Anal sexAnal sex has always been a highly controversial subject, and the controversy that surrounds it looks set to continue into 2012 because evidence accumulates that this practice may sometimes lead to anal cancer. 'Fisting' – which means putting the hand into the rectum; this activity is rare among heterosexual couples. Taboos and infection There are taboos surrounding the various types of anal sex – and particularly anal intercourse. These may arouse strong feelings of moral indignation, guilt and anxiety. It is important to remember that while some people find these activities repugnant, others may find them stimulating, exciting and a normal part of their sexual intimacy. Research shows that, whether we like it or not, the anal area is equipped with many erotic nerve endings – in both men and women. So it's not surprising that many couples (including a lot of heterosexual ones) derive pleasure from some form of 'bottom stimulation'. What about infection? Most sexual activities carry a risk of transmission of sexually transmitted diseases (STDs) ranging from gonorrhoea and herpes to hepatitis B and HIV. There's evidence that anal intercourse carries a higher transmission risk than almost any other sexual activity. Information about these risks is given below. What is it? Anal sex means sexual activity involving the bottom – in particular, the type of intercourse in which the penis goes into the anus. It's often referred to as 'rectal sex'. Anal sex does carry considerable health risks, so please read our advice carefully. Our impression is that anal sex has become rather more common in heterosexual couples, partly because they have watched 'blue movies' in which this activity so often occurs. One small study carried out in 2009 suggested that in the UK, 30 per cent of pornographic DVDs feature rectal intercourse. Often, it is presented as something that is both routine and painless for women. In real life, this is not the case. Other types of sexual activity which involve the anus include: 'postillionage' – which means putting a finger into the partner's bottom insertion of 'butt plugs' – which are sex toys that dilate the anal opening and create a sensation of fullness use of vibrators on or in the anus (please see cautionary note below) 'rimming' – which is oral-anal contact; this carries a significant risk of infection Consent What consenting adults enjoy sexually in the privacy of their homes is their own business provided that the law does not prohibit it. The main health risks. According to one estimate. if practiced with care. however. Intoxication with drugs or alcohol is associated with lowering inhibitions and experimentation with unusual or unsafe sexual behavior – and can lead to serious consequences. Many individuals. It does. is possible for most couples. Some partners will reluctantly acquiesce. both men and women. may have secret fantasies involving anal intercourse but feel unable to discuss them with their partner. which affect both heterosexual and homosexual couples. Is it safe? Anal sex. Who does it? There is a common misconception that anal sex is practiced almost exclusively by gay men.The key issues are legality and consent. But these agents do carry some risk of side-effects. Forcing or pressurizing a partner to submit to an activity that they find distasteful or degrading is completely unacceptable behavior. It remains forbidden in some states of the USA. It should be remembered that in the absence of freely given consent. more heterosexual couples have anal sex than homosexual couples. the very serious criminal offences of assault and rape are committed. In some countries it is still a criminal offence punishable by long custodial sentences. anal intercourse is now a legal activity between consenting men and women aged 16 and over. even though the partner does not share their interest. . In absolute numbers. It's widely claimed that one third of gay couples do not include anal intercourse in their lovemaking. about a third of heterosexual couples have tried it from time to time. except in Northern Ireland where it's 17 and over. This is certainly not the case. Therefore. Some may try and pressurize their partner to have anal intercourse. and corporal or even capital punishment. In the UK. though in practice a Supreme Court decision of 2003 appears to invalidate these state laws. because many more people are heterosexual. Some male gay couples use the drugs known as 'poppers' (nitrates) to try to relax the anal sphincter and so make penetration easier. it's essential that both partners agree that they wish to try anal sex as a part of their sexual repertoire and that they are sure of the legal position on anal intercourse in the country that they are in. Consent freely given by both partners is an essential feature of sexual activity in a loving relationship. Anal intercourse is legally forbidden in some former colonies of Britain. notably in the West Indies. others may be pressured or even physically forced to allow it. in both heterosexual and homosexual relationships. are described below. carry health risks and there are safer sexual practices that couples can enjoy. It's thought that about 10 per cent of heterosexual couples have anal intercourse as a more regular feature of their lovemaking. gastroenteritis. certain strains of HPV virus do have carcinogenic (cancer-provoking) potential. although sufferers can feel quite ill. coli) can also cause urinary tract infections (UTIs). or even (very rarely) fatal. Anal intercourse can facilitate this transfer. Hepatitis C may be transmitted by anal intercourse. The use