Anal sex is the practice of inserting the penis, fingers, or a foreign object such as a vibrator into the anus for sexual pleasure. With the appropriate precautions, anal sex is mostly safe.
However, there are different potential risks that may not be present in vaginal or oral sex. For example, the anus cannot naturally lubricate itself to reduce discomfort and friction-related concerns, such as skin injuries.
This article will discuss some of the potential risks of anal sex as well as dispel some myths related to the practice.
Increased risk of bacterial infection
The anus lacks the cells that create the natural lubricant the vagina has. It also does not have the saliva of the mouth. The rectum’s lining is also thinner than that of the vagina.
Lack of lubrication and thinner tissues increase the risk of friction-related tears in the anus and rectum. Some of these tears may be very small, but they still expose the skin.
Because stool that naturally contains bacteria passes through the rectum and anus when leaving the body, the bacteria can potentially invade the skin through these tears.
This increases the risk of anal abscesses, a deep skin infection that usually requires treatment with antibiotics.
How to reduce the risk
To minimize these risks, a person should take some precautions to prevent the skin from tearing:
- Use a water-based lubricant to minimize friction-related tears.
- Change condoms if moving from anal to vaginal sex to avoid introducing different bacterial forms to each.
- Move slowly until a person establishes enough lubrication.
- Slow or stop anal sex if a person experiences pain or discomfort.
Using spermicides can also increase the risk of anal irritation. People should avoid them during anal sex.
Increased risk of STIs
Because anal sex can lead to bacterial infections in the ways we mention above, it can also increase the risk of sexually transmitted infections (STIs). For example, because the skin is more likely to tear during anal sex than during vaginal sex, there is greater opportunity to spread STIs.
Examples of these include chlamydia, gonorrhea, hepatitis, HIV, and herpes. These can be long-term conditions, as many STIs do not have a cure.
According to the Centers for Disease Control and Prevention (CDC), “anal sex is the highest-risk sexual behavior for HIV transmission” in comparison with other forms of sex, such as vaginal or oral sex.
In receptive anal sex, or bottoming, HIV is 13 times more likely to infect the bottom partner than the insertive partner.
How to reduce the risk
To minimize the risk of STI transmission, a person should wear a condom during anal sex.
They should also pay attention to the type of lubricant they use, as oil-based lubricants such as petroleum jelly can damage latex condoms. Water-based lubricants are safer to use with condoms.
There are several water-based lubricants, such as K-Y jelly and Astroglide, available for purchase online.
A 2016 article in the journal Sexually Transmitted Infections suggests that using saliva as a lubricant is a risk factor for gonorrhea in men who have sex with men. As a result, using a commercial lubricant may be a safer choice.
Condoms are not 100 percent effective at preventing STIs. The CDC recommend that those who are at high risk of HIV, such as people who have multiple sexual partners or are in a relationship with someone who has HIV, consider taking pre-exposure prophylaxis, or PrEP. This is a series of medications that can reduce a person’s risk of getting HIV.
Hemorrhoids are areas of blood vessels inside and outside of the rectum that can cause itching, slight bleeding, and sometimes pain.
While hemorrhoids can be unpleasant and painful, they are easily treated and very preventable.
Anal sex can irritate existing hemorrhoids for some people. However, anal sex itself is not likely to cause hemorrhoids if a person did not already have them.
How to reduce the risk
It is not always possible to prevent irritating hemorrhoids while having anal sex, but using sufficient lubricant can help minimize the irritation.
A common myth is that a woman cannot get pregnant as a result of having anal sex.
This is not entirely true, as it is possible for semen to enter the vagina after anal sex. While this occurrence is not likely, it can happen.
How to reduce the risk
It is important to use a condom when having anal sex to prevent pregnancy. If the partners decide to change from anal to vaginal sex, they should change the condom to minimize bacterial exposure.
Increased risk of fistula, a rare complication
In very rare instances, it is possible that a tear in the lining of the anus or rectum can grow larger. Doctors call this a fissure or large tear.
Sometimes, this tear is so big that it extends beyond the bowel to other parts of the body. Doctors call this a fistula.
A fistula can be an emergency medical situation because it allows stool from the bowel to go to other places in the body.
Because stool naturally contains significant amounts of bacteria, having a fistula can introduce bacteria to other parts of the body, leading to infections and damage. Doctors usually suggest surgery to repair a fistula.
Again, this is a rare but potential complication of anal sex. For this reason, it is important to use proper lubrication and stop anal sex if pain occurs.
Are there any long-term risks?
Some people believe that a possible risk of anal sex is that the rectum will stretch long-term, and that this damage can lead to fecal incontinence. For the most part, medical experts disagree with this.
However, a 2016 study in the American Journal of Gastroenterology looked at the sexual behavior of 4,170 adults. Researchers asked the adults whether they had ever had anal intercourse, and whether they had fecal incontinence.
They found that 37.3 percent of the women and 4.5 percent of the men had had anal intercourse. They also found that the rates of fecal incontinence were slightly higher among men and women who had anal intercourse in comparison with those who had not. Men who had anal intercourse had a higher rate of fecal incontinence than women.
The study led the researchers to conclude there was a potential link between fecal incontinence and anal sex. However, many experts criticized the study because it did not evaluate other contributing factors to fecal incontinence.
Therefore, it is difficult for doctors and researchers to fully endorse the study and its results as evidence that fecal incontinence is a true possible long-term risk of anal sex.
Generally, if people take precautions that include using sufficient lubricant and refraining from intercourse if a person feels pain, they should not expect to experience fecal incontinence as a long-term complication of anal sex.
Anal sex can be a safe and pleasurable intercourse option for some people. If a person takes precautions, such as using water-based lubricants, they can minimize the risks.
Communicating with a partner about any discomforts associated with anal sex can also reduce the likelihood of friction-related injuries.
Also, those not in a monogamous sexual relationship or who want to avoid pregnancy should use condoms to minimize the risk of STI transmission and pregnancy.
Medically reviewed by Janet Brito, Ph.D., LCSW, CST
Written by Rachel Nall, MSN, CRNA