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Anal Sex Safety and Health Concerns

An estimated 90% of men who have sex with men and as many as 5% to 10% of sexually active women engage in receptive anal intercourse.  

Often referred to simply as anal sex, anal intercourse is sexual activity that involves inserting the penis into the anus. People may engage in anal intercourse, which has health risks, because the anus is full of nerve endings, making it very sensitive. For some recipients of anal sex, the anus can be an erogenous zone that responds to sexual stimulation. For the giving partner, the anus may provide a pleasing tightness around the penis.  

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While some people find anal sex enjoyable, the practice has downsides and requires special safety precautions.

 

Is Anal Sex Safe?

There are a number of health risks with anal sex, and anal intercourse is the riskiest form of sexual activity for several reasons, including the following:

  • The anus lacks the natural lubrication the vagina has. Penetration can tear the tissue inside the anus, allowing bacteria and viruses to enter the bloodstream. This can result in the spread of sexually transmitted infections including HIV. Studies have suggested that anal exposure to HIV poses 30 times more risk for the receptive partner than vaginal exposure. Exposure to the human papillomavirus (HPV) may also lead to the development of anal warts and anal cancer. Using lubricants can help some, but doesn't completely prevent tearing. 
  • The tissue inside the anus is not as well protected as the skin outside the anus. Our external tissue has layers of dead cells that serve as a protective barrier against infection. The tissue inside the anus does not have this natural protection, which leaves it vulnerable to tearing and the spread of infection.  
  • The anus was designed to hold in feces. The anus is surrounded with a ring-like muscle, called the anal sphincter, which tightens after we defecate. When the muscle is tight, anal penetration can be painful and difficult. Repetitive anal sex may lead to weakening of the anal sphincter, making it difficult to hold in feces until you can get to the toilet. However, Kegel exercises to strengthen the sphincter may help prevent this problem or correct it.  
  • The anus is full of bacteria. Even if both partners do not have a sexually-transmitted infection or disease, bacteria normally in the anus can potentially infect the giving partner. Practicing vaginal sex after anal sex can also lead to vaginal and urinary tract infections.  

Anal sex can carry other risks as well. Oral contact with the anus can put both partners at risk for hepatitis, herpes, HPV, and other infections. For heterosexual couples, pregnancy can occur if semen is deposited near the opening to the vagina. 

Even though serious injury from anal sex is not common, it can occur. Bleeding after anal sex could be due to a hemorrhoid or tear, or something more serious such as a perforation (hole) in the colon. This is a dangerous problem that requires immediate medical attention. Treatment involves a hospital stay, surgery, and antibiotics to prevent infection. 

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