How to Do It is Slate’s sex advice column. Have a question? Send it to Stoya and Rich here. It’s anonymous!

Dear How to Do It,

I’m a woman with a thing for bisexual men and I have multiple boyfriends at the moment. Two of them frequent the local gay bathhouse but only give and receive oral sex there. I am their only female sex partner.

I am wondering if it’s especially dangerous for me to have unprotected oral and vaginal sex with these men considering the fact that they are giving and receiving unprotected oral with men anonymously. I know that there is always some risk involved, but aside from the virus that causes genital warts, are there any other STIs that I am at high risk for getting?

We do get tested regularly but I don’t know if normal tests would show an infection of the throat.

—Hot for Bi Men

Dear Hot for Bi Men,

“High risk” is a bit of a fuzzy concept here because of the medical interventions that science and technology have afforded us. Doxy PEP (that is antibiotic therapy taken after potential exposure) reduces the risk of contracting bacterial STIs like syphilis and chlamydia (and, perhaps to a lesser degree, gonorrhea). If your guys are on this, their risk is lowered and yours would be as well. There is little risk of contracting HIV via oral, but PrEP could also potentially help with this, as regular STI testing is part of the regimen. That can catch STIs that are asymptomatic and would have gone otherwise undetected.

HPV is certainly a risk, though given your sexual activity, you have likely already been exposed to it (the overwhelming majority of sexually active people have been). Herpes, too. There are also lesser discussed infections like trichomoniasis, shigella, and giardia (the latter two generally come from anal contact).

The simple fact is that to some degree, you’re at risk for all of this. So are your partners. Highly sexually active partners may create more opportunities for these infections, but all it takes is one act to contract one (or more). This is the risk you assume when you have sex with someone. Routine testing and the medical interventions described above can help (note that doxy PEP has only been CDC-recommended for cis men and trans women). If your STI testing doesn’t include throat and rectal swabs, you can certainly request them.

Please keep questions short (<150 words), and don‘t submit the same question to multiple columns. We are unable to edit or remove questions after publication. Use pseudonyms to maintain anonymity. Your submission may be used in other Slate advice columns and may be edited for publication.

Dear How to Do It,

My wife and I have had only very vanilla sex for our 40+ years of marriage. Very enjoyable, but not as exciting as it used to be. It is pretty much always the same. And I am always the one initiating.

I have gladly given her oral during our pre-marriage and married years, as I enjoy giving it as much as she enjoys receiving it. However, she has never reciprocated or even asked if I’d like her to do that. I haven’t ever asked her why. I know I should. I’m just afraid of a negative reaction if I ask.

I have also asked her many times if she has anything different that she would like me to do or for her. Her answer has always been that she is very happy with what we do now. She has never asked me if there is anything that I would like her to me. Ditto to my fear above.

I have two fetishes that I would like my wife to perform. One is to tie up my cock and balls, then jerk me off. The other is to incorporate her smoking a cigarette during our intimacy and foreplay. I have asked her if she would be willing to smoke a cigarette. Her answer was a hard no. I know the tying up of my genitals is a wholly different level of ask.

Any suggestions on what actions I should take to change the results?

—Wanting More

Dear Wanting More,

You are a living embodiment of the quote (sometimes attributed to Madonna) that goes: People don’t get what they want because they don’t ask for it. You have two choices. You can continue to live in fear of rejection and not get what you’re looking for sexually, or you can challenge that fear, ask your wife for what you want, and maybe not get it. More importantly, maybe you will get it. It’s an uncertain outcome, but if you keep going the way that you are, you will certainly not get the experiences that you seek.

It sounds like you’ve been extremely considerate toward your wife, to the point of over-politeness. Hold onto that love and compassion, and extend some to yourself. Your wife turned down your request to smoke a cigarette during sex, and while I understand what you mean about tying up your genitals being “a wholly different level of ask,” life isn’t a video game. There isn’t an A to B progression when it comes to sex acts. There isn’t always logic to apply to what people are and aren’t into. On top of that, there are reasons to refrain from smoking a cigarette that have nothing to do with sex—maybe your wife doesn’t like the smell or how cigarettes make her feel. Maybe she just finds cigarettes generally disgusting. I can relate to this way of thinking—I would put just about any penis in my mouth before I would put a cigarette in it. As you can surmise, I’m not a prude; I just loathe cigarettes.

