Anal Sex Safety: What to Know

Unlike the vagina, the anus does not self-lubricate. So you need to use a lot of lubrication, whether you use fingers, a sex toy, or a penis. It will help you avoid tearing or other injury to the area. 

People with penises usually have a prostate gland. This gland has many nerve endings, making the area sensitive. Since the prostate sits on the other side of the rectum, it’s possible to stimulate it by putting a finger or a sex toy inside the anus. Some people with prostates find anal play a pleasurable activity for this reason.

Anal sex may be slightly painful, or it may simply feel strange the first time you try it. Remember, you can always stop any time you want and try again some other time. You can also decide that anal sex is not for you. 

Anal Sex Risks

As with many forms of sex, it has risks, but by planning and communicating with your partner you can reduce a lot of these risks and enjoy the intimacy.

Risks to be aware of include: 

• The lining of the anus is thinner than the vagina, and it lacks natural lubrication. That makes it much more vulnerable to tearing. Tears can allow viruses and bacteria to enter the bloodstream. This can include sexually transmitted infections, such as HIV. Studies have suggested that receptive anal exposure to HIV poses a much higher risk for the receptive partner than vaginal exposure -- 17-18 times greater. Anal intercourse can also boost the risk of getting the human papillomavirus (HPV). HPV may also lead to the development of anal warts and anal cancer. Using lubricants can help, but it 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 doesn't 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 have a bowel movement. When the muscle is tight, anal penetration can be painful and difficult. Repetitive anal sex may weaken the anal sphincter, making it difficult to hold in feces until you can get to the toilet. Kegel exercises to strengthen the sphincter may help prevent this problem or correct it.
• The anus is full of bacteria. Bacteria normally in the anus can potentially infect the giving partner. Having vaginal sex after anal sex can also lead to vaginal and urinary tract infections.

There are other things to be aware of as well:  

• If you have a uterus and semen gets near the opening of your vagina during anal sex, you could get pregnant.
• Even though serious injury from anal sex isn't common, it can happen. Bleeding afterward 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 needs medical attention right away. 
• Anal sex also increases your chance of getting an anal fissure. A fissure is a split in the tissue of your anus.
• Oral contact with the anus can put both partners at risk for hepatitis, herpes, HPV, and other infections.

Anal Sex Safety

Use a condom to protect against the spread of infections and diseases.

Other ways to stay safe include:

• Clean well before you have sex. An enema, or anal douche, can flush you out. Make sure you ask your doctor before giving yourself an enema to be sure you’re doing so safely.
• If using your hands, make sure your nails are short and clean before having anal sex.
• After you have anal sex, change condoms before having oral or vaginal sex. This will lower the chance of infections like urinary tract infections (UTIs) and bacterial vaginosis (BV). You can also use a dental dam, a latex or polyurethane sheet you put between your mouth and your partner’s anus.
• Use plenty of lubricant to reduce the risk of tissue tears. With latex condoms, always use a water-based lubricant.
• Relaxing beforehand can help lower the risk of tears. A warm bath may help. 
• Stop if it's painful.
• If you bleed afterward or you notice sores or lumps around the anus or discharge coming from it, see your doctor as soon as possible.
• If you’re at a high risk for HIV, your doctor can prescribe a daily medication called pre-exposure prophylaxis (PrEP) to lower your chances of getting it. You still need to use condoms to protect yourself from other STIs.
• If you have unprotected anal sex for any reason, you can takepost-exposure prophylaxis (PEP) within 72 hours of the activity to protect yourself from HIV.
• Get an HPV vaccine.
• Be open and honest with your partner. Communication is key for a safe and enjoyable experience.
• Afterward, clean with mild soap and water to help prevent infection. You can also apply a water-based cream to help with soreness.

Anal Sex Complications

You may deal with:

• Soreness and irritation. A water-based cream can help with some soreness. Be sure to avoid harsh soaps when you clean your anus.
• Light bleeding. This can be a sign of tears (fissures) or hemorrhoids. Tell your doctor if you have bleeding.
• Trouble with bowel movements. If your soreness makes it harder to poop, you can take stool softeners to make it easier.

Some problems need a doctor’s treatment. Talk to your doctor if you have:

• Pain
• Fissures
• Loss of control over bowel movements (fecal incontinence)
• Continued or heavy bleeding
• Symptoms of STDs, such as a discharge, bumps, sores, or a fever

Treatment for Anal Sex-Related Problems

Talk to your doctor about your symptoms. They may suggest: 

• A rectal exam. Your doctor will use a gloved hand to feel inside your anus and rectum.
• STI or STD tests. Your doctor may take blood, urine, or other fluid samples and send them to a lab to check for sexually transmitted infections or diseases.

Treatment for problems from anal sex will depend on your symptoms and diagnosis. For pain, fissures, and hemorrhoids, your doctor may suggest: 

• Warm water baths 
• Numbing creams 
• High-fiber foods 

To treat an STD, you may need antibiotics or antiviral medication, depending on your infection.