're not the first to have such feelings and not speaking up could have fatal consequences. That goes for discussions with your doctor, as well. I know one man who didn't want to speak to his physician about his anal warts which consequently went untreated and developed into rectal cancer.

3. Speak your truth, whether it's your HIV status, the need to use condoms, or your concern that your sex life might be a little out of control. Don't keep it to yourself. Speak up and be willing to listen to the feedback you receive.

4. Make your healthcare provider an ally. Be certain that you can frankly discuss your sexual practices and concerns in a safe, non-judgmental atmosphere. Even if you want to ask what you might think is a naive question, speak up, Believe me, they have heard it before.

Sex should be fun, but anxiety, anger, or other negative feelings resulting from unspoken concerns can quickly destroy the mood. When discussing something as important as sexual needs or sexual health, everything should be on the table. Your life depends on it.