of condoms and water-based lubricants. Sharing of equipment for intravenous drug use is a far more important risk for transmission. HPV and anal cancer: unfortunately. . ranging from cystitis to pyelonephritis – a serious kidney infection. It can be transmitted by oral-anal contact. but there are enough data to suggest that if you are going in for anal intercourse. Human papilloma virus and warts: this virus can be transmitted during anal intercourse and that may lead to anal warts. Round about the beginning of the present century. will offer some protection. coli strains (uropathic E. Escherichia coli (E. Hepatitis A is not usually a lifethreatening illness. Specially toughened condoms designed for anal intercourse may offer more protection. although this seems to be a rare occurrence. E. safer sexual practices that can be exciting and rewarding. coli): may sometimes cause mild to severe. so causing a urinary infection. it became clear that people who had been anally penetrated by multiple partners were unusually likely to get carcinoma of the anus. particularly for the receptive partner. By 2008. particularly if it is immediately followed by vaginal intercourse. but many couples may still wish to try the anal route. There are some types of HPV that cause cancer of the cervix in women and probably also cancer of the throat. There are other. Some E. research showed that HPV could be isolated from the tissues of many anal cancers. A Danish study has recently suggested that gay men may have a 17-fold increase in risk of anal cancer – but close inspection of this paper reveals that the number of people involved was very small. Protection Avoiding anal sex altogether is of course the best way of avoiding these risks. coli very readily crosses the short distance between the female anus and the female urinary opening. So the case is not quite proven yet. such as K-Y Jelly. it's safest to do it with only one regular partner. It is one of many viruses and bacteria that can be transmitted by oral-anal contact. Hepatitis A (infectious hepatitis): this is a viral infection that can cause jaundice and abdominal pain. as will over-energetic thrusting without adequate lubrication. Other lubricants may cause condoms to split. Hepatitis C: is a cause of progressive and sometimes fatal chronic liver disease. Human papilloma virus (HPV): there is no doubt that anal intercourse carries a greater risk of transmission of HIV – the virus that can cause acquired immunodeficiency syndrome (AIDS) – than other sexual activities. adequate lubrication and anal relaxation are required. It is possible for both men and women to 'receive' it. so as to give the receptive partner time to allow the sphincter to relax. We do not recommend this. If the bowel is empty. Amyl nitrate. not the insertive partner pushing harder! If condoms are used for penile penetration. including Viagra (sildenafil). Having managed to accommodate one finger. Again. dildo or vibrator (see below about the risks of sex aids and anal sex). perhaps covered by a condom or glove into the anus. Muscle relaxant drugs (amyl nitrate. This must be done delicately so as not to cause pain or injury. butyl nitrate. have been used to reduce anal pain during intercourse. Local anaesthetics. Ensure the anal area is clean and the bowel is empty. such as lignocaine (lidocaine) cream or even locally applied cocaine. By numbing the anal skin there is a real risk of causing serious injury to the anal sphincter through overvigorous thrusting. This is important both aesthetically and practically. it is important to use a water-based lubricant. the couple may agree to try with a well-lubricated penis or with a butt plug (a broad-based anal dilator). may cause a catastrophic drop in blood pressure with potentially fatal consequences. which is advisable to reduce the risk of sexually transmitted disease. we strongly advise against this. there is no risk of the receptive partner passing faeces. including facial flushing. Other nitrates may have the same effect. All erectioninducing drugs. First try gently inserting a lubricated finger. glyceryl trinitrate) have been tried to make anal intercourse easier or more comfortable. although care is needed for it to be safe and comfortable. are popular in the gay community and have a reputation both for enhancing the intensity of orgasm and helping relax the anal sphincter. you can run it around the anal canal – gently stretching it. local anaesthetics . can be very dangerous if you are using nitrates. care. Amyl nitrate 'poppers' sold in small bottles for inhalation. Cialis (tadalafil)and Levitra tablets (vardenafil). By following the steps above it is possible to gently dilate the sphincter for comfortable intercourse. dizziness and low blood pressure. this may become easier. Gentleness. which may lead to faintness and loss of consciousness. If this is successfully achieved. The purpose of pain is to make us aware that we are causing injury and. There's no real evidence to support these assertions and its use is not recommended by medical authorities. when taken with Viagra (sildenafil). headaches. It is important to remember that amyl nitrate is a potent drug with many side-effects. This will enable the receiving partner to find out whether penetration is comfortable and enjoyable. With time and practice. therefore. The insertive partner must be gentle with any thrusting.How to have intercourse safely anal Drugs and anal sex Anal intercourse involves the penetration of the anus and rectum with the erect penis for the purpose of sexual stimulation. orgasm and ejaculation. One additional