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?
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
When we first published this post in 2011, I wrote, “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.” Well, since 2011, two new studies have been published (one in 2016 and another in 2017) – the first looking at survey data from women and men, and the other including only women.
Some but not all analyses included in this newer research suggest that penile-anal intercourse may be associated with a higher risk of fecal incontinence for both women and men. However, as neither study was detailed in their questions about anal sex (for example, neither asked about frequency of anal intercourse; to what extent the anal sex was wanted, consensual or enjoyable; or whether the anal sex engaged in was typically gentle or rough; and the study that included men asked no questions about anal sex toy use), we still have much to learn on the topic. The study that included men didn’t even distinguish between men who performed anal sex on a partner (topped) versus those who received anal intercourse (bottomed) or those who had experiences of both, so that makes it even more difficult to know what sense to make of the data.
For a clinical perspective, I spoke with Charles Moser, PhD, MD, whose expertise is in sexual medicine, men’s health and LGBT health (among other areas). He found the studies “interesting but not convincing” since they address correlation and not causation, and also because of the lack of detail they addressed about anal sex. Dr. Moser noted, too, that the researchers defined fecal incontinence as including release of mucus, gas, and liquid stool – symptoms that could be caused by other things, such as bacteria introduced from anal sex or other kinds of sex (like ass to mouth sex play), enema/laxative use (fairly common prior to anal sex), or problems further up in the intestines.
What we do know is that most people who have anal sex do not develop fecal incontinence; however, the general trend in the very few studies available suggest that people who report having engaged in anal intercourse seem to be more likely to also develop symptoms of fecal incontinence at some point. There is also a sense from other areas of research that forceful sex in general (even vaginal sex) carries greater risk for trauma or damage, as one might expect, so if you are engaging in anal intercourse you might want to consider (a) using lubricant, as mentioned above and (b) engaging in anal sex that is more gentle than rough. And certainly, whatever kinds of sex you do or don’t engage in, if you experience signs of urinary or fecal incontinence, please mention them to a healthcare provider, who may be able to offer suggestions for lifestyle changes and/or treatment.
[Also, according to the Mayo Clinic, there are a number of causes or contributors to fecal incontinence; for example, women are more likely than men to experience it, possibly because of the risk that childbirth plays in developing fecal incontinence even many years later; diabetes, chronic constipation, and surgery involving the anus and/or rectum may also increase the risk of fecal incontinence.]
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, with lubrication, during anal sex should you and your boyfriend ever decide to go from having a monogamous relationship to an open relationship.
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) as might the use of pre-exposure prophylaxis (PrEP); you can ask your healthcare provider for their thoughts on whether PrEP would be right for you.
Other STIs, including gonorrhea, chlamydia, and the human papillomavirus (HPV) can also be transmitted during anal sex as well as during oral sex and vaginal sex. Unfortunately, widespread HPV testing isn’t available for men but you can request tests for rectal gonorrhea, rectal chlamydia, and/or examination for warts (or other lumps or bumps) around the anal area.
Although most people 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 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, and something you both want, 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 silicone-based or water-based 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.
Next Question: Embarrassed About Buying Sex Toys, Sex Toy Parties
I’d like to buy a vibrator, but I have no idea how to go about getting one. I’m too embarrassed to go into a store and pick one out, but I’m also hesitant about buying one online, as I bought one off a website recently that totally didn’t work for me and I don’t want to waste more money! Can you give any advice about how and where to get vibrators?
Read Dr. Debby Herbenick’s response.
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Reviewed and updated on May 3, 2017 with links to newer research not available at the time of original (2011) publication and on May 7, 2017 with comments following clinical review.