So have these conversations with your wife. Ask her about oral. See if she will allow you to engage her in what are sometimes difficult or uncomfortable conversations. It sounds like she is entirely satisfied with your sex life, which is a wonderful thing. Emphasize that you have found it very enjoyable as well—so enjoyable that you’d like to explore a bit more with her, since she’s been such a wonderful partner. She may turn you down entirely, which is her right, but if you keep things kind and positive, she will be way more likely to at least hear you out.

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Dear How to Do It,

I had prostate surgery three years ago and have still not been able to get back to my normal sex life. Before prostate cancer, my wife and I had sex three to five times a week. Sometimes it was quickies; other times it was longer play. We are both in our 60s.

The doctor has prescribed pills and pumps and cock rings, but they don’t sustain my erection long enough to satisfy my wife. I have used the Trimix injection, which works well and keeps my erection for an hour.

My question is this: When we travel to Europe, I can’t take Trimix with me. It has to stay refrigerated and you have to declare it, making for an embarrassing discussion at customs. I am wondering if a penis sleeve that could go over my flaccid cock but be rigid enough for sex, including anal, is a possibility.

The internet is full of dildo-style toys, but I’m looking for something more specific. Any advice would be appreciated.

—To Sleeve or Not to Sleeve

Dear To Sleeve or Not to Sleeve,

Congrats on finding a solution for you—post-prostatectomy sex can be very difficult to navigate. It’s generally not a topic of mainstream conversation, and though many options exist, not all work for everyone, as you know well. But you found a way. The good news is that even if you were to find no suitable alternative for your trip to Europe, that trip is only temporary and you will soon return home to your Trimix, which you don’t have to discuss with anyone (though I’m assuming your wife is aware). The problem here will resolve even without the solution that your letter seeks.

I think a sleeve is definitely worth a try. These range in price. You could get a relatively inexpensive one like Adam’s Extension, which has nubs outside (for her) and inside (which may provide stimulation to you). Higher end ones like those from RX Sleeve could set you back a few hundred or even more, depending on your desired level of customization. (With that brand specifically, there is a chance of insurance reimbursement.) Keep in mind that the data on these is not robust, but the authors of the 2017 paper “Non-pharmacological and non-surgical strategies to promote sexual recovery for men with erectile dysfunction” did not consider that to be invalidating. “Studies on these aids are admittedly sparse and mostly anecdotal, but that should not preclude considering them as therapeutic options,” they wrote.

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Another option in that paper that you might want to consider is The Elator, an “external penile support device.” This allows penetration without an erection via a rod that runs along the bottom of the penis that’s attached via rings at the base and around the head. The price point is in the $300 range. There is also the option of a strap-on, which is typically a dildo connected to your body via harness. Typically, the penis does not go into the penetrating object (unlike a sleeve, though the RX Sleeve also attaches via harness).

“What’s the point?” you may be asking, but according to the authors of the above cited paper, “case reports indicate that an external prosthesis, when incorporated in penetrative sex, may recreate the sensory experience of coital sex without the patient needing the penile rigidity for intercourse.” Your partner could play with your penis while you penetrate her with the dildo, but also the entire experience could get you in the headspace of penetrative sex.

So say the authors:

For men who are adventurous and attuned to the totality of sensory stimulation during sex, the sensory experience achieved during intercourse with an external penile prosthesis may closely match the sensory experience of normal coitus and lead to orgasm. Use of the prosthesis can empower patients who accept the prosthesis as part of themselves, much the same way that well-adapted wheel-chair dependent patients come to accept their chair as an extension of who they are.

I find that fascinating. Maybe you will, too. The paper is well worth reading, as the benefits of these non-medical ED options are well articulated and it may also give you more ideas. For example, the authors stress the importance of including your partner in selecting and using these devices (setting them up/putting them into place may be a form of foreplay). They write:

Involving partners in such activities can build intimacy in a broad sense, even when the aids do not restore full erection. This is predicated on the fact that intimacy can be considered as something a couple shares with each other and no one else. While penetrative sex may be considered archetypal intimate act, a simple activity of shopping together for sex aids is still an intimate act that can thus strengthen co-supportive spousal/partner bonds.

Good luck!

—Rich

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