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As has been shown in other studies, the lack of formal sex education resources targeted to msm may lead them to alternative sources of information, such as sexual partners, msm peers, web-based resources, and pornography (. Participants also reported that prevalence and severity of painful rai decreased as sexual experience increased (. Poor access to lubricants and sti treatment may make it harder for msm to minimize pain during rai and increase their likelihood of contracting or transmitting hiv and other stis. The content is solely the responsibility of the authors and does not necessarily represent the official views of the national institute of mental health or the national institutes of health. Difficulty in passing stools and extreme constipation are common symptom of the condition. Black msm living in south african townships were the focus of the study given the relative invisibility of msm in hiv/aids research in that setting (. Feeling a continuous urge to pass a motion, with no production, possibly with increased mucus can also be a warning sign.

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In some cases this leads men to self-medicate, seek treatment from unqualified health workers, or not be forthright about their symptoms when seeking treatment (. ), and thus understanding the links between painful rai, alcohol use, and unprotected sex is crucial to hiv prevention efforts for this population. These strategies are discussed in further detail below.