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Anal Sex Safety: What to Know

Medically Reviewed by Isabel Lowell, MD on October 20, 2021

What Is Anal Sex?

Anal sex is the term used for any sexual activity that involves the anus. It doesn’t always include anal intercourse.  

The anus is full of nerve endings, making it very sensitive, and many people find anal sex pleasurable.  An estimated 90% of men who have sex with men and as many as 5% to 10% of sexually active women have anal intercourse. 

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 anal exposure to HIV poses 30 times more risk for the receptive partner than vaginal exposure. 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 after 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 tips 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. 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 before you can help lower the risk of tears. A warm bath may help. 
  • Stop if it's painful.
  • If you bleed after, 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 wear a condom to protect yourself from other STDs.
  • Get an HPV vaccine.
  • Be open and honest with your partner. Communication is key for a safe and enjoyable experience.
  • Afterwards, 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 health care provider if you have:

  • Pain
  • Fissures
  • Loss of control over pooping (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 infection or disease.

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. 

WebMD Medical Reference

Sources

SOURCES:

News release, International Microbicides Conference.

University of Illinois at Urbana-Champaign McKinley Health Center: "Anal Sex: Questions and Answers."

News release, New York City Department of Health and Mental Hygiene.

University of California, Santa Barbara, SexInfo Online: "What Are the Dangers of Anal Sex?"

Columbia University's Health Q & A Internet Service, Go Ask Alice: "Pain from anal sex, and how to prevent it."

Cedars-Sinai: “Anal Fissure,” “Anal Fistula.”

Mayo Clinic: “Is colon cleansing a good way to eliminate toxins from your body?” “Sexually transmitted diseases (STDs).”

CDC: “Nail Hygiene,” “Dental Dam Use,” “Anal Sex and HIV Risk,” “Genital HPV Infection -- Fact Sheet.”

Center for Community Health: “Tips for Anal Health -- Ways to Take Care of Your Bottom.”

American Journal of Gastroenterology: “Anal Intercourse and Fecal Incontinence: Evidence from the 2009-2010 National Health and Nutrition Examination Survey.”

Healthdirect: “Anal Injury.”

Harvard Medical School: “Digital Rectal Exam.”

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