Anal sex includes any type of sexual activity involving the anal area. The three main forms of anal sex are penetrating the anus with a penis, penetrating the anus with fingers or sex toys, and stimulating the anus using the mouth or tongue through oral-anal sex, also known as analingus or “rimming”.¹ Anal sex is not as widely practiced as penile/vaginal sex due to its taboo nature and various health risks. Nevertheless, many people around the world engage in anal sex; when practiced safely and consentingly, anal sex can be a fun and enjoyable experience! By knowing more about anal sex, people can make informed choices about it, reduce the anxiety that comes from a lack of knowledge, and begin to erase the negative stigmas that surround it.

Many couples (both heterosexual and homosexual) choose to engage in anal sex for a variety of reasons. It is important to remember that anal sex is considered a risky sexual behavior, and can lead to the contraction of STIs, including HIV/AIDS. Therefore, it is important to be properly educated about how to engage in anal sex safely.

In order to have safe, enjoyable anal sex, it is important to understand the anatomy of the anus. The anus is a short tube at the end of the rectum that is about two to three inches long.² Two rings of muscles, known as the external and internal sphincters, control the anus.³ Control of the external sphincter is generally voluntary while control of the internal sphincter is involuntary, meaning the individual is unable to control it. The sphincter muscles control the opening and closing of the anus.² Difficulties with anal sex can arise if the two sphincters are too tense, which can make it difficult (and sometimes painful) for an object such as a penis to enter. Behind the two sphincters lie the anal passage, and then the rectum.³ Both the anus and rectum have the ability to expand and stretch, although they must be stretched slowly so that they do not tear.

Like the penis and the vagina, the anus is full of sensitive nerve endings, which can make anal sexual activity very enjoyable for both males and females.⁴ Unlike a vagina, the anus does not expand during arousal (because it is not a sex organ), and thus the sensations of anal sex can be very intense. These sensations can be pleasurable if anal sex is engaged in carefully and safely.

In males, the prostate gland, a walnut-sized gland located between the bladder and the penis (see photo), can be stimulated through anal play, which many males find extremely pleasurable. The prostate gland is oftentimes referred to as the male G-spot, and is believed to lead to or enhance orgasm when stimulated.⁵

Risks of Anal Sex

Anal sex is one of the riskiest forms of sexual activity. The lining of the anus is thin and easily damaged, making it more vulnerable to infection.¹ Inserting the penis (as well as a finger or sex toy) into the anus without using generous amounts of lubrication can easily cause small tears or fissures in the anal tissue as well as considerable pain to the receiving partner.

The small tears in the delicate anal tissue are open pathways for the transmission of STIs and viruses. Some of these viruses include chlamydia, genital herpes, genital warts, gonorrhea, hepatitis B, syphilis, and human immunodeficiency virus (HIV).¹ HIV is the virus that causes the life-threatening disease AIDS (Acquired Immunodeficiency Syndrome). Even if lubrication is used, these small tears in the anal tissue can still occur, which is why it is very important to always wear a condom when engaging in anal intercourse. STIs and infections can also be spread during oral-anal sex, such as hepatitis A and E. coli. It is possible to spread STIs by inserting unclean fingers and sex toys into the anus as well.¹ 

The spread of human papilloma virus (HPV) is another major concern related to anal sex, because HPV can sometimes lead to anal cancer. Just like other STIs, HPV can be transmitted during anal sex due to the easily permeable tissue in the anus. HPV infection can cause genital and anal warts, but many people who contract the virus do not show any signs of infection. Penetration does not have to occur for HPV to spread. HPV can be spread through skin-to-skin contact with any infected body part, such as genital-to-genital, genital-to-anus, or hand-to-genital contact. HPV is relatively common, and in many cases the body can fight off the disease on it’s own. However, if the infection persists and becomes chronic, HPV can eventually cause certain cancers, including anal cancer.¹⁴ There are ways to lower the risk of contracting HPV, which include using protective barriers (such as condoms and dental dams), getting the HPV vaccine, and asking a physician for an anal cancer screening.¹⁵

It is important to know the risks of anal sex before choosing to engage in it, as well as to maintain sexual safety and follow preventative measures in order to protect the health of all people involved.

