[Question #1832] Mutual Masturbation Clarification

90 months ago

Good Afternoon, Doctors:

I understand that you have written a lot on this subject both on here and on medhelp; however, I just wanted to ask some additional questions that I had re mutual masturbation.

Background: I'm a man who has sex with men who is in a committed relationship with another man. Recently, I had an incident at a local spa that has concerned me. The incident only involved mutual masturbation and incidental exchange of miniscule amounts of precum.

My questions are as follows:

1) what is the risk associated with mutual masturbation where each party is touching his own genitals and then the other party's genitals and back and forth?

2) what is the risk associated with the other party "tapping" the head of his penis with his finger (as if he was checking for precum) and then (in quick succession) "tapping" the head of my penis with the same finger?

3) does such brief tapping or running his finger along my meatus actually provide direct access to the urethra's mucous membrane? Or is the urethra's mucousal surface located further in my penis?

4) I read an older CDC report saying that HIV loses infectiousness as soon as it is outside the body; is this true? How would that play out in this scenario? Would the dry heat of a sauna have any effect on the breakdown of the virus?

5) would I put my partner at risk if I resumed unprotected sexual relations with him from the event I described?

6) does this incident necessitate testing?

Thank you in advance for your time and consideration.

Concerned Inquirer

Edward W. Hook M.D.

90 months ago

Welcome to the Forum. I happened to see your questions soon after you posted them and will do my best to help out. Your question as a tone of "how close can I go to the fire without being burned". The activities you describe are almost certainly safe sex although as noted, one might argue about theoretical risk. Sorry I cannot provide scientific data for this situation as there are none but I suspect contact of the sort you describe has occurred thousands and thousands of times in the past without consequence.

1) what is the risk associated with mutual masturbation where each party is touching his own genitals and then the other party's genitals and back and forth?

This is a no risk exchange of secretions. In the absence of penetration, contact with a partner's genital secretions during mutual masturbation carries no risk for STIs or HIV, even if that person is infected and is considered "safe sex". My assurance is validated by similar statements from the U.S. CDC.

There are no studies on this specific act however from a theoretical perspective, one might see how such an activity might result in introducing infected material into the urethra and as such lead to infection. having acknowledged this as a theoretical concern however, I would expect this risk to be quite small.

3) does such brief tapping or running his finger along my meatus actually provide direct access to the urethra's mucous membrane? Or is the urethra's mucousal surface located further in my penis?

See above.

This is true. It is unlikely that the dry heat of a sauna would do anything to prolong infectiousness of such activity. If anything, I would expect the infectivity to decline even faster, if that is even possible.

5) would I put my partner at risk if I resumed unprotected sexual relations with him from the event I described?

Most unlikely. You are dealing with the realm of theory here. I would not be worried.

6) does this incident necessitate testing?.

I do not recommend testing for such activity unless symptoms develop (which again, I emphasize, is most unlikely). I would not be worried about unprotected contact with a regular partner.

I hope these responses are helpful to you. EWH

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90 months ago

Thank you for your prompt reply, Dr. Hook! I have some follow up questions. First, I would like to clarify that my tone is more how much did I mess up rather than how closely can I toe the line.

Nonetheless, my questions are as follows:

1) if this is a "no risk exchange of sections," why is it most unlikely that I put my partner at risk? Shouldn't it be a no, I wouldn't put my partner at risk?

2) if HIV loses infectiousness outside of the body, how is there even a theoretical concern for genital hand genital contact of the kind I described?

3) I am still trying to understand where the mucousal surface of the urethra begins...does touching the meatus when its sides are touching (like closed lips on your mouth) provide direct access to the mucous membrane lining the urethra?

4) I recently read that in order for the hiv enter a mans urethra, the penis would almost certainly have to be inside a vagina or anus. Is this true? If so, could you please explain why?

5) I know we were both speaking a lot in theoretical terms in your first exchange; however, from my practical standpoint, how would you quantify this risk? 1 in 100,000? 1 in 1,000,000? Even smaller?

Thank you again and I appreciate your patience.

Edward W. Hook M.D.

90 months ago

Thanks for the clarification. Now I should clarify my statements. In science there is no such thing as "no risk" or "impossible" as something that has never been seen before could happen in the future. That said, the term "no risk" might better be said as "virtually no risk" in the same way that while I suppose it is possible, I would say that there is "virtually no risk" that you will be struck by lightening while reading this reply. In my world no risk, and very unlikely are synonymous. With this background, let me address your follow-up questions.

1) if this is a "no risk exchange of sections," why is it most unlikely that I put my partner at risk? Shouldn't it be a no, I wouldn't put my partner at risk?

Your regular partner is not at meaningful risk. I urge you not to worry.

2) if HIV loses infectiousness outside of the body, how is there even a theoretical concern for genital hand genital contact of the kind I described?

Please see above.

The mucosal surface begins inside the opening of the urethra. If the sides of the meatus is touching the mucosal surface is not exposed.

4) I recently read that in order for the hiv enter a mans urethra, the penis would almost certainly have to be inside a vagina or anus. Is this true? If so, could you please explain why?

I am not sure of the source of this information. The act of penetrative sex would lead to opening of the urethra, allowing infected secretions to enter the urethra and penetrate the mucosal surface.

5) I know we were both speaking a lot in theoretical terms in your first exchange; however, from my practical standpoint, how would you quantify this risk? 1 in 100,000? 1 in 1,000,000? Even smaller?

there are no scientific data to inform my answer however I would estimate your risk for infection as being less than 1 in a million. I really would not be worried about the events you have described. Sorry if my terminology was concerning. EWH .

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90 months ago

Thank you for your consideration, advice and patience thus far. I understand this is my last post and I would truly appreciate if you answer my "leftover" questions:

1) Given that the theoretically infected precum (as I don't know the other party's HIV status) was transferred in a such an indirect manner (genital hand genital), would it have been rendered non-infectious by the time that he touched my genitals?

2) would infected materials be able to "crawl" or "seep" past the closed meatus into the urethra?

3) have you or your colleagues ever seen an instance where a miniscule (I cannot even be sure if it was precum or sweat given the sauna) amount of pre ejaculate lead to infection?

4) if you were me, would you just try to put this behind you and move on without any concerns?

Thank you again for your time and consideration. You have been most helpful and sorry if my last round of questions was a tad renduant.

Edward W. Hook M.D.

90 months ago

1. Questions about the timing of events is splitting hairs. There is no evidence that contact of pre-ejaculatory fluid from an HIV infected person in the context of mutual masturbation will lead to infection. This is a function of both exposure of secretions to the atmosphere and the barrier function of the skin.

2. No.

3. No.

4. Yes, I would put the events you described entirely behind me and move forward without concern. I would not feel a need to seek (or recommend) testing.

I'm pleased you found my comments helpful. This thread will be closed later today. Take care. EWH

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