risk from the use of sex aids in anal sex is that of losing the aid into the rectum.should be avoided. If you do lose a sex aid into the rectum you should attend the Accident and Emergency department of your local hospital as soon as possible. Sex aids must be kept clean and washed carefully between use. anal fisting is very rarely used by heterosexual couples. but it is incredibly foolish to insert potentially breakable objects into the anus and terrible injuries may result. For that reason. however embarrassing it may be. Another problem with local anaesthetics is that they may make the penis of the insertive partner numb. So we cannot recommend this practice. But the diameter of the hand is so much greater than that of the penis that there's an increased risk of anal injury. The situation will only get worse if it is neglected and the object may break or become more difficult to recover. Fisting This means putting the whole hand into the rectum. Vaginal vibrators are not designed in this way. If they are still vibrating when the patient arrives at the hospital. and it may be acceptable and enjoyable for some couples. ranging from vibrators to milk bottles. Condoms may be placed over sex aids as an additional precaution. Human ingenuity seems to know no bounds in this area. we do not recommend this practice. and can easily slip inside and buzz their way up the colon. In reality. Sex aids and anal sex – a cautionary note Some couples like to use sex aids for insertion into the anus. This may lead to problems with erection. The same principles apply as for genital insertion in that relaxation is essential. In general. you should only use a sex aid which is designed for the anus. Butt plugs and anal vibrators have a broad base. Some have been recovered by surgeons from far inside the abdomen. This involves a high risk of transmission of infection. Rimming Rimming involves oral contact with the anus for sexual stimulation. they produce an interesting but alarming phenomenon called 'the rotating umbilicus sign'. Don't let this happen to you. Some medical school pathology museums have a wide selection of novel foreign bodies recovered from the rectums of both men and women. Certain individuals may use them for solitary sexual stimulation. With adequate relaxation it's physically possible. which makes it difficult to 'lose' them inside the rectum. . and hepatitis. Health considerations What is anal sex? Anal Intercourse . The official term for this is analingus. Unprotected anal intercourse is considered a high-risk activity for both males and females.one’s own or a partner’s into the anal opening and gently rotated. 25% of heterosexual undergraduate students have experimented with anal sex at one point in their lives. HPV. including rimming. For heterosexual couples.internal muscle that is involuntarily controlled by the body. pregnancy can occur if semen is deposited near or around the vaginal opening.tube like structure made of soft tissue that is eight to nine inches in length and is surrounded by muscles. can put both partners at risk for hepatitis. Taking care of hygiene . The anus is the entry to the rectum. Anal complications not related to anal sex include: irritable bowel syndrome. make an appointment with a health care provider as soon as possible. Manual Stimulation . This statistic is also consistent with national trends for heterosexual adults. Appointments can be made at McKinley Health Center by calling Dial-A-Nurse at 333-2700. hemorrhoids. The internal sphincter cannot be contracted. gonorrhea. including HIV due to lack of natural lubrication. If you notice any pain. Condom use during anal sex is a must. Fisting . Internal sphincter . it is one and half inches long. HIV.―Rimming‖ is a slang expression that refers to oral stimulation of the anus.muscle that is closest to the anal opening. sores. The rectum is able to expand. like the anus or vagina.McKinley Health Center Who does it? Anal Sex: Questions and Answers Know your anatomy A variety of people engage in anal sex and stimulation despite their sexual orientation.―Fisting‖ is a form of anal sex in which several fingers or even the entire hand and forearm are inserted into the rectum and sometimes into the lower colon. and is surrounded by two rings of muscles: the external sphincter and the internal sphincter. herpes. Rimming . and parasites. which can lead to tears and exposure to blood. Sexually Transmitted Diseases (STD’s) can and do occur around the anus and inside the rectum. do not engage in anal sex until you have consulted with a physician. It can be contracted at will because it is controlled by the central nervous system. herpes. Rectum . or analingus. chlamydia. HPV.Anal intercourse is sexual activity that involves insertion of the penis or a sex toy into the anus. External sphincter . People who have unprotected anal intercourse are at high risk for many sexually transmitted infections. syphilis. discharge. including intestinal parasites. If you are suffering from any of these medical concerns. fissures or tears. or lumps around or inside the anus. Oral sex.Manual stimulation can include rubbing the anus externally or insertion of a finger(s) . For safer rimming. like the vagina. The highest concentration of nerve endings is around the anal opening itself. Remember to go light on the soap as it can be irritating to your insides. Putting safety first and communicate with your partner about how you feel . It is also important to stop if anything hurts Why do some people do it? The anus is full of thousands of nerve endings both inside and outside. The main function of the