Ask the Doctor of Perversity
by Beth Brown, MD

From Issue 3.2 - December 1996/January 1997

Just How Safe is Piss Play?

Sex is inherently wet, wet in all its aspects. Arousal means oozing, slippery vaginal juices, shiny drops of precum, saliva on lips and tongue.

Some people like their sex to be more than a little wet. Watersports aficionados sometimes prefer their favorite wetness, piss, to be measurable in quarts, not drops. Besides volume, urine fetishists may admire its taste, color, and odor. It feels nice coming out, and those who enjoy drinking it think it feels nice going in, too. Some piss players enjoy marking or being marked with this product of the body, a sign of possession, dominance, or submission.

All these are aesthetic considerations, and thus not valid grounds for controversy. However, the safety of piss play is addressable on scientific grounds, and so is a much different aspect of watersports. Splash Alan writes in "The Tao of Urine" that urine is safe because it cannot transmit HIV. There are two premises here which should be discussed separately: 1) can urine transmit HIV? and 2) is the ability to transmit HIV the only aspect of safety?

In the age of AIDS, it is easy to forget the other sexually transmitted diseases (STDs) which used to be around and haven't gone anywhere. Urine is theoretically sterile in persons free of all infections. For those of us who do not live in a bubble, however, viruses, bacteria, and fungi are secreted in the urine of infected persons, and can indeed cause disease.

Piss Is Not Sterile

Hepatitis B can be found in the urine of infected persons, even those without symptoms. While drinking piss is unlikely to cause infection, golden showers onto areas of broken skin can cause passage of hepatitis B into the blood stream. Before you play, wipe an area of skin with alcohol. Does it sting? If so, there's a small skin break through which viruses could travel. Cytomegalovirus (CMV) is a very common virus which can cause an acute flu-like illness and may be passed intermittently in the urine, sometimes for years. It is the same virus which causes blindness and other serious illnesses in people with AIDS. This may be transmissible by drinking infected piss.

People with genital herpes may intermittently pass herpesvirus in the urine, whether or not they are having an outbreak and whether or not they know they are infected. A piss bottom who is pissed on with herpes-containing urine could become infected via a skin wound, developing a lesion called herpes gladiatorum. This can come back over and over and over, just like genital herpes or a cold sore.

Chlamydia is a bacterium which causes what used to be known as nonspecific urethritis or nongonococcal cervicitis. Chlamydia is the most common STD in the U.S. Both chlamydia and gonorrhea may be found in the urine of infected people, and drinking their urine could theoretically cause these infections in the throat, although I am unaware of any documented cases. I imagine an undocumented case would be just as annoying as a documented one, so caution is warranted.

Of particular importance for those who are HIV positive are fungal infections that can be transmitted in the urine which may cause major infections in people with AIDS. These include histoplasmosis, blastomycosis, and coccidiomycosis (valley fever). All three can be a major pain in the ass to get rid of, and in a person with severe immunosuppression can be life-threatening.

There is no evidence of HIV ever being transmitted through urine. The evidence of HIV showing up in urine at all is, to my knowledge, inconclusive. However, HIV does concentrate in semen, vaginal fluids and some types of white blood cells. Anyone with an STD or a urinary tract infection may have white blood cells in their urine, and thus might theoretically be able to transmit HIV. Is it possible to catch HIV from golden showers or from drinking piss? Probably not, but your mileage may vary.

Some medications or recreational drugs taken by a piss top may end up in anyone drinking their piss. Some drugs don't end up in urine at all. Some are excreted by the kidneys only after being inactivated. However, some are passed in the urine either in their original form or a more active form. For specific information on legal drugs, you can ask a health care professional or look it up in a book such as the Physician's Desk Reference under the heading "route of excretion." Illegal substances are harder to look up, and run the risk of showing up in the bottom's urine later on, perhaps during a drug test at work.

Choose Your Risks

Is playing with piss too dangerous? Not necessarily. Like any other sexual behavior, each of us must make our own decision about how much risk we care to take. The more information we have about ourselves and those we play with, the easier it is to make intelligent decisions about our own safety. Like any other sexual behavior, honesty and trust are essential to piss play -- even more important than drinking plenty of liquid.

Beth Brown, MD (DoctorBeth@aol.com) is a Bay Area family physician. She is a contributor to The Lesbian S/M Safety Manual (Pat Califia, editor; Alyson Press, 1988). Please send questions that you would like her to address in future issues to DoctorBeth@aol.com.

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Last updated: 8 January 1997