Anal Sex Safety: What to Know

Medically Reviewed by Jabeen Begum, MD on March 10, 2023
Written by Mary Anne Dunkin
6 min read

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. 

Myth: Only gay men have anal sex.

Many gay male couples have anal sex, but not all do. Also, people of any sexual orientation or gender can enjoy it, including heterosexual couples.

People without penises can use a sex toy to anally penetrate their partners. "Pegging" is a term for when a woman does this to a man. 

Myth: There's no chance of getting pregnant from anal sex.

While the chances of getting pregnant from anal sex are certainly lower than with vaginal sex, there is still a small possibility. Any time the penis is close to the vagina, there is always the chance that semen will enter the vagina and lead to pregnancy. 

Myth: It's harder to get sexually transmitted infections from anal sex.

It's just as easy, if not easier, to get sexually transmitted infections (STIs) from anal sex. The tissue of the anus is delicate and can tear easily. This can leave more openings for an infection to enter the body. The person who is getting anally penetrated, sometimes called the bottom, is more at risk for STIs than the person doing the penetrating, sometimes called the top.

You need to relax the sphincter muscle of the anus — the muscle you squeeze when you need to have a bowel movement but have to wait — to receive anal sex. So it’s important to try to stay relaxed as you explore anal sex by yourself or with a partner. 

A study of how frequently people have orgasms found that the sexual activity of women who orgasm often (compared to women who have orgasms less frequently) was more likely to include anal stimulation. Another study looked at specific ways people got pleasure from anal touch. Three options were:

  • Anal surfacing. This involves touching on the surface of the anus.

  • Anal shallowing. penetration just inside the opening of the anus (compared with the deeper penetration usually viewed as "anal sex")

  • Anal pairing. This is anal touch that happens at the same time as other kinds of sexual touch, such as vaginal penetration or clitoral touching.

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. 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. 

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.

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.

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

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: 

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

Show 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?"

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,” "HIV Risk Behaviors."

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.”

PLoS One: "Women's techniques for pleasure from anal touch: Results from a U.S. probability sample of women ages 18-93."

Archives of Sexual Behavior:  "Difference in Orgasm Frequency Among Gay, Lesbian, Bisexual, and Heterosexual Men and Women in a U.S. National Sample."

Stanford Medicine Health Care: "Risk of Exposure to HIV/AIDS."

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