FIST THEORY

==Taken from a post by Finn Vortex on F-Squared==
Fisting and Your Doctor
How to Talk About Fisting with your Primary Care Giver
Introduction
A recent discussion in an online fisting forum brought to light a few misconceptions regarding interaction with your physician. They included the following:
•	You don’t need to discuss fisting with your doctor (it’s only necessary on a need to know basis)
•	Your doctor can determine if you fist or have been fisting by a rectal examination
•	Most doctors know about fisting and the associated medical considerations and complications
This article deconstructs these myths with regards to your primary care provider. It does not provide details relevant to specialized providers (gastroenterologists and colorectal/general surgeons).
Breaking the Ice
Because anal fisting is considered taboo in most parts of the world, it may be difficult for both you and your practitioner to discuss the topic. Societal values push us into the closet, and many fisters wonder if it is even necessary to come out to their primary care provider. After all, what one does in the privacy of his own bedroom is hardly relevant to his medical care, right? Wrong! Fisting can affect your overall mental and physical health in ways that traditional sex (anal or other) does not.
Unfortunately, there is no easy way to come out other than having a specific conversation with your doctor. Most providers are trained to be non-judgmental and non-reactive (at least while in the consult room) to any piece of information you tell them. This training is designed to make you feel comfortable so that you can share any information regarding your health, regardless of how awkward or embarrassing it may be. That being said, practitioners are people too, and may be uncomfortable themselves because of their upbringing or lack of knowledge about the subject.
If your provider lectures you about fisting after coming out, it may be time to change to a more kink-friendly provider. It may also be a time to re-examine your own behaviors because he may know more than what you expect him to know based on interactions with other patients.
Educating your Doctor
It is incorrect to assume your doctor knows anything about brachioproctic insertion. His knowledge may be limited to pop-cultural references or previous experiences with patients over the years. Medical schools and residency programs do not have curriculum dedicated to this activity. It may be important to ask your doctor about his familiarity with the practice and provide him some education. He can then alter your advice, screenings, and treatment plans based on this education and his knowledge of male physiology.
Use Your Words
You and your doctor need to speak the same language. You may need to teach him some basic vocabulary and jargon so that you are on the same page. These are common terms you use that may be new or unfamiliar to him: session, ass play, rosebud, hole, rings, and j-lube.
Diversity in Handball
You may also need to explain to him that there are several sub-genres of play: depth fisting, punch fisting, girth- and double-fisting, prolapse play, and advanced toy play. It’s important to let him know what kind of play you are into so that he is aware of potential complications.
Risk Tolerance
You can also discuss with your doctor that the very nature of fisting increases your risk of contracting certain infections or experiencing other medical conditions compared to the non-fisting public. Specifically, you should educate him on the following:
	Boundaries and Societal Norms – You may be at risk because of decreased inhibitions of you or your partner. Fisters have less inhibitions than others and are willing to experiment sexually with many things such as group sessions, oversized and non-traditional toys, and mind-altering substances (specifically pot, poppers, Molly, and meth).
	Etiquette – You may be at risk because of you or your partner’s assumptions and experience levels. Generally, Fisters follow a set of unspoken rules and guidelines during a session. This includes things such as sanitation practices, extensive douching, pinkness, aftercare, and communication. While most fisters try to evaluate in advance the skill level of their partners, some assumptions are always made to avoid dampening the mood.
	Micro-tears – You are at risk because all fisting results in micro-tearing. Fisters monitor their sessions with observations on lube coloration. Lube is usually clear or white when a session starts but may turn pink as a session continues. Usually, a Top will notify a Bottom about the coloration of the lube, especially as it darkens. Dark red spots or streaking will often result in termination of the session. Many fisters won’t present to a doctor for dark red spotting until other symptoms are observed. Micro-tears increase the opportunity for transmission of STIs, specifically HIV and HEP C.
	Protection – You may be at risk for higher transmission of STIs. Glove and condom usage is usually at the discretion of the Bottom. Not all sessions include anal sex; however, many do. It’s not uncommon for penetration to occur before, during a session. Ejaculation isn’t necessary, nor is it the terminating point of a session. Both the Top and Bottom may receive oral sex during a session, usually unprotected. And finally, many Tops enjoy anilingus (rimming) during a session.  A majority of fisting sessions occur without any protection at all.
