Savage Love: I'm addicted to butt stuff and I won't give it up, even though it makes my balls hurt

Dear Dan: I'm a heterosexual cisgender man who loves prostate stimulation. I discovered it later in life, but it's been a staple for the last 15 years. I'm worried I'm pushing the envelope too much and need your advice.

Lately, the last six months or so, I will have an orgasm that's so intense I have pain just to the right of the base of my penis and balls immediately afterward. If I push a finger in toward the center of my body, it's tender. It goes away after a few minutes, but sometimes my right ball remains sensitive. I've even taken an ibuprofen to lessen the pain and I've had a prostate exam when it's happening and I do self-exams of my testicles regularly, and I've noticed no changes. Usually my next orgasm is normal, and there's no pain or sensitivity afterwards. As I said, though, it happens after intense sessions with a lot of prostate stimulation. While I've been practicing butt stuff for a long time, I feel as I've only perfected it in the last year or so.

I should also state that my sessions last up to two hours, and I'm erect during most of that time. I obviously don't want to hurt myself, and I don't think I am, but it's a concern. It's very hard to stop something that feels so incredibly good. I'm a little uncomfortable talking with my urologist because he treats me like a long-lost uncle. At our first visit, I told him very directly that my father had prostate cancer and I really wanted him to take his time with the exam and to really make sure all is well with my prostate. I added that the last exam I got from my primary care physician didn't last long enough to feel very accurate and encouraged my urologist to take as much time as he wanted up there. He did not. Hoping you can help me out. — Pain Around Balls Concerning

"I've never had a patient specifically say they wanted me to 'take my time' with a prostate exam," says Dr. Ashley Winter, a board-certified urologist in Portland, Oregon. "But on numerous occasions, I've had a patient say, 'Wow, that was way more detailed of a prostate exam than my primary care doctor did.' And generally, that comment is meant as a 'thank you,' as in, 'thank you for being detail-oriented.'"

To be perfectly honest, PABC, I shared your letter with Dr. Winter because I suspected the request you made — "take your time up there, doc" — might've been the reason your doctor rushed through that prostate exam. Dr. Winter assures me that was unlikely.

"I understand when someone wants their doctor to do a thorough exam," Winter says. "A detailed exam shows the clinician is actually intent on collecting information about their body apart from lab tests and imaging studies. The patient feels 'seen.' Or touched. You get my point."

But just as a prostate exam that ends quickly isn't evidence a doctor is worried a patient might be perving, an exam that ends quickly also isn't evidence a doctor isn't being thorough.

"Some patients have a very 'high-riding prostate,' for example, and that's difficult to feel except for the apex, or the tip, of the prostate," Winter says. "And I have long fingers! In those cases, I will probably do a quick in-and-out because taking longer would just involve me massaging the anus with no specific information being gathered."

There's nothing wrong with massaging an anus for the sake of massaging an anus, of course, but no one needs to go to med school and/or to the doctor for that. But while I had her on the phone, I asked Winter again if some people do go to the doctor for that.

"In extremely rare instances patients are manipulative or fetishize their exams, but this is extremely uncommon," Winter says. "And while I can't rule out the possibility that the urologist who saw PABC was 'weirded out' by his comments, it seems more likely that PABC is projecting that on to his doctor. There is so much shame around 'butt stuff' and so I can easily see how this happens." (It's also possible that I'm the one doing the projecting here, as I was the one who raised the issue.)

That said, while intentional perving is rare, some people do get aroused during exams.

"Unintended genital responses — whether erection, or prostatic secretion during a rectal exam — are normal and occur on occasion," Winter says. "It is the role of any self-respecting sex-positive clinician to acknowledge that these things are normal and move on. But it's super uncommon and when it happens, the patient is usually stressed out and very apologetic about it."

As for your problem — sensitivity around the base of your penis after one of your extended butt-play JO sessions — Winter thinks you might need a different sort of exam altogether.

"It sounds like what he's having is a pelvic floor muscle spasm," Winter says. "People tense and contract muscles in their pelvis — muscles at the base of penis — during periods of prolonged stimulation. He's not doing anything wrong, and he doesn't have to stop. But he might want to take a warm bath after. And if it's too uncomfortable or gets worse, he should ask to be referred for a pelvic floor exam and possible pelvic-floor physical therapy."

Follow Dr. Ashley Winter on Twitter @AshleyGWinter.

Dear Dan: There's a long-running controversy among the Adult Baby/Diaper Lover (ABDL) community about the long-term impacts of continuously wearing and using diapers. Some argue that adult babies may or may not become a bedwetter and/or incontinent from continual diaper use. The ABDLs who claim to have been successfully "un-potty trained" are loudly decried as liars by other members of their community.

Naturally, there aren't a lot of medical studies on this (there aren't any), and I'm not going to ask my family doctor. Can you figure this out? — In Nappies Cancels Out Nocturia

Dear INCON: Nope.

Dear Dan: I'm a 74-year-old straight man. I don't have a problem for you. Instead, I am writing to share an idea with you with potential benefit to society. But, unlike you, I don't have the means to spread the news. Based on the success of your "It Gets Better" Project, you seem like the perfect person to publicize it. My idea and my proposal to you is this: International Come-Out-of-the-Closet Day. It would include coming out about your sexual orientation, but would not be limited to sexual orientation. It would include all long-suppressed "secrets," including affairs, crushes, no longer being in love with your spouse or anything else a person might have kept hidden.

I even have a suggestion for when to celebrate International Come-Out-of-the-Closet Day: March 4. The slogan would be "March Forth on March Fourth!" What do you think? — Movement About Really Changing Hearts

Dear MARCH: We already have a National Coming Out Day, when closeted queer people everywhere are encouraged — if they can do so safely — to come out to their families, friends, neighbors and co-workers. NCOD is not a new thing; it's taken place on Oct. 11 every year since 1988. And while I appreciate the spirit of your proposal — let's all get those long-suppressed secrets off our chests — I'm not sure you've thoroughly thought this one through.

If one day a year we blurt out our secrets — affairs and crushes and secret second families included — the result would probably look less like National Coming Out Day and more like The Purge. And since most people regard breaking up on an annual holiday as a needless and avoidable cruelty, people who confess to affairs or no longer being in love on International Come-Out-of-the-Closet Day will not be seen as courageous truth-tellers, MARCH, but as inconsiderate assholes.

It's fine to dump someone; people fall out of love, people have affairs. But no one thinks it's OK to dump someone — or to share a secret that forces someone to dump you — on Thanksgiving or Christmas or Valentine's Day. Because then the person whose heart you stomped on winds up being reminded every year when that holiday inevitably rolls around. So, for the same reason it wouldn't be OK to blurt out terrible secrets on the holidays we already have, it wouldn't be OK to blurt them out on a day dedicated to blurting out terrible secrets.

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