Physical Sensations Associated with Anal Sex

For some, the first few times receiving anal sex can be uncomfortable, or even painful. However, for many people, anal sex begins to feel very pleasurable with time, patience, and experience. When first engaging in anal sex, slow penetration and lots of water-based lubrication can help to lessen the pain.⁶ Inserting fingers or small sex toys can aid in preparing the anus for penetration by a larger object, such as the penis. It is important to go slowly when first inserting a penis, sex toy, or finger into the anus. Many recipients feel an initial burning sensation in the anus upon insertion, but this should not be overly uncomfortable. If at any point the recipient feels pain, both partners should stop and be still until they feel ready to move again. Honesty between the recipient and their partner, as well as listening to one’s own body, are key in understanding what activity feels pleasurable and what feels painful.

While some aspects of anal sex can cause discomfort, many people experience intense pleasure from anal sex. For males, stimulation of the walnut-shaped prostate gland inside the rectum can be very pleasurable for the receiving partner, and has been known to cause powerful orgasms. For the inserting partner, the tight walls of the anus can result in satisfying friction that positively stimulates the penis. Plenty of women also find stimulation of the many nerve endings in the anus to be a source of intense pleasure and arousal. Additionally, many participants of anal sex report that trying anal sex with their partner(s) creates an exciting bond, a new form of stimulation, and an intense experience for all involved.¹⁶ Anal sex can produce a wide variety of sensations that vary from person to person; open communication between partners, as well as patience and understanding, is key when it comes to having pleasurable anal sex.

Views on Anal Sex 

Anal sex is a relatively taboo topic that is seldom discussed publicly in many societies, especially in the United States. There are various cultural and societal interpretations of anal sex that have perpetuated its forbidden nature. Issues relating to cleanliness, health, sexuality, and morality surround this controversial activity.

Although anal sex has traditionally been viewed as a strictly homosexual activity between two males, this is not the case. Heterosexual couples often incorporate this behavior into their sex lives as well.⁹ Because of the homosexual connotations of anal sex, some heterosexual couples might feel that it is “unnatural” for them to engage in this behavior, or they may believe that only the woman should be the receiving partner. These, however, are incorrect assumptions. Anal sex is a natural behavior that both homosexual and heterosexual partners engage in, and many heterosexual men find that they enjoy anal stimulation.

Religious, cultural, and moral beliefs can also affect views about anal sex in a variety of ways. For example, some religions dictate that penile/vaginal intercourse is the only proper form of sexual activity because it is the primary behavior that leads to reproduction. Many views on the morality of anal sex have shaped different societies attitudes toward the activity. In fact, in the United States, all states considered sodomy (sexual intercourse involving oral or anal copulation) a felony until 1962. This was largely implemented under the ideologies of church law, in an attempt to restrict all sexual activity outside of marriage. In the late-1960s, these laws shifted in ways that specifically targeted the gay population in the U.S.¹⁰ While the U.S. Supreme Court ruled anti-sodomy laws unconstitutional in Lawrence v. Texas, 2003, there are still some conservative states that attempt to limit sodomy through antiquated and largely homophobic laws.¹⁷ It is important to remember that each person’s individual level of comfort with the topic of anal sex may vary considerably.

Furthermore, people may choose to refrain from engaging in anal sex because it is thought of as dirty and unsanitary. Because the anus and rectum are sites through which fecal matter passes, this type of sexual activity may be a “turn-off” to some. Many people believe that things should only exit the anus, not enter it, because of hygienic reasons. This can be a valid concern. Both the anus and rectum do contain bacteria and fecal matter, which can spread diseases and infections.⁴ However, there are precautions one can take in order to have a safe and hygienic anal sex experience; these precautions include emptying the bowels and washing the anus with mild soap and water before anal play, as well as always using protection (such as condoms or gloves) on any objects or body parts entering the anus. While anal sex involves some extra preparation, it can be a meaningful and pleasurable addition to a sexual relationship.

Homosexual Anal Sex

During homosexual anal sex, one man often takes the role of the “top” while the other takes the role of the “bottom”. In many modern societies, the “bottom” position, or the receiving male partner in anal sex, is often associated with passiveness; the “top” position, or the inserting male partner in anal sex, is often associated with dominance. This dynamic is not always true, however. In gay relationships, some bottoms are known as “power bottoms” and enjoy taking control over the top partner and the penetration.⁷ While this is one example of a sexual dynamic, every relationship is different. The healthiest relationships tend to include open communication, honesty, trust, and exploration between partners, regardless of who is penetrating or receiving. There are many sex positions partners can explore that have both dominant and passive roles. Sexual partners should do what feels best to them, and have fun exploring different positions and roles. Engaging in a variety of sex positions can greatly enhance a person’s anal sex experience.