	Lubrication – You may be at risk because of the type and quantity of lube used. Tons of lubrication options exist for play sessions. Most fisters use Crisco or veterinary obstetrical lube (J-Lube). J-lube is typically safe except when introduced into the peritoneal cavity in larger quantities via a tear or puncture. It is not uncommon to have large quantities of J-lube in a Bottom.
	Douching – You may be at risk because of your douching practices. While I know many fisters have been douching daily for decades and experienced no health concerns, there is growing evidence regarding natural expulsion of fecal material has certain health benefits. If you notice gastro-intestinal or general health issues, you may want to discuss the frequency and style of douching with your doctor; otherwise, you can probably keep this one to yourself.





Educating Yourself
Over time, your doctor builds a profile about you to help him effectively monitor your health and treat your medical conditions. Your own assumptions about fisting may be impeding the compilation of a correct profile.
Developing a Baseline
It is helpful for your doctor to have a baseline of your overall health and an understanding of your sexual practices in order for him to test and treat you correctly.
Sexual Health and Screenings
Your doctor should order the standard STI panel based on frequency of sexual activity. He has general guidelines for ordering the panel based on requirements from national health system and medical associations. To know what tests are necessary, you should tell him the approximate number of sexual partners since your last screening, whether protection was used, and the activities that occurred. Cultural taboos may prevent your doctor from asking these questions directly, so you should offer the information unsolicited.
While HIV, syphilis, gonorrhea, and chlamydia are part of the regular battery of tests, hepatitis B, hepatitis C, HPV, HSV, c-diff, throat/rectal occurrences of gonorrhea and chlamydia, and gastro-intestinal parasitic infections are not. Most doctors will only run those additional tests if you complain of certain symptoms. Ask your doctor how often you should be tested for these items. Fisters are at a higher risk of contracting HIV and HEP C due to the micro-tearing that occurs in most sessions.
Note that if you were treated for an STI in any place other than his office, you should inform your doctor and bring testing results so he can maintain a history in your chart. Most electronic medical records systems do not communicate information freely, including those from your local health department.
Colorectal Health and Screenings
There are additional tests and screenings that doctors routinely check unrelated to your sexual health. The primary examination involves prostate screenings: digital (fingering) and Prostate Specific Antigens (PSA). Stimulating the prostate via fisting can increase your PSAs and send false flags to providers. Your doctor needs to know if you have fisted recently to determine the validity of those tests. In general, you should avoid fisting for at least a week prior to your physical to get accurate results.
At a certain age, you will need a colonoscopy to assess cancer risks and other aging diseases related to the large intestine. Identifying your fisting practices to the screening physician will allow him to look for damaged areas (small rips and tears), identify any additional areas of concern, and eliminate false flags during his screening.
Piles (hemorrhoids) can be a complication due to fisting. They may result in discomfort and anal itching.
Ocular Health and Screenings
Poppers in small amounts are not dangerous; however, a fisting session may last several hours and involve extensive use of poppers. You don’t need to share your fisting history with your eye doctor, but if you frequently use poppers (daily), or in large doses (three or more hits with regular weekly or bi-weekly sessions), you should let your physician and your eye doctor know. Your doctor will advise against use or will advise that you limit use to decrease your risk of permanent nerve damage and blindness. This is not anecdotal or judgmental advice. There are multiple documented cases where extensive popper use has resulted in blindness.
Mental Health and Screenings
When discussing fisting with my personal physician, he noted that men who identify fisting as their primary sexual activity often have a different mindset than the general public. Fisting becomes an integral part of their identity and may affect behavior and rational thinking. Modifying destructive behavior or irrational thinking related to fisting is often very difficult for fisters.
A mental health professional may be needed to alter inappropriate, dangerous, or high-risk behavior. With that in mind, you should discuss with your doctor the frequency of your play, substances used during play (and the frequency at which they are used), the type of fisting that dominates your play (punch, depth, girth, prolapse), your role in fisting (top or bottom), and the type of relationships you have with partners.  If he notes anything dangerous above the normal risks and the general spectrum of emotion and behavior related to human sexuality, he can refer you to outside assistance.
Summary
Fisting does affect your general health and thus, your relationship with your doctor. You should not be ashamed of your sexual practices, and you should openly discuss your practices and behaviors with your provider to ensure a long and happy life and fisting career. Avoiding these discussions can result in misdiagnosis and inappropriate testing and treatment.