Q&A: Anal Sex And Long Term Health Concerns

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QUESTION: I’m a gay man and I’m in a long term monogamous relationship. We frequently engage in anal intercourse. We always use sufficient lubrication and my boyfriend never experiences pain during sex. But, is there any danger of damaging his anus over the long term and causing him health issues?

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Although anyone can be infected with HIV, regardless of their sexual orientation, HIV is more common among men who have sex with men.

Even though millions of people in the US engage in anal sex – as many as 40% of men and women in some age groups have tried it (though far fewer practice it regularly) – it remains a taboo topic. However, the taboo nature of many sex topics unfortunately keeps many people from asking questions about them, so I’m glad that you felt comfortable asking your question.

Let’s Talk About Health

As far as we know, regular anal sex – when practiced comfortably and safely and without risk of infection – is not likely to damage a person’s anus or rectum or to cause significant health problems.

Although I know of no long-term scientific studies that have examined this particular issue, I would imagine that if anal sex was particularly dangerous, doctors would have noticed by now given the large number of people of all sexual orientations that have engaged in anal sex.

That said, there are a few things that you should take into consideration.

As anal sex is considered a high risk sexual behavior for passing sexually transmissible infections (STI), you may want to use condoms during anal sex should you and your boyfriend ever decide to go from having a monogamous relationship to an open relationship.

HIV

Although anyone can be infected with HIV, regardless of their sexual orientation, HIV is more common among men who have sex with men. In a recent study conducted by the Centers for Disease Control and Prevention, they found that nearly 1 in 5 men who have sex with men in urban areas had HIV.

Also, 44% of those infected with HIV didn’t know that they had it. If you have both tested negative for HIV and other STIs and you remain monogamous, then this won’t be an issue for you two. But if you either of you has sex with others, then condom use would be recommended (with the other person and possibly amongst yourselves).

HPV

The human papillomavirus (HPV) can also be transmitted during anal sex as well as during oral sex and vaginal sex (and even dry humping). Unfortunately, most clinics do not test men for HPV as there aren’t particularly good tests available for men.

Although most women and men who are sexually active will have HPV at some point in their lives, it doesn’t cause noticeable problems for most people. However, HPV can cause genital warts and can also increase the risk of various cancers, including genital cancers and anal cancer.

As such, you and your boyfriend may not know if either one of you contracted HPV from a previous partner. You may find it helpful to examine your own or each other’s bodies from time to time and report any noticeable changes related to lumps, bumps, or chronic itching to a healthcare provider. There is a very low chance of having anal cancer, and even genital warts are fairly uncommon, but these are still things to consider.

Learn More

As for the act of sex itself, if your boyfriend is the receptive partner (bottom) and you are the insertive partner (top) – which is what it sounds like – then as long as the sex you engage in is pleasurable, he should be fine. I would recommend steering clear of anal desensitizing creams which can mask discomfort or pain. You’re wise to use plenty of lubricant as well.

To learn more about this topic, check out Anal Pleasure and Health: A Guide for Men, Women and Couples, which is relevant to people of all sexual orientations and varying levels of experience.

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Read Dr. Debby Herbenick’s response.

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Dr. Debby Herbenick (M.P.H., Ph.D.)

is a sexual health educator at The Kinsey Institute, Associate Director of the Center for Sexual Health Promotion at Indiana University and author of several books including Sex Made Easy and Because It Feels Good: A Woman's Guide to Sexual Pleasure and Satisfaction.
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