Safe Anal Sex

Safe Anal Sex
Medically Reviewed by Isabel Lowell, MD on October 20, 2021
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.
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.
There are other things to be aware of as well:
Use a condom to protect against the spread of infections and diseases.
Some problems need a doctor’s treatment. Talk to your health care provider if you have:
Talk to your doctor about your symptoms. They may suggest:
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.
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.”
Harvard Medical School: “Digital Rectal Exam.”
© 2005 - 2022 WebMD LLC. All rights reserved.
WebMD does not provide medical advice, diagnosis or treatment.

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March 3, 2022 / Sex & Relationships
Anal sex can be safe if you’re prepared for the experience

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If you’re considering anal sex for the first time, you’re not alone. Though it may have once been taboo, it’s become more widely accepted over the last few decades.

Cleveland Clinic is a non-profit academic medical center. Advertising on our site helps support our mission. We do not endorse non-Cleveland Clinic products or services. Policy

And if you think anal sex only involves penetration by a penis, you’d be wrong: Anal sex can include fingers, tongues and accessories, too. It can also be enjoyed by any gender and sexual orientation.
Of course, like sexual activity of any kind, there are some risks. But with the right amount of communication, preparation and patience, anal sex can be a positive experience for all parties involved.
Gastroenterologist Michelle Inkster, MD, PhD, walks us through the anatomy of the anus while offering helpful tips to avoid injury and infection.
Getting started might sound really intimidating. But it can be less scary (and actually fun) the more you learn.
Your anus doesn’t create its own lubricant. That means you’ll need to lubricate it yourself. Without lubrication, the delicate tissue inside of your anus can tear, which can be painful and put you at risk for infection.
Sometimes during foreplay, people will lubricate their anus with their mouth before moving on to water or silicone-based lubricant. This process, medically known as analingus, can help your partner relax. But it does add its own set of risks.
“It’s a good way to get infections if you’re not clean,” says Dr. Inkster. “If you’ve got cracks in the skin in your mouth or you have irritated gums from brushing your teeth, it’s a really easy way to get a bacterial or sexually transmitted infection.”
You can use barrier protection like a dental dam to avoid possible infection. Ultimately, your method of lubrication is a personal choice. What’s important is that you and your partner are both well-prepped for the experience. You’ll want to lubricate the outside of your anus, as well as the penis or accessory that’s penetrating it. And if you’re ever uncomfortable — try more lube.
“Making sure you’re adequately lubricated is the main thing,” says Dr. Inkster.
Your anus provides a protective barrier to your intestines. While the tissue on the outside of your anus tends to be rigid, the tissue on the inside is thin and delicate making it easier to tear or bleed. This means there’s a higher chance of transferring an infection or virus to your partner if a tear occurs.
“Whatever bacteria is back there shouldn’t be an issue when you’re using a condom,” says Dr. Inkster.
There are also many blood vessels supplying blood to the entire area. When pressure occurs inside of your anus, this can cause those blood vessels to swell, resulting in hemorrhoids . If left untreated, this can cause more pain and potential bleeding.
But there are also a ton of nerve endings on the inside and outside of your anus, making the entire area more sensitive.
“A massage there before you do anything else can help people relax,” suggests Dr. Inkster.
Your anal sphincters are elastic rings of muscle. They open and close so you can push bowel movements out of your body and keep other things from getting inside. You can relax those muscles to allow for anal sex, too.
“If you’re anxious, your anus can tighten up and it can make it hard to insert anything,” says Dr. Inkster.
You probably wanted to hear something different, but accidents can happen. And even if this never happens to you, there are billions of bacteria inside of your anus (just like the vagina). This means it’s important to be prepared whenever possible.
Dr. Inkster suggests going to the bathroom up to 30 minutes beforehand. If you have time, showering before sex can be helpful as well. Using your fingers with a little bit of water may help you relax, too. When cleaning daily, make sure you don’t over-wipe or use any chemical products because that can irritate your skin.
Non-chemical, unscented baby wipes are best for staying fresh. But some people prefer to douche or use an enema. Most doctors advise against douching or using an enema because it can thin the tissue inside of your anus if it’s done excessively. Plus, thinning of your anal tissue can make you more likely to get an infection. If you do intend to use an enema or douche, it’s important you only use warm water an inch or two inside of your anus. “You don’t have to clean everything out,” says Dr. Inkster.
“For some people, the only way they think they might be able to have anal sex is by using an enema or douching, but as long as it’s water and it’s not chemical, it’s not as bad,” notes Dr. Inkster. “Anything that’s chemical on a chronic basis is not a good idea.”