Heterosexual Anal Sex

Heterosexual anal sex is performed by many couples, and can include both the male and female as the receiving partner. While depictions of heterosexual anal sex have been known to exist since 300 AD, public conversation and research surrounding hetero-anal sex increased in the United States following the AIDs epidemic in the 1980s. While much discussion focuses on the prevention of HIV during anal sex, which is a very important topic, some people also question why heterosexual couples choose to participate in anal play. Some answers to this question include variety, intimacy, experimentation, taboo, and domination/submission games.⁹ Other couples may participate in anal sex because they see it as a form of preserving virginity, or they simply wish to save penetrative-vaginal sex until marriage (or some other date). Anal play is an exciting form of sexual activity for many heterosexual couples, and should be explored safely, responsibly, and with consent.

Female-receptive

In the United States, a relatively large number of females participate in anal sex. According to one U.S. survey, roughly one-third of females aged 25-44 have engaged in anal sex with a male at least once.⁸ Some females prefer anal sex to vaginal sex, and orgasm from it very frequently. That being said, other females do not find anal sex pleasurable. Every person is different, and no one should be coerced or forced into participating in anal sex—like all sexual activities, consent from both partners is required before anal sex can occur. When the female is receiving anal penetration, it is important to remember that the anus is very different from the vagina, and therefore anal intercourse should be practiced differently from vaginal intercourse. Unlike the vagina, the anus has no ability to produce a natural lubricant. Water-based lubricants, such as KY Jelly, should be used generously during anal sex. Additionally, a finger, penis, or sex toy that has been in the anus should not enter the vagina afterwards, unless it has been thoroughly cleaned or a new condom/glove is used. Bacteria from the anus can cause vaginal and urinary tract infections.⁴ Anal sex typically cannot result in pregnancy, except in rare cases where the ejaculate leaks onto or in the vagina from the anus. Therefore, condom use is always recommended during anal sex.

Male-receptive

A growing number of heterosexual males also enjoy taking part in receptive anal sex.⁸ Just like females, heterosexual males can obtain lots of pleasure, excitement, and enjoyment from anal sex. Generally, the female partner would use a finger or sex toy, such as a dildo or strap-on, in order to stimulate the male anus. Whenever a finger or sex toy is used, it should be carefully cleaned and protected with a barrier, such as a glove or condom. Lots of lubrication is helpful and necessary for most couples when inserting objects into the anus. Some heterosexual men may be worried about the stigma associated with anal sex, mainly that it is a traditionally homosexual act. These men should feel no shame if they wish to explore anal play with their partner(s). The anus and prostate are highly erogenous zones in the male body, and stimulation with a mouth, finger, vibrator, or other sex toy can be a pleasurable act for many males.⁵ That being said, no one should be pressured into participating in anal play. Open communication, honesty, and trust between partners is key when considering new sexual behaviors and desires. 

Exploring the Anus

To have pleasurable anal sex, many find it important to first become comfortable with their own anus. Becoming more comfortable with one’s own anal anatomy and pleasure can help a person better communicate their needs and desires to their partners. Here are some tips for exploring the anus:

Before beginning to explore the anus, one should wash both their anus and their hands with mild soap and water. Then, a person should trim and file their nails.¹¹ A person may choose to lie on their back in bed, or to explore in a warm shower or bath. Once comfortable, a person may start by gently massaging the area around the anus, including the perineum (the bit of skin between the vagina and anus, or the scrotum and anus). As one becomes more relaxed, they can add a generous amount of lubrication to their finger, and gently press against the surface of the anus. The person can repeat this process several times, slightly increasing the pressure each time. When a person becomes comfortable enough to insert their finger into the anus, they should move slowly and gently, taking time to relax the external sphincter. At this point, a person should explore their anus in a way that brings them pleasure. Males may be able to find the prostate, which can be identifiable as a small, walnut-sized bump located approximately two inches inside the anus. Once a person feels comfortable with the insertion of their finger, they can experiment with different sex toys such as dildos or anal beads. Note that discomfort is normal when first exploring the anus, but that most discomfort should pass after three attempts.¹¹ Becoming comfortable with the anus is a personal and ongoing process. Every person is different and must listen to their own body when exploring the anus.

How to Have Safe and Enjoyable Anal Sex 

One of the most common fears about anal sex is the possibility of having an unwanted accident involving fecal matter. Having an accident while having anal sex, whether it is an unexpected leak or unwanted smell, can be embarrassing for both partners. It is important to remember that everyone has bowel movements, and that accidents can happen to anyone. However, there are preparations that can be done in order to have a clean anal sexual experience and minimize any unwanted incidents. Additionally, these precautions are important in preventing the spread of STIs, such as HIV, and bacterial infections. The following actions can help ensure that all participants have as safe and enjoyable of an anal sex experience as possible.

