Hemorrhoids have long been a subject of quiet embarrassment for gay men. Multiple attempts to get quotes for this article on Craigslist elicited laconic responses. Except for a couple of “this is the funniest Craigslist post I have ever read” and, my personal favorite: “this is a hookup site, not a science lab, bitch,” nobody wanted to talk. It turns out talking about hemorrhoids can be as difficult as properly spelling the word.

Hemorrhoids are a problem for many people, ladies and gents. They are caused by excessive straining or pressure on the anus, especially during defecation or pregnancy. This straining causes veins in the anus or rectum to swell and tear slightly. A hemorrhoid can cause small amounts of blood to pass with the stool and some pain, but they're pretty harmless and usually will clear up on their own.

Whether or not the case of hemorrhoids becomes a problem can have a lot to do with the size of the enlargement and the activities in which you choose to involve your butt. While humans can't choose whether or not to release fecal matter, they do choose which body parts they want touched and penetrated. While anal sex can be totally hemorrhoid-free, not using enough lube is an easy way to cause rectal tearing that can turn into nasty hemorrhoids.

An All Too Common Problem

Men and women, gay, straight and celibate—our anal canals all work the same way. Too much pressure can cause hemorrhoids, and anal sex can exacerbate them. And once you have hemorrhoids, if you clean them too much or scratch them too hard, they can get worse and you’ll find yourself in a vicious cycle.

The peak age for having hemorrhoid problems is between 45 and 65, but younger people can certainly still get them, and pregnant women are particularly prone to these little monsters. In fact, hemorrhoids have become a problem for over 10 million people in the United States alone. Some researchers estimate that as many as half of all Americans have some sort of hemorrhoid problem.

But how can you tell if hemorrhoids are lodged right in between your cheeks? There are two different kinds of hemorrhoids. Internal ones usually swell and cause bleeding without pain. External hemorrhoids ache because they are the result of blood clots that have become swollen.

Both kinds of hemorrhoids can cause pain and feel rather uncomfortable. They may also be itchy, but this isn't the fault of the hemorrhoid, per se. Rather, it is an indication that you need to do a better job wiping the area clean after use and make sure you wash the area with mild soap and water when you shower. You should see a doctor if you notice any lumps, bumps or flaps around your anus.

Embarrassment from Below

What can seem like a mere feces-related nuisance for some can be a consuming issue for others. For men and women who do not see their rectal area as an erogenous zone, hemorrhoids may never leave the bathroom. But for women who enjoy anal sex and gay men who count on their butts as their main sexual asset, the enlargement of these tissue clumps called hemorrhoids can represent an obstacle in the pursuit of sexual satisfaction.

As if anal sex wasn’t complicated already (the artificial lubrication, the tightness, the puritanical guilt), hemorrhoids can help traumatize sexual experiences for gay men in a similar way that—an ironic analogy—women’s periods do in heterosexual relations. And being an issue so inexorably related to a body part so prone to uneasy sentiments and juvenile jokes, shame can hinder people from diagnosis and treatment—but, not from the embarrassment of stained bed sheets and wine-colored, post-coital condoms.

Hemorrhoids can bring trouble to oral sex for gay men as well. What is this extra fat flap doing up in here?Why do I taste blood…? This bodily annoyance can add to the psychological baggage gay men inevitably take to bed with them, consciously or not. Is this natural? Is this really supposed to take place? Why does my pleasure make me bleed?

The problem of shame echoes other utterly intimate maladies that often make people timid about seeking help: sexually transmitted infection and HIV testing, breast and testicular exams, and so on. It seems like the more intimate the issue, the more we feel compelled to hide it.

The Cause of the Concern

But what causes the anus to go from well-behaved tissue to a vicious, blood-spewing queen? It is well-known that not getting enough fiber and ingesting too much fat—basically eating the average American diet—can cause anuses to go from quiet ladies to obnoxious bitches. For the java-addicted Starbucks junkies, brace yourselves: caffeine can worsen the symptoms. So can alcohol and spicy foods. But there's no real evidence that any of these things cause hemorrhoids in the first place.

The good news is there is no causal relationship between anal sex and hemorrhoids. While the practice may make the symptoms worse (you can’t throw a stick in the beehive and expect the little bees to stay quiet) one doesn’t cause the other. So go ahead; work it. Just make sure you use lots of lube.

The old wives’ tale that reading in the toilet causes the problem, however, might be true; putting pressure on the lower rectum for extended periods of time can cause the veins to swell. This, in turn, can cause the tissue down there to inflame. So make it quick, and don’t bring the Blackberry with you.

In men and women who are HIV positive, the immune system’s impaired function can make hemorrhoids take longer to heal, especially among those who practice anal sex. If you have persistent, mean hemorrhoids, by all means get tested for HIV. Another medical issue is inflammatory bowel disease, which can irritate the digestive tract and cause recurrent hemorrhoids.

Fixing the Problem

The good news is that there are several options for treating these annoying little bulges. You can try modifying your diet, using topical creams, or as a last resort, surgery.

A diet rich in fiber helps to soften stools and lessen pressure during defecation, which should relieve the problem. Eating fiber-rich foods should be your first strategy, but you can supplement your diet with over-the-counter medication such as Metamucil®, Fibercon® and Citrucel®, which aim to make the bowel movements softer (now you know what the tube of Proctosedyl® is doing on your roommate’s shelf of the medicine cabinet). But laxatives are a no go; they tend to cause even more burning.

Metamucil® actually offers free samples on their website, where they go on to suggest ice packs (now picture that) and warm baths as ways to reduce hemorrhoid-related pain. They also recommend using the soft, silky toilet tissue on your million-dollar derriere. You can also get creams and ointments, like Preparation H®, to soothe the burning on your bum.

Medical intervention (such as hemorrhoidectomy, a surgery that requires either general or spinal anesthesia and removes the hemorrhoids with a scalpel or laser) is a possibility but is usually reserved for the most severe cases, not as cosmetic remedy. Recovery time can last 2-3 weeks, so the surgery is by no means a quick fix. Sorry, but you can't get yourself new ass like you would a new nose.

To maintain a hemorrhoid-free ass, keep that diet high in fiber; don’t take all day in the John; and, make sure your anal adventures are well lubricated. If you follow these steps, your erogenous back door should stay embarrassment-free.