Is Anal Sex Safe?

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.

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.

Understanding the anatomy of your anus

Getting started might sound really intimidating. But it can be less scary (and actually fun) the more you learn.

The importance of anal lubrication

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.

Anal tissue is delicate

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.

You have two sphincters in your anus

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.

Accidents happen

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.

How to avoid potential risks

Anal sex can present a lot of complications. But you can avoid a lot of risks if you’re patient, communicative and safe.

Communication is key

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.

Consistent pain is never good

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.

You can tear sensitive tissue

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.”

Is bleeding normal?

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.”

You can develop bacterial infections and sexually transmitted infections

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.

Why you may want an anal pap smear

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

Is it dangerous?

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.