Be Clean

Prior to engaging in any form of anal sexual activity, it is a good idea for the receiving partner to clean their anal region. Fecal matter is most concentrated in the rectum prior to a bowel movement. Therefore, going to the bathroom prior to anal sex reduces the amount of feces in the rectum. Nevertheless, there are always some traces of feces and bacteria left behind. A person can clean the outside of the anus using mild soap and water, or using a hypoallergenic, fragrance-free wet-wipe. By lightly and carefully cleaning the general area, the receiving partner can reduce the risk of transmitting bacteria and diseases. In addition, a douche or enema can be used to better clean the inside of the rectum. A douche is an instrument that can be used to introduce a stream of water to the body for medical or hygienic reasons. An enema is a device that injects fluid into the rectum in order to wash away its contents. Douches and enemas can be found at most local drug stores. Before engaging in anal sex, one should fill the douche or enema with room temperature water, assume a comfortable position (usually bending over), and squeeze the entirety of the water into the anus. One should then hold the water inside the anus for around ten seconds, before emptying the fluids into the toilet. This can be repeated two to three times, or until a person feels clean and comfortable.¹² After using a douche or enema, a person should disinfect the object with mild soap and water and store it in a safe place for future use.

Though the process of cleaning out your anus may seem embarrassing at first, it is important to talk to your partner if it is something you are worried about. Even in a spontaneous sexual situation, communication is important in ensuring both parties have a clear understanding of any preparations made beforehand, and they can both help prepare for a potential accident if it occurs. In addition, it is important to wash any object that has been inside the rectum to avoid the spread of bacteria. After a finger, penis, or sex toy has been inside the rectum, never insert it into the vagina or mouth without using proper sanitation methods to clean if first. If the bacteria from the rectum are introduced into any other orifice, they can cause serious infections.

Use Protection

Due to the many bacterial and viral diseases that can be contracted from anal activities, it is extremely important to use barrier forms of protection. If a penis or sex toy is entering the rectum, a condom should be worn over the penis or toy. Wearing a condom while having anal sex can protect a person from transmitting or contracting HIV/AIDS.¹ Also, a condom shields the penis or sex toy from coming into contact with the fecal bacteria in the rectum. If a finger or fingers are entering the anus, latex gloves can be worn, ensuring that the hands are germ-free. If latex gloves are not used, it is important to make sure that the fingers are clean and the fingernails are trimmed short. Dental dams should be used as a barrier if the mouth and/or tongue is being used to stimulate the anus. This act is called anilingus or “rimming,” and can lead to the spread of STIs and other infections if performed without barrier protection. Using a barrier method is vital to one’s safety and health when engaging in any form of anal play.

Go Slowly and Communicate

In order to safely and comfortably insert the penis, finger, or sex toy into the anus, it must be done very slowly and gently—along with generous amounts of extra lubrication—for a number of reasons. If insertion is rushed and if the partners fail to communicate with each other and give feedback, anal sex can cause the receiver pain and potentially tear the lining of their anus and rectum. It is generally a good idea to agree beforehand on what each partner is comfortable with during anal sex, and to continue that level of communication throughout the experience. It is crucial that the partner who is penetrating check in often with the receiving partner to ensure that they are comfortable with whatever sexual act is happening. While “no” and “stop” should always be respected, partners should also establish a “safe word” before attempting anal sex, so that each person knows when to stop.¹¹ 

Use Lube

It is extremely important to use lots of lubrication. Be sure to apply plenty of it to the penis, toy, or finger as well as the anus. It may be necessary to continually reapply more lubrication over time. Water-based lubricants work best, especially with a condom; oil-based lubricants can increase the risk of a condom breaking and/or slipping off.¹³ Using copious amounts of lubrication can ease insertion and help avoid creating fissures or tears in the anal tissue.