If you’re having diarrhea, it can be a possible sign of infection or cause further irritation.
Of course, we can’t always plan for every occasion. If you find you’re not prepped for the occasion, make sure you communicate. A quick trip to the bathroom while your partner gets things ready might save you both some headache.
“You might have to do a short rinse with water or something like that just for cleansing,” says Dr. Inkster.
Anal sex can present a lot of complications. But you can avoid a lot of risks if you’re patient, communicative and safe.
As with any sexual activity, you and your partner should hold each other accountable. It’s important to check in with one another often or whenever you experience a sign of pain or discomfort. Sometimes, people have a safe word, just in case, to let their partner know they’ve had enough. But you could just say no, too, if it gets too intense.
“If you penetrate someone and there’s a little bit of discomfort, you can pause and gently move along when they’re ready,” says Dr. Inkster.
The first time is always the most uncomfortable. Your anus may not be used to being penetrated, so it’s important that you work up to the moment. If you rush, you can cause serious injury, and no one wants that.
It’s normal to experience some discomfort and pressure the first time you try anal sex. But if pain increases or if it’s consistent, you should stop. Pain often means you may not be lubricated enough or your anal muscles are too tight. Some people just have a tighter sphincter, which can also make it difficult for them to have bowel movements.
Being anxious about the experience can also cause you to clench and tighten up. It’s important that you trust the person you’re having anal sex with, and it’s important that person takes their time. Start gradually and move your way up to what you’re comfortable with.
“Once you’re used to the actual act itself, and you know you’re enjoying it, that anxiety tends to go away,” says Dr. Inkster.
If you’re still having difficulty, you can train your anus — like any other muscle — by using dilators, a tube-shaped stretching device. Ideally, you would start with a small dilator, leaving it inside your anus for 10 minutes at a time a couple of times a day for about a week. But if it’s not enough, you can then move up to a larger dilator and repeat the process until you’ve relaxed your anus enough to allow for penetration.
“After about three weeks, it might be relaxed enough to be able to have sex and not have pain,” says Dr. Inkster.
If you’re a first-timer or you’ve never used a dilator before, Dr. Inkster suggests having your healthcare provider show you how to use them properly before trying it yourself to avoid injury.
Thin tissue means it can tear easily. It’s important that your partner trims their nails to avoid any jagged edges. If you’re using sex accessories, it’s also important that you avoid ridges or those large in size. If your accessory has a base, make sure you avoid putting the base inside of your anus, as it can tear the opening.
If you experience a sharp, intense shooting pain, that means you may have perforated or torn a hole in your rectum and you should stop immediately. If the pain doesn’t go away within 30 minutes, you should go to the emergency room.
“You would know because it would be the most incredible pain,” says Dr. Inkster. “This can happen with fingernails or accessories if you put them in sideways, or if they’ve got sharp edges or they’re too long.”
Small spots of blood are normal, especially if it’s your first time. But if you’re bleeding heavily, or you’re experiencing blood an hour or more after sex, you should see your doctor.
“Bleeding can happen with perforation because you rip some blood vessels,” says Dr. Inkster. “It can also happen when you’re forcing things or if you’re having rough sex.”
Syphilis, chlamydia, gonorrhea, HIV — you name it, you can catch it if you’re not cautious.
“But with a condom, it’s less risky,” says Dr. Inkster.
Even if you or your partner don’t have any sexually transmitted infections, you can pass bacterial infections and viruses to each other. This is also why it’s incredibly important that you don’t pass accessories back and forth and that you clean them between uses or before you use them in areas other than your anus.
If you’re with a consensual partner and don’t use a condom, it’s important that you consider using PrEP (pre-exposure prophylaxis) because it can be 99% effective in reducing the risk of contracting HIV.
HPV (human papillomavirus) is a highly contagious sexually transmitted disease you should be concerned about especially if you’re engaging in anal sex.
“It’s really important to wear a condom because if you have HPV that’s not treated, it can lead to anal cancer,” says Dr. Inkster.
There are more than 200 types of HPV. While healthcare providers often perform HPV tests during Pap smears or Pap tests , you can also request an anal Pap test.
“If you see something in the cervix where HPV can live, it’s probably in the anus, too,” says Dr. Inkster.
Whether you have a cervix or not, Dr. Inkster suggests getting an anal Pap each year if you’re regularly having anal sex — especially if you’re immunosuppressed.
“If someone has a negative anal Pap smear, we may skip a year here or there, but if you actually have something, then we try to find whatever is causing the problem,” says Dr. Inkster
Anal sex can be risky if you’re not prepared. By making time to prep for proper hygiene and relaxation, you can have an enjoyable experience. Like vaginal sex or oral sex, condoms and barrier protection are most important when avoiding bacterial infection or sexually transmitted infections.

