Is anal sex risky?

Yes. Anal sex carries a risk of:

• Transmitting sexually transmitted infections (STIs) The risk of transmitting STIs, such as Chlamydia, Gonorrhea, Syphilis, Hepatitis C, Herpes, HPV, and HIV, is higher during anal intercourse than any other type of sex.
• Transmitting other types of infections. Intestinal parasites and bacteria which normally live in the intestinal tract are passed out of the body in feces. They can cause serious infections if they get into someone’s mouth or vagina.
• Tearing the sensitive skin around the anus, the skin lining the rectum, or the sphincter muscles. The sphincter muscles are rings of muscles that rim the inside of the anus and control the passage of feces.
• Tearing of the anal sphincters may result in severe pain and fecal incontinence (the inability to control the passage of feces).
• Pregnancy (very rare). The rectum is not directly connected to the reproductive system, therefore sperm cannot get from the rectum to the egg. However, if any semen gets near the vaginal opening there is a small risk of pregnancy.

Why is anal sex so risky?

Anal sex is risky because of the anatomy of thus anus and the rectum.

The rectum does not produce a lubricant. This means the skin inside the rectum is susceptible to tearing during anal sex, which increases the chance for STI transmission.

Inside the anal canal there are two muscular rings, the inner and outer anal sphincters.

• The outer sphincter is under voluntary control, which means a person can tense and relax the ring of muscle when they want to.
• However, the inner anal sphincter is under involuntary control. This means that it responds to internal signals, such as fear and anxiety, and can tense automatically. If it tenses during sex, the risk of tearing increases.
• A person can learn to voluntarily control the inner sphincter with practice. By learning to relax the inner sphincter, people may decrease the chance of tearing it.

How can anal sex be made safer?

Get consent. Consent is a clear, sober (no drugs or alcohol), verbal, yes. Consent should be given freely by both partners.

• NOT every sexually active person has or has had anal sex, nor does everyone enjoy anal sex.
• It is okay to say no to anal sex and/or any other sexual practice(s) you are not comfortable with.
• Respect your partner if they do not want to have anal sex or you sense they are not comfortable with anal sex, do not pressure them.

Use a condom or latex barrier EVERY TIME, this includes covering sex toys and fingers. Even if both partners know they are negative for STIs there is still a risk of bacterial and/or parasitic infections and a small risk of pregnancy. If going from anal sex to vaginal sex or oral sex, a new condom must be used.

If not using a condom, the penis, finger, or sex toy should be washed with soap and water before going from the anus to the vagina or mouth.

Make sure the anal area is clean and the bowel is empty.

Use a water-based lubricant. Because the anus does not produce its own lubricant, it is important to use a water-based lubricant, without chemical additives. Using a water-based lubricant will:

• Help prevent the condom from breaking (condom failure).
• Decrease the likelihood of tearing the sensitive skin around the anus and inside the rectum.
• Increase the comfort and pleasure of the receptive partner.

Take it in steps, especially the first time.

• Some people choose to start by inserting their finger or having their partner insert a finger into their anus.
• To help teach the inner anal sphincter to relax, a person can gently run their finger along the sphincter and the inside of the anal canal.
• The finger should be clean with clipped fingernails.
• Using a latex glove and a water-based lubricant will make it safer and more comfortable.
• Once a person is comfortable with a finger, they can try two fingers, or a sex toy. When using a sex toy or other object, it is important that the base is wide, to prevent it from getting lost in the rectum. Nothing breakable should ever be inserted into the anus.

Let pain be a guide. Anal sex should not hurt. Pain is the way of telling someone that something is wrong. The receptive partner should always be in control of insertion. It should be agreed upon that if the receptive partner says, “stop”, “slower”, “gentler”, or any agreed upon command, the request be respected immediately.

Avoid using drugs.

• The use of muscle relaxants to help relax the sphincter muscles is not recommended as they can have serious side effects, such as: facial flushing, headaches, dizziness, and low blood pressure, which may lead to faintness and loss of consciousness.
• In combination with erection-inducing drugs (i.e. Viagra, Cialis, etc.), muscle relaxants can potentially cause a fatal drop in blood pressure.
• Using a local anesthetic to reduce anal pain is not recommended. Because pain the body’s way of telling someone something is wrong, numbing the area could cause serious injuries, such as tearing the anal sphincter(s). It could also make the penis of the insertive partner numb.
• Using drugs that increase a person’s energy and sex drive (like methamphetamines), may increase a person’s risk of STIs. This is especially true when they are used with erection-inducing drugs. This is because:
• These drugs can cause prolonged sexual activity, increasing the risk of anal tissue damage and condom failure.
• People may not be aware of pain associated with anal tissue damage.

If you have any questions or concerns, ask your health care provider. We are here to help.