No matter who you are or how your body works, when it comes to anal sex there are some special considerations to keep in mind. This is doubly true if you have any health issues that effect your stomach, intestines, rectum, or anus. And these issues might be more prevalent than you realize. For example, the Mayo Clinic categorizes irritable bowel syndrome (IBS) as “very common” with 25-45 million people in the United States affected.
For some people, these health issues simply make anal play a no-go. But for many, the pleasure or intimacy derived from this kind of contact make it worth working through some additional considerations.
Consider Play Without Penetration
I talked to Jeff Huyett, MSN, APRN, who has been working in queer health since the 1980s and he echoed what I and other sex educators regularly tell people, “Encourage people to focus not just on penetration, but on intimacy and all the other parts of sex. Find ways that will make sex gratifying for you, not focusing on acts your body can’t do.” That means focusing on touch, massage, body contact, and all forms of closeness. You can also incorporate fantasy play or dirty talk as a way of including acts your body might not be up for.
Listen to Pain
If you do want to engage in anal play, the same advice holds whether you’ve got health considerations or not, “Let your body give you the message if it’sOK or not.” This really can’t be emphasized enough. Pain is your body’s way of telling you something is wrong. And although many of us push though some kinds of pain intentionally - from exercise to kink - pain during sexual penetration should not be ignored. According to Ryan Cain PA-C, MPAS, “persons with alarming symptoms like significant pain, bleeding, or cramping should seek medical help immediately.”
Gauge Your Symptoms
Whatever the health concern you have, consider where you are with it at the moment. From IBS to hemorrhoids, to Crohns, to ulcerated colitis, there tends to be an ebb and flow to symptoms. Anal play may be possible while the condition is well managed and may need to be avoided during flare-ups. And if your body is already sensitive you may want to forego anal douching or other prep that can further irritate already sensitive tissue.
Both Huyett and Cain emphasize the increased risk of infections when there is already damaged tissue. Cain says, “Our normal flora do a great job of protecting us from foreign bacteria making a permanent home and causing infection, but persons who are immunocompromised (particularly persons suffering from Crohns/ulcerative colitis, HIV/AIDs) can be at higher risk.”
This is especially important to note because condom use is actually down in some communities, particularly among gay men, thanks to the prevalence of PrEP. Huyett urges people to consider the risk of not only STIs, but also skin infections. And Cain points out that tears in the skin aren’t caused only by penetration, abrasions and cuts can occur from facial hair, biting, or finger nails.
Some sources advise changing your diet to manage some of these conditions, such as eating more fiber. But Huyett cautions that diet advice is never one-size-fits-all. Your best bet is talking to your own medical provider.
Talk to Your Doctor About Your Concerns
What should you do if you don’t feel comfortable talking to your doctor about sex? Huyett sums it up nicely, “get a new provider.” He also acknowledges that might not be possible in every circumstance, in which case he suggests bibliotherapy (my new favorite word.) “Get some books, get informed.” His top recommendation is "The Ins and Outs of Gay Sex" by Stephen Goldstone. Another book you can check out is "The Ultimate Guide to Anal Sex for Women" by Tristan Taormino.
Try At-Home Treatments
If you’re dealing with hemorrhoids, one option is to use an over-the-counter cream (such as Preparation H) after sex to help manage inflammation or to soak in a bath to soothe the tissues. Other tips that apply to all anal adventures become even more important if you’re prone to stomach upset - make sure you’re never receiving anal penetration when you’re not ready, or your body isn’t relaxed. And please, use lots and lots of lube.
If you’re worried about mess, have some dark towels handy and also some baby wipes and also consider your clean-up etiquette. While your instinct might be to freak out if you see poop, try to remember that you signed up for that risk, and also that (ideally) you want to save your partner from embarrassment. So try and quickly wipe up any mess that you see without calling attention to it, unless it’s really a show stopper.
Overall, anal sex with health considerations isn’t all that different from other kinds of sex. It’s important to know your body and what it’s up for at any given time, to have open communication with your partner, and to have a solid relationship with your medical care provider.