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If you don't want to be the kind of person who cheats on his boyfriend, you'll have to find one who shares your kink or is willing to share you.

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I am a genetic male with questions about my gender identity. Straddling desires to maintain my stature in the professional world, keep my wife at my side, and become who I feel like I am, I have experimented with crossdressing, chastity, antiandrogens and steroids. My wife and I have reached a middle ground where I can pursue sexual and aesthetic androgyny. I have started wearing unisex clothes, stepped up cardio to sculpt a more feminine shape and am getting hair-removal done. My question: I want to keep my sex drive and sexual organs intact, but I want to urinate like a woman with no choice but to sit. There are body-modification communities that showcase this procedure, but I don't know where to track down someone to do it. Ideally, a urologist should, but I'm not sure I can put together a justification strong enough for a doctor. Any advice? Do you know any piercers who have done this kind of work?

Seeking Insights That Take Erotic Rerouting Seriously

"Most urologists aren't qualified to do this, let alone piercers — although I know that there are aggressive ‘body modifiers' out there. I wind up cleaning up their messes," said Dr. Keith D. Newman, a urologist and a Fellow of the American College of Surgeons. "So my main advice for SITTERS is to have a urologist do this, preferably someone who has experience with this surgery."

The procedure you're curious about — creating a new pee hole on your taint, behind your balls — is known as a perineal urethrostomy.

"It's one of the steps involved in total gender-reassignment surgery," said Dr. Newman. "As such, doing this one thing probably won't preclude further anatomical reassignment in the future. On the other hand, there are potential complications and consequences."

The biggest consequence is a heightened risk of urinary-tract infections due to your shortened urethra. The urethra, of course, is the tube that runs from our bladders to our pee holes. Women's are shorter, making it easier for bacteria and other bugs to get up into the bladder and cause infections. But infections aren't your only worry. "Any artificial orifice has a certain incidence of stricture," said Dr. Newman. "So the opening might need frequent dilations or more surgery if this complication arises."

By "stricture," Dr. Newman means "your new pee hole could start to close up." And by "frequent dilations," he means "you could wind up shoving steel rods up your urethra to stretch it back open — frequently." And there's more!

"There may be less than full diversion of urine (some may still come out the end of the penis) unless the urethra distal to the new opening is closed," said Dr. Newman. "If it is closed, we run into issues of what is called a ‘mucous fistula,' and the urethra beyond the diversion might need to be irrigated from time to time. Similarly, urinary dermatitis may occur — that's diaper rash — so perineal care and good hygiene will be a must."

Assuming you're still interested in relocating your pee hole, how do you find a urologist? You make appointments with qualified urologists, tell them what you want and risk being turned away. "I believe that enough justification for the surgery exists — others may not," said Dr. Newman. "But it's the insurance company that will need convincing. Many institutions do not allow any surgery for sexual reassignment in adults. And it sounds as if SITTERS is not yet convinced of the validity of this request, so counseling might be helpful."

One final note ...

"Ejaculation will occur through that new hole in a somewhat non-directable way —which could be fun or not," said Dr. Newman. In other words, you'll not only be peeing sitting down: You'll also be coming all over the back of your sack.

I'm a 24-year-old gay male in a three-year relationship with a man I love. I also have a diaper fetish. I told him about it once, two years ago, but haven't brought it up since. I have talked to other diaper lovers (DL) online, but I have never gotten the courage to meet up. I recently started talking with a DL who lives a few miles away. I don't want to cheat, but I would like to indulge my fetish at least once in my life. If there is no sex, would that be cheating? I would just change his diaper and powder him, and he would be doing the same to me and whatnot.

Diapered Dilemma

Here's what Good Dan would tell you: Tell your boyfriend you love him, remind him about the conversation you had two years ago, and ask if he's up for exploring this aspect of your sexuality. If so, great! No need to see that other guy. If not, ask your boyfriend how he'd feel about you getting together with someone who shares your kink — just for diapering and powdering and whatnot. If he doesn't mind, great! If he does mind, you need to think about whether staying in this relationship is wise ... because sooner or later, you're going to cheat. And if you don't want to be the kind of person who cheats on his boyfriend, you'll have to find one who shares your kink or is willing to share you.

Here's what Bad Dan would tell you: Seeing as you're only 24, and you've been in this relationship for three years, and you've never engaged in diaper play ... sneaking off to play might help clarify things. Either you'll learn that diaper play is something you can't live without (which will prompt you to force the issue with your boyfriend) or you'll realize that diapered reality is less sexy than diaper fantasies, and your kink will evaporate (highly unlikely).

Good Dan thinks you should take his advice, because Good Dan is an annoying prick. But Bad Dan thinks you should know that Actual Dan took his advice — about exploring his sexuality generally, not about exploring diapers specifically — at your age, and it helped clarify things for Actual Dan.

On the Lovecast, Dan gets a second-opinion assist from Slate's Dear Prudence: savagelovecast.com.

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