This is Part 2 of a two-part series on anal sex. 

In Part 1 of this series, we laid out the what and the why of anal sex. If you are wondering, “Why do people have anal sex?,” or “How many American have anal sex?,” or even “Can I have an orgasm from anal sex”—we suggest heading there first! For those of you have read Part 1 (or are just really eager to get down to it), welcome!

Below you will find tips for how to engage in anal sex, drawing on the best available evidence. But, warning, the evidence is limited. There isn’t a whole lot of funding for research on women’s anal sex lives. Little attention has been given to anal sex among women, particularly strategies for safe and pleasurable anal sex (McBride and Fortenberry 2010). We will edit these tips as the evidence evolves and in response to your feedback and questions. For now, here is what we know:

Reasonable steps to consider when getting started with anal sex:

1. Have a discussion with your partner (i.e. the person you plan on having anal sex with) and ensure that you both consent. This is nonnegotiable, as with any kind of sex. With anal sex, you might need some practice and additional patience to get it right. Everyone involved should be comfortable and consenting before the party gets started.
2. Consider lubrication Remember our blog on lubricants? Many people find anal intercourse to be more comfortable with lubrication, but there is very little scientific evidence to endorse one kind of lubricant or another. The rectum, unlike the vaginal canal, does not produce its own lubrication for sex. Some women use vaginal secretions or saliva to help with lubrication for anal sex. Other people use lubricants that they buy in the store and there are pros and cons to these. There are also special considerations as we age. Notably, the tissues around the anus and in the rectum (like lots of the skin on our bodies) weakens with age. This weakening means that middle aged and older adults are even more susceptible to scrapes and tears (usually microscopic) during intercourse. While using a lubricant may reduce the risk of these tears, the lubricants themselves may cause trouble. Irritants in lubricants can cause inflammation in the rectum and anus that increases susceptibility to infection. Oil-based lubricants can cause condoms to weaken or malfunction. Silicone lubricants are both compatible with condoms and may be the least likely to cause inflammation (Martin 2017, Dezutti 2012, Fuchs et al. 2007).
3. Go at a slow and comfortable pace While there is little research about the safest way to actually engage in anal sex, we know that the anal sphincter’s main job is to remain tightly shut so nothing slips out… unexpectedly. Thankfully, it is usually very good at its job. This means, however, that it’s important to be very gentle when moving anything into or out of the anus so as to not cause pain or even damage the muscle or skin around the anus.
   
   To overcome these challenges, experts recommend easing into anal penetration. It’s possible, just like the first time with vaginal intercourse, that you may not achieve penetration on the first try. Practice could start with small and slow. There are many ways to do this. For example, your first attempt at penetration could be with a finger or a small sex toy (commonly called a “butt plug” in this context). Once you are comfortable with that sensation, move to something slightly larger i.e. a larger finger or toy. Do this until you feel comfortable getting to your goal, such as a penis or dildo.

Stay safe—important considerations for anal sex

As with any kind of sexual activity, anal sex comes with risks in addition to its benefits. Some things to think about:

1. Use barriers Sexually transmitted infections are as much of a consideration with anal sex as with other kinds of sexual activity. In fact, HIV is more likely to transmit from a man to a woman receiving anal intercourse than to a woman receiving vaginal intercourse. This higher risk may be due to small breaks in the rectal tissue that result from mechanical thrusting during intercourse, inflammation related to semen and lubricants, and cells in the rectum that are particularly susceptible to HIV infection (McBride and Fortenberry 2010). For middle age and older adults, as we have mentioned, the mucosa or lining of the rectum can become more fragile with age, which also increases risks of giving or getting a disease during intercourse. For these reasons, we strongly recommend that condoms be worn during anal intercourse. Even if you are with a trusted partner, other bacteria that live in stool (aka “poop” or “feces”) can be transmitted to your other body parts (like your vagina or mouth). A dental dam is a barrier, typically made of latex or polyurethane, that can be used during oral sex. Both partners can use this on the anus as a protective barrier for oral-anal stimulation. Good old handwashing is a good idea before and after sex, especially after anal contact or penetration.
2. Enemas Some people might think that performing an enema before sex (i.e. douching the rectum to clean it) is a good way to protect against risk. But, there is no evidence that an enema will protect against disease transmission. In fact, although enema is seemingly a common practice before anal sex, some research suggests regular enema use might even break down the lining inside of the rectum and could increase the risk for infection (Carballo Dieguez 2018, de Vries 2008, Shmelzer 2004). In a 2017 clinical review, one group of doctors specifically recommended against patients with inflammatory bowel disease using enema for these reasons (Martin 2017). These doctors, and others, say that people who feel like they really need to use an enema (against a doctor’s advice) should use a bulb syringe with plain tap water (no extra chemicals or high powered faucets needed) (Martin 2017, Joannides and Gross 2006).
3. Choose your sex toys wisely If using a sex toy—such as a dildo or butt plug—for penetration, make sure it is specifically designed for anal penetration (examples here*). This means the product should have a flared base or some other way of holding on to it once it is inserted into the rectum. Sex toys without this design feature can get stuck in the rectum and are difficult to retrieve without the help of a medical professional. We’d venture to guess that would not be your ideal way to end a night of experimentation…

Still have more questions about how to engage in safe, pleasurable anal sex? Email us at info@womanlab.org or @ us on Twitter (@WomanLab_) or Facebook!

*Note: Names of specific products or places to buy products should not be considered as endorsement. We provide examples to help make this information easier to understand.

Sources

1. Carballo-Diéguez A, Lentz C, Giguere R, Fuchs EJ, Hendrix CW. Rectal Douching Associated with Receptive Anal Intercourse: A Literature Review. AIDS and Behavior. 2018 Apr;22(4):1288–1294.

2. de Vries HJC, van der Bij AK, Fennema JSA, Smit C, de Wolf F, Prins M, Coutinho RA, MorrÉ SA. Lymphogranuloma Venereum Proctitis in Men Who Have Sex With Men Is Associated With Anal Enema Use and High-Risk Behavior: Sexually Transmitted Diseases. 2008 Feb;35(2):203–208.

3. Dezzutti CS, Brown ER, Moncla B, Russo J, Cost M, Wang L, Uranker K, Kunjara Na Ayudhya RP, Pryke K, Pickett J, LeBlanc M-A, Rohan LC. Is Wetter Better? An Evaluation of Over-the-Counter Personal Lubricants for Safety and Anti-HIV-1 Activity. Tachedjian G, editor. PLoS ONE. 2012 Nov 7;7(11):e48328.

4. Fuchs EJ, Lee LA, Torbenson MS, Parsons TL, Bakshi RP, Guidos AM, Wahl RL, Hendrix CW. Hyperosmolar sexual lubricant causes epithelial damage in the distal colon: potential implication for HIV transmission. J Infect Dis. 2007 Mar 1;195(5):703–710. PMID: 17262713

5. Joannides P, Gross D. Guide to getting it on! Waldport, OR: Goofy Foot Press; 2006.

6. Martin T, Smukalla SM, Kane S, Hudesman DP, Greene R, Malter LB. Receptive Anal Intercourse in Patients with Inflammatory Bowel Disease: A Clinical Review. Inflammatory Bowel Diseases. 2017 Aug;23(8):1285–1292.

7. McBride KR, Fortenberry JD. Heterosexual Anal Sexuality and Anal Sex Behaviors: A Review. Journal of Sex Research. 2010 Mar 24;47(2–3):123–136.

8. Schmelzer M, Schiller LR, Meyer R, Rugari SM, Case P. Safety and effectiveness of large-volume enema solutions. Applied Nursing Research. 2004 Nov 1;17(4):265–274.

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Edited by Megan DePumpo