rectum is to act as a passageway for feces. Proper hygiene should also be taken into account with anal sexual activity. However. The inner portion responds mostly to pressure. It’s also important not to pressure partners to engage in anal sex if they are not comfortable. people use latex barriers . The outer portion of the rectum. The anus does not produce a sufficient amount of lubricant for comfortable intercourse and adding more lubricant reduces the risk of tearing anal tissue and having a condom break. Using anti-bacterial soap after direct contact with feces is also recommended. the anus is an erogenous zone that can respond to sexual touch and stimulation. some latex barriers come in different flavors. Some people enjoy . do not insert a penis or sex toy into the mouth or vagina after it’s been inserted in the rectum until your partner puts on a new condom or cleans the sex toy in between (rubbing alcohol. especially if the feces are not well formed. If you are not comfortable with anal sex. It contains its own natural bacteria to help fight against infections. Remember to always use only waterbased lubricants with latex condoms.placed over the anus. With routine daily hygiene. Additionally. the anus is as clean as other parts of your body. the first thing to do is to relax. Plastic wrap and cut-open condoms can also be used as a barrier for analingus. Small amounts may remain in the rectum. To prevent other infections. The risk for HIV increases for the receptive partner. Like condoms. or a mixture of one part bleach to 9 parts water).thin pieces of latex . But feces are not normally stored in the rectum except just prior to a bowel movement. enemas may cause trauma to the rectum which can increase the risk for HIV and other STD’s. To prepare for anal sex. Proper use of latex condoms or female condoms can significantly reduce the risk of contracting dangerous infections such as HIV. Anal douching before lovemaking sex may help some people especially who are concerned with cleanliness to relax. has several nerve endings. Men and women can contract an STI during anal sex. whether male or female.sex play that is painful or uncomfortable should not continue. It is also important to utilize latex gloves during digital intercourse or ―finger sex‖ or fisting of with the anus. It may be best to allow a few hours to pass after an enema before anal sex. Anal sex should not be painful. A thicker lubricant may be needed for anal sex. This acts as a barrier between the mouth and anus. then don’t do it! Empower yourself to choose what sexual acts are most pleasurable in meeting your sexual needs. the use of enemas before anal sex can be used to feel cleaner and to prevent the need to evacuate the bowels during sex. For some people. Slipping a soapy finger inside you while showering is another good way to cleanse the anal area. making it very sensitive. The sphincter muscles around the anus will not allow things to pass through unless you relax and take it slow. the feelings of pressure and fullness once they understand that these sensations do not presage an impending bowel movement. a few people have orgasms only with anal stimulation. What your mother never told you about sex. Anal Sex: An ‘extraordinary taboo. Orgasms from anal stimulation are most likely to occur when the participants become thoroughly absorbed in their sensations and fantasies (as with vaginal or oral sex). or "bulb".can be a source of pleasure when massaged by a finger. I.which is just beyond the rectal wall. Org: Society for human sexuality. they tend to focus on the prostate. 357-373. is near the anal opening. J.” Contemporary Sexuality Vol. Women probably do so through pelvic muscle contractions . Putnam’s Son. (2000). an object. D. a few inches in. Heterosexual anal intercourse: An understudied high-risk sexual behavior.. J. T. 11 Hutcherson. or a penis. References Melby. When men experience an orgasm from anal stimulation.and a small minority even through the sheer excitement of being anally penetrated. & Baldwin. New York: NY: G. . It is stimulated indirectly by most types of anal sex. the lower end of the penis. In men. (2007). Also. (2002). towards the front of the body . P. A minority of men and women can achieve orgasm from anal sex without direct genital stimulation. Sexuality. On the other hand. Baldwin. Archives of Sexual Behavior. Anal pleasure can be psychological as well as physical. H. 41 No. the prostate . They may they are also be responding to indirect stimulation of the penile bulb. 29. Can anal sex lead to orgasm? Most people require direct genital stimulation in order to climax. Because feces that pass through the rectum contain bacteria. is produced during anal sex. because contrary to what you heard. can be passed to or from an anal sex partner. it does not heal as quickly. Lining tears may lead to other problems such as an anal abscess. which may irritate the rectum Never moving from anal to vaginal sex without first changing condoms Stopping if there is severe pain during penetration Anal sex may make a person more susceptible to bacterial infection around . However. This is because the lining of the rectum is not as heavy as the lining of the vagina. the enemy of pleasure and safety during sex. so it is more susceptible to tears. Additionally. And although you already seem aware. and enjoy. which can make transmission of STIs and HIV more likely. Steps to safer anal sex include: the anus and rectum. anal sex does not loosen the anus or cause an inability to control bowel movements. a tear in the lining can develop into a fissure (a larger tear or