Anal Sex

What Is Anal Sex?

Often referred to simply as anal sex, anal intercourse is sexual activity that involves putting a penis into an anus. An estimated 90% of men who have sex with men and as many as 5% to 10% of sexually active women have anal intercourse.

The anus is full of nerve endings, making it very sensitive. Some people find anal sex enjoyable, but the practice does have health risks, and you need to use precautions to be safe..

Anal Sex Risks

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 that 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. It 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 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. 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.

Anal sex can carry other risks as well.

• For heterosexual couples, a woman can still get pregnant if semen is deposited near the opening to the vagina.
• Even though serious injury from anal sex is not 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. Treatment involves a hospital stay, surgery, and antibiotics to prevent infection.
• Anal sex also increases your chance of getting an anal fissure. A fissure is a tear 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

The only way to completely avoid anal sex risks is to not have it. If you have anal sex, use a condom to protect against the spread of infections and diseases.

The following are more tips to help with anal sex safety:

• Clean well. An enema, or anal douche, can help rid your rectum of feces before you have sex. An enema flushes you out, using water. 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.
• Don’t put a penis into the mouth or vagina after it's been inside the anus until your partner puts on a new condom. 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 have anal sex can help lower the risk of tears. Taking a warm bath before anal sex or lying on your stomach may make insertion easier.
• Stop if anal sex is painful.
• If you had bleeding after anal sex or you notice sores or lumps around the anus or a 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.
• After you’re done, clean with mild soap and water to help prevent infection. You can also apply a water-based skin protectant 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

Diagnosing Complications from Anal Sex

To tell if you’re dealing with certain complications from anal sex, your doctor will talk to you about your symptoms. Then you might have:

• 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 Anal Sex-Related Problems

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.