Ask the Doctor of Perversity
by Beth Brown, MD

From Issue 3.5 - June 1997

The Basic of Buttplay

Dear Dr. Beth:

I am concerned about possible physical problems resulting from anal sex. I have experienced recent bowel problems such as diarrhea and constipation. Even though anal sex is a turn-on for me, getting over the initial discomfort and later the fear of permanent damage is a problem. Can you give me some facts on this topic?

Sincerely, Verna

Dear Verna:

You don't say whether you are being penetrated by a penis, sex toy, fingers, or a fist. Some of the principles are the same no matter what is being used to pleasure your asshole: take your time, use lots of lube, and pay attention to what your body tells you.

Unlike the vagina, the anus has a two-part muscular sphincter which must be relaxed in order to permit comfortable penetration. The mucosa, or lining, of the anus is more delicate than that of the vagina, and produces less natural lubrication during sexual arousal. Injudicious force in entering the anus can damage the sphincter muscle or tear the delicate mucosa; proper relaxation and technique are essential.

Whatever the final object of penetration you desire, it is very helpful to start small and work up. By beginning anal sex with one well lubricated finger, you can start small, and the owner of the finger can feel the condition and readiness of your asshole. Pressing gently on the sphincter muscles and slowly increasing the depth and rate of penetration will prepare the asshole for more fingers, and then for a penis, dildo, or fist. The size of the object which can be safely inserted depends on the size and readiness of the asshole. The anus and rectum are normally used to pass stool, which can be quite large in diameter, and the muscles and tissue are stretchy and flexible. Spasm due to anxiety or fear of being damaged is more likely to cause problems than the size of an object itself. Stimulation of other erogenous zones during entry can help the anus relax.

Some types of illness may be associated with problems with anal sex. People with Crohn's disease or ulcerative colitis may have areas in or just above the rectum that may be susceptible to damage during fucking. Such persons should check with a doctor before engaging in any type of anal play that is new to them, or if new symptoms happen during or after anal sex. Irritable bowel syndrome is a nerve disorder in which constipation and/or diarrhea can occur or worsen in response to stress, and sometimes due to anal or vaginal sex. This isn't dangerous -- just annoying and painful -- and can sometimes be prevented by using a medication like Imodium AD before anal sex. Avoiding post-sex worry can help prevent attacks of irritable bowel syndrome.

Don't go butthole diving without a wetsuit! The anus is full of bacteria, and infected persons can pass various viruses in their stool, including herpes, cytomegalovirus (CMV) and hepatitis A. Parasites like Giardia and amebas are easily transmitted by contact with infected stool or anal secretions. It is also possible to have an infection with a sexually transmitted disease such as gonorrhea, chlamydia or warts in the anus with no apparent symptoms. The area around the outside of the anus may also be infectious; microscopic bits of fecal matter may contain eggs of intestinal parasites. Condoms and gloves are essential for anal penetration. Fingers and toys that touch the anal area should be washed thoroughly with antibacterial soap and water before they touch anything else. It is best to use gloves even on the outside --warts and herpes can infect microscopic cuts on the fingers, and may be contagious even when no visible sores are present. Once anal sex has occurred, condoms or gloves should be changed before a woman's cunt is entered.

Rimming is an amazingly efficient way to pick up diseases -- don't do it without protection. Latex dental dams are good barriers; if none are available, plastic kitchen wrap is a decent substitute, although brands vary in quality. Internal condoms (Reality) made of polyurethane have both an internal segment for protection during fucking and an external segment to cover the area around the butthole. These are marketed for vaginal sex, but were actually designed to be versatile enough for either the cunt or the asshole.

Many people feel they must douche or use an enema before being fucked in the ass. I'm not a big fan of this practice. Enemas remove some of the natural lubricant and immune system chemicals in the anus and rectum, increase the likelihood of spasm, and can traumatize the delicate mucous membranes. Any blood present in the rectum after douching can transmit blood-borne diseases including HIV. The natural way is safer and easier.

If symptoms of diarrhea and constipation are ongoing, get them checked out by a medical professional. Otherwise, just remember the basic rules of anal sex: relax, communicate, take your time, and always wear your rubbers.

Beth Brown, MD (DoctorBeth@aol.com) is a Bay Area family physician. She is a contributor to The Lesbian S/M Safety Manual (Pat Califia, editor; Alyson Press, 1988). Please send questions that you would like her to address in future issues to DoctorBeth@aol.com.

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Last updated: 8 July 1997