crack) and may extend outside of the bowel.Alice. so it's important to take steps to minimize these risks. This is called a fistula and it is a significant medical issue because it allows feces to pass outside of the bowel. so you may want to carefully consider anal sex activities if you have them. Anal sex enthusiasts can relax (a good thing to do during anal sex!). Being very gentle and moving slowly Using plenty of lubricants (not just saliva) Using a condom Avoiding spermicide. there can be risks associated with anal sex other than sexually transmitted infections (STIs). whether you are a beginner. Friction. —Anal Wonders Dear Anal Wonders. In extreme cases. However. If the anus or rectum does get torn. Pregnancy is not a concern during anal sex (unless vaginal sex is also included on your agenda). much as it is during vaginal sex. I heard that anal sex causes the rectum/anus to become larger and creates problems with going to the bathroom. So. Can you please tell me what the risks are when it comes to anal sex beyond the normal STI/STD and pregnancy risk? Are there any risks involved with anal sex that are not involved with oral or vaginal? Thanks in advance. you can relax. The tips above will help you avoid tears and other uncomfortable complications. an old hat. any tear in the lining is at risk of getting infected. there is some suggestion that anal sex may worsen existing hemorrhoids. or simply curious. and requires major surgery to repair. friction may be more of an issue during anal sex because the lining of the anus is more delicate and produces less natural lubricant than the vagina. it is important to mention that STIs. move slowly. including HIV. This is why unprotected anal sex is often considered riskier than unprotected oral or vaginal sex. so using condoms is always a good idea. Preventing Anal Sex Problems The only way to completely avoid anal sex risks is to abstain from anal sex. The tissue inside the anus does not have this natural protection. This is a dangerous problem that requires immediate medical attention. making it very sensitive. Repetitive anal sex may lead to weakening of the anal sphincter. anal intercourse is sexual activity that involves inserting the penis into the anus. and other infections. HPV. Kegel exercises to strengthen the sphincter may help prevent this problem or correct it. Studies have suggested that anal exposure to HIV poses 30 times more risk for the receptive partner than vaginal exposure. because the anus is full of nerve endings. Anal sex has a number of health risks. While some people find anal sex enjoyable. anal penetration can be painful and difficult. surgery. For the giving partner. The tissue inside the anus is not as well protected as the skin outside Anal sex can carry other risks as well. but doesn't completely prevent tearing. If you engage in anal sex. Is Anal Sex Safe? theanus. making it difficult to hold in feces until you can get to the toilet. Often referred to simply as anal sex. This can result in the spread of sexually transmitted infections including HIV. the practice has downsides and requires special safety precautions. the anus may provide a pleasing tightness around the penis. When the muscle is tight. However. the anus can be an erogenous zone that responds to sexual stimulation. Treatment involves a hospital stay. Oral contact with the anus can put both partners at risk for hepatitis. including the following: The anus lacks the natural lubrication the vagina has. herpes. The anus is full of bacteria. Exposure to the human papillomavirus (HPV) may also lead to the development of anal warts and anal cancer. which has health risks. Penetration can tear the tissue inside the anus.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. Bleeding after anal sex could be due to a hemorrhoid or tear. People may engage in anal intercourse. The anus is surrounded with a ring-like muscle. The anus was designed to hold in feces. pregnancy can occur if semen is deposited near the opening to the vagina. Even if both partners do not have a sexuallytransmitted infection or disease. called the anal sphincter. For heterosexual couples.Our external tissue has layers of dead cells that serve as a protective barrier against infection. it can occur. Using lubricants can help some. or something more serious such as a perforation (hole) in the colon. Practicing vaginal sex after anal sex can also lead to vaginal and urinary tract infections. and antibiotics to prevent infection. allowing bacteria and viruses to enter the bloodstream. bacteria normally in the anus can potentially infect the giving partner. Anal intercourse is the riskiest form of sexual activity for several reasons. which leaves it vulnerable to tearing and the spread of infection. For some recipients of anal sex. which tightens after we defecate. Even though serious injury from anal sex is not common. it is always important . Stop if anal sex is painful. With latex condoms. see your doctor as soon as possible. If you experience bleeding after anal sex or you notice a sores or lumps around the anus or a discharge coming from it.to use a condom to protect against the spread of infections and diseases. always use a water-based lubricant. Taking a warm bath before anal sex or lying on your stomach may make insertion easier. Use plenty of lubricant to reduce the risk of tissue tears. Relax prior to insertion of the penis to help reduce the risk of tears. . Following are more tips for increasing anal sex safety: Avoid inserting a penis into the mouth or vagina after it's been inserted in the anus until your partner puts on a new condom.