Work Your Way Up

To avoid tearing anal tissue or causing discomfort to the receiver, it is a good idea to start slow with any anal sexual activities. In other words, start with smaller objects (such as fingers) before attempting to insert a penis or sex toy. Being relaxed is essential. Though a person has some control over their external sphincter, it is important that their internal sphincter is also relaxed, or penetration will be difficult. By starting out small, one can gradually adjust and increase the size of the object being inserted. If a finger or two has been successfully inserted without causing pain, inserting larger objects can be attempted if both partners feel comfortable. It is never a good idea to force insertion; it must be done gently. If a couple is having difficulty, they should use more lubrication, and have the penetrating partner lead their penis or toy with a finger during insertion. This can sometimes help the anus relax, and facilitate the entrance. The receptive partner should always remember that it is okay to stop at any point, for any reason. Communication throughout this process is the best way for both partners to foster mutual trust, respect, and comfort.

Unprotected Anal Sex

Although the importance of condoms cannot be stressed enough, situations do arise in which condoms are not used or may break. If a person is engaging in anal sex with a consistent monogamous partner and both partners have tested negative for all STIs, then STIs cannot be spread during unprotected anal sex; however, bacteria from the anus can still be spread from the receptive partner to the insertive partner. If a receiving partner engages (or is planning to engage) in unprotected anal sex with a partner whose STI status is unknown to them, they may benefit from the following information:

• One should not use a douche or enema prior to anal sex. Cleaning out the anal cavity may cause tearing and increase the risk of contracting an STI.
• One should not let their partner be too rough! Rough sex can cause anal tearing
• One should consider the benefits of asking their partner to ejaculate outside of them. Though practicing anal sex without a condom already places a person in a high-risk situation, having their partner finish outside the anal cavity is safer than having him finish inside the anal cavity.

While talking about STIs is not always easy, it is the responsible thing to do, and can make both partners feel more safe and comfortable engaging in sexual activities together. A person should be honest with their partner(s) about STIs and should always use protection, especially when engaging in anal sex. 

Concluding Remarks

When practiced safely, anal sex can be an exciting, fun, and adventurous way to spice up a person’s sex life! It is important to remember that anal sex is not mandatory. Many people (including gay men) abstain from anal sex and have very happy and fulfilling sex lives. A person should never feel pressured into having anal sex if it is not something they are comfortable with. That being said, the anus is a natural and pleasurable part of the body, and there is no reason why it should not be explored. While anal play may not always feel “natural” at first, it is something that becomes more comfortable and enjoyable for most people with time, patience, and practice. Open communication and trust between partners is key when exploring anal sex, as well as extra safety and hygiene precautions to protect against STIs and bacterial infections. Exploration is a valuable part of sexuality, and those who choose to explore anal sex should have fun, be safe, and learn what feels right for them.

Here are two great videos that outline advice for preparation and participation in anal sex:

References

1. “Does anal sex have any health risks?” NHS Choices. NHS, 02 Oct. 2015.
2. “The anus.” Human Anatomy. Anatomy Medicine, n.d.
3. “Anatomy of the anus.” Anal Cancer Information. University of California, San Francisco, n.d.
4. “Anal Sex Safety and Health Concerns.” Sexual Health. WebMD, 2015.
5. Thorn, Katy. “Erogenous Zones: The Anatomy of Male Pleasure.” Volonté. N.p., 24 Oct. 2016.
6. “Is sex painful the first time?” NHS Choices. NHS, 30 Mar. 2015.
7. Rzepczynski, Brian. “The Power Bottom.” The Gay Love Coach. N.p., 20 Nov. 2010.
8. Lehmiller, Justin. “Sex Question Friday: Do Women Enjoy Anal Sex?” Sex And Psychology. Justin J. Lehmiller, 09 Aug. 2013.
9. Castleman, Michael. “Heterosexual Anal Play: Increasingly Popular.” Psychology Today. Sussex Publishers, 01 Dec. 2010.
10. “Why Sodomy Laws Matter.” American Civil Liberties Union. ACLU, 2017.
11. Doe, Lindsey. “Anal Sex Prep.” Youtube. Sexplanations, 22 Apr. 2014.
12. “Cleaning Out – For Anal Sex.” YouTube. Watts the Safeword, 29 Jan. 2016.
13. “Male condoms – How to use condoms and lubricant.” HIV & AIDS Information. NAM Publications, 2017.
14. “What Are the Risk Factors for Anal Cancer?” American Cancer Society. American Cancer Society, 20 Jan. 2016.
15. “Anal Cancer.” American Society of Colon and Rectal Surgeons. ASCRS, n.d.
16. “What Does Anal Sex Feel Like?” New Health Guide. N.p., 28 Sept. 2015.
17. “12 states still ban sodomy a decade after court ruling.” USA Today. The Associated Press, 21 Apr. 2014.

Last updated: 6 June 2017.