Cleveland Clinic is a non-profit academic medical center. Advertising on our site helps support our mission. We do not endorse non-Cleveland Clinic products or services. Policy

If you’re considering anal sex for the first time, you might be feeling nervous. But with a little preparation and ample communication, you can have a safe and positive experience.

How to Prepare for Anal Sex, According to Actual Doctors
Let’s talk about butt sex, shall we?
1. Decide what kind of anal play you’re interested in.
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3. Make sure your toys are safe for anal.
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5. Be aware of how your poop might impact anal sex.
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7. Try some anal masturbation first.
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10. Try beginner-friendly positions.
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12. Clean up if you need to, but don’t worry about pooping.
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At SELF, Lindsey has specialized in culture, love, and sex, but also written about health, food, fitness, and beauty. Prior to SELF, Lindsey wrote about fashion and entertainment for NYLON and Mashable .
Anna Borges is a writer and a former senior health editor at SELF. She's the author of the book The More or Less Definitive Guide to Self-Care and can be found writing around the internet about mental, emotional, and sexual health. (Most importantly, she's also a Virgo sun, Aquarius moon,... Read more
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Whether you’re new to anal play or a total expert, knowing how to prepare for anal sex is the key to a pleasurable time. Okay, not just pleasurable. Preparation is just as important for safety as it is for comfort. Don’t worry, though—as long as you take the proper precautions and time to prepare, anal sex is generally safe. And luckily for you, that preparation is exactly what we’re covering in this article. So let’s get on with it!
Below, learn how to prepare for anal sex, as well as everything else you need to know about making anal sex safe, comfortable, and enjoyable, from prep to cleanup.
This is where the real preparation happens. Consider this everything you need to do before heading to the bedroom (or wherever you’re getting your anal play on).
Because spoiler alert: You have options! Sure, anal sex typically refers to penetrative sex—meaning, something going into your anus—and penetrative sex typically requires the most preparation. But anal is a wide umbrella, and knowing ahead of time what you’re interested in can help you prep however you need to. So the types of anal sex to be aware of include:
Penis in anus: Pretty self-explanatory—P-in-A sex is what many people think of first when you talk about anal sex.
Toy in anus: You have a lot of variety when it comes to anal sex toys . There are anal dildos that can be used for penetration much like a penis, sure, but your options don’t end there. There are also plugs, which are smaller and designed to be left in place. With anal beads, the pleasure is in the removal as much as the insertion. Prostate toys are uniquely shaped devices designed to massage the prostate—kind of like the anal toy equivalent of a G-spot vibrator or dildo.
Digital penetration: Exploring anal play with your fingers is excellent, especially for beginners who might be worried about size. Also, it’s also worth noting that if you’re going to explore penetration with a penis or a toy, a little bit of digital penetration will likely be involved as you “work up” to it. So you should always make sure your hand hygiene and nails are on point—and by that I mean clean, filed smooth with no rough edges, and fairly short (unless you really know what you’re doing).
Oral: Also known as anilingus...or rimming, tossing salad, or your other favorite oral-anal euphemism. If you’re not already a fan, oral sex on the same place poop comes out might make you squeamish, but you have nothing to worry about. If the receiver has had normal, regular bowel movements, anilingus is generally hygienic. But more on the poop of it all later.
Listen, we recommend lube in most sexual experiences anyway, but using lube is an absolute must during penetrative anal play, Joseph Frankhouse , M.D., medical director of colorectal surgery at Legacy Health in Oregon, tells SELF. That’s because while the vagina produces natural lubrication, the anus doesn’t. Anal penetration without adequate lubrication can cause the tissue in your anus to tear.
Not only is that painful, it also makes you more susceptible to sexually transmitted infections , like gonorrhea and HIV , board-certified ob-gyn Jacques Moritz, M.D., tells SELF. That’s because these tears create openings in the skin, potentially allowing infection-causing pathogens to enter.
When it comes to lube, you pretty much have three options: oil-based, silicone-based, and water-based. Oil- and silicone-based lubes are thicker and longer lasting, making them great for anal play. But oil-based lubes (like coconut oil) can break down condoms and render them less effective, so if you’re using a condom, steer clear of that kind of lube.
If you’re bringing silicone anal toys into the mix, you’ll want to avoid silicone-based lubes, since this kind of lube erodes silicone toys. But don’t worry—if you want to use silicone-based lube and toys, there are other toy materials out there that work just fine, such as glass or metal.
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