What You Didn’t Know About Anal Sex

“First it was shocking, then it was having a cultural moment, now it’s practically standard in the modern bedroom repertoire—or so a quick scan of any media, from P0*n to HBO, will tell you,” the Goop editors wrote in the introduction.

While research suggests an*l isn’t quite as prevalent as pop culture might suggest—a 2016 study found that just 12.2% of American women had done it within the last three months—there’s no question curiosity about the backdoor position has grown.

“Let’s face it, the anus was not made for intercourse. It’s supposed to be a one-way passage,” Dr. Streicher points out. The v**ina, on the other hand, “has a thick, elastic, accordion-like lining designed to stretch to accommodate a man-hood, or a baby.”

Rectal tissue is thinner and doesn’t share the same elasticity, so there’s a greater chance it can tear, says Dr. Streicher, who is the author of s*x Rx. And tearing increases your odds of contracting a sexually transmitted infection.

Rectal gonorrhea, an*l chlamydia, and HIV are all real risks. According to the United States Centers for Disease Control and Prevention, “an*l s*x is the highest-risk s*xual behavior for HIV infections.” But an*l s*x is perhaps most likely to transmit the human papillomavirus (HPV). “Very few heterosexual men have HIV, but over half of men have HPV,” says Dr. Streicher. HPV can cause an*l warts and an*l cancer.

What’s more, she points out, you’re probably not going to get screened for an*l STIs at your doctor—unless he or she specifically asks if you’re having an*l s*x (unlikely) or you specifically request those tests.

Then there’s pain, bleeding, and fecal incontinence. “Poop in your pants is not a nice thing to talk about,” says Dr. Streicher. She points to new research from a team at Northwestern University that found that women who considered an*l part of their regular bedroom behavior were more likely to say it changed the consistency of their stools, and report both urinary and fecal incontinence.

But if you’re interested in trying an*l s*x, or giving it another whirl with your partner, what’s the safest way? Use protection no matter what, says Dr. Streicher. “As a gynecologist, I tell people even if you are in a monogamous relationship, you should always use a condom for an*l s*x.” And if you have vaginal s*x after an*l, have your partner put on a new condom to protect against the likelihood of a urinary tract infection.


Although anal sex can be pleasurable, this doesn’t erase the fact that the main purpose of the anus is to excrete fecal matter. So it make sense that some people are naturally worried about any messy issues that may arise.

Most people can have safe anal sex as along as they empty their bowels up to a few hours before anal sexual activity. There is a small chance that some fecal matter can come into contact with your toy or partner’s penis. If you want to feel more assured, you can purchase an anal douche and fill it with warm water to rinse out your anus over the toilet before engaging in sex.


Aside from taking the safety precautions discussed above, you’ll also want to consider using condoms. Not only do condoms make it easier to clean up, but they prevent you from spreading STIs such as HIV and HPV, which are actually more easily transmitted through anal sex than vaginal penetration.


Although you’ll commonly see ass-to-mouth or ass-to-vagina in porn, this isn’t a safe practice because it moves the bacteria that’s normally inside the anus to other parts of the body. This can lead to bacterial infections. 


“Medically there no reasons not to have anal sex. Just follow safer sex practices as you’re at a slightly higher risk for STI transmission. You also have to be mindful though of not having anal sex then vaginal sex without changing the condom.” —Michael Krychman

“From a medical standpoint, anal sex is safe if you take the usual safe-sex precautions , such as condoms and dental dams, and loads of lube, since the anus is typically much tighter than the vagina. Many women enjoy anal play due to the incredibly rich nerve supply and heightened sensitivity and the added bonus of not having to worry about getting pregnant. On the flip side, many women are really turned off by anal sex and the fear of soiling themselves. Washing well and/or using an enema beforehand is an option that would make this less likely.” —Alyssa Dweck

“Anal sex is so pleasurable to many women because our bodies really do have a very, very rich cluster of nerves surrounding the anus. There’s a reason why we like to be kissed on our lips more than on maybe our elbow, because our lips have more nerve endings. That said, if you’re engaging in anal sex, you have to take more precautions from an STD standpoint. If you’re not in a mutually monogamous relationship then you should absolutely be using condoms for protection. Any time people have intercourse, even vaginal, there could be microscopic tears, which is how people catch viral STDs. But if you use lubricant, you’ll reduce those tears, which could decrease your risk of transmitting a viral STD.” —Jennifer Gunter

“One concern about anal sex is related to the transmission of HPV. Certain strains of HPV do cause cancer, and with anal intercourse, HPV infections in this area can lead to anal cancer. There have been studies documenting that people who have had anal penetration by multiple partners are more likely to develop carcinoma of the anus, so be monogamous and use a condom. Other reasons to proceed with caution with anal sex is the risk of infection with E. coli. You can also develop urinary tract infections, as well as infections of the bowel from anal intercourse. Repetitive tearing and injury to muscles of the anus can affect someone’s ability to control their bowel movements, and can result in fecal incontinence or inability to hold stool effectively inside, until they make it to the bathroom. Although not common, a more serious injury such as a penetration or tear in the colon or bowel can occur, which would require an invasive surgery to correct.” —Karen Elizabeth Boyle

“Anal sex play cannot cause pregnancy, but it can easily pass infection. So if a condom breaks during anal sex, talk to a health care provider or your nearest Planned Parenthood health center about STD testing . If you’re mainly having anal sex as a method of birth control, you can talk to the doctors while you’re there about getting on birth control so you don’t have to worry about pregnancy.” —Vanessa Cullins


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