Sex

5 Negative Side Effects Of Anal Sex

Plus, how to play safely.

A woman prepares for anal sex and the effects of bottoming. Is anal sex bad for your health? Doctors explain.
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When it comes to the negative side effects of anal sex, it's hard to get a straight answer. Because the act of anal sex is still relatively taboo, it’s now easier than ever to get helpful information about all its aspects, including how to do it safely. For people who like it (and who use lots of lube), there are some benefits of anal sex, like the possibility of anal orgasms and feeling closer to your partner. But there are also dangers of anal sex that doctors want you to know about before getting into it.

Whether the thought of anal makes you swoon or cringe, people are doing it in droves. Research by the National Survey of Family Growth, published by the Centers for Disease Control and Prevention (CDC) in 2019, found that 32.6% of women had had anal sex with an opposite-sex partner (no stats were available for same-sex anal between women). These stats, according to the CDC, are up quite a bit from the 1990s, when only 20% of women had tried it (or, revealed that they'd tried it).

But, as with everything in life, there are definitely some negatives to having anal sex. Bottoming may not be your style, or you may need to take it very slow as a beginner. For those who love anal sex, are apprehensive about it, or are just plain curious, here are five possible negative side effects to having anal sex.

1. It Can Create Tears In Your Butthole

The reason anal sex aficionados are so adamant about using lube isn’t just because it makes it feel better, but because it also helps limit anal tearing.

“Your anal canal is really absorbent, and unlike a vagina, your butt is not self-lubricating, so you absolutely need to use lube when you're having anal sex to avoid tearing, which can increase risk for STI transmission,” sex educator Emma McGowan previously wrote for Bustle. While anal tearing may not seem like that big of a deal (although uncomfortable), and all STIs are treatable, having cuts in your butthole is a recipe for all sorts of bacteria that can easily make their way into the bloodstream.

Harvard Health notes that while some tears can be superficial, others can be deeper, harder to heal, and more likely to get infected. Doctors recommend that people doing anal sex use both lube and a condom in order to minimize anal tears and protect from STIs. Double check that the lube itself is compatible with the condom, since oil-based lubes can degrade latex.

2. Anal Sex Carries The Highest Risk Of STIs

According to the CDC, anal sex is the riskiest type of sex that people can have. One of the major dangers of anal sex is how easily it can be to contract and transmit HIV when having it. Because the anus doesn't naturally produce lubrication and the skin in this area is very thin, anal tears are basically welcome mats for HIV, HPV, and other STIs. It’s one of the potential side effects of bottoming.

"It's important to remember that [STIs] can be transmitted through anal sex as well as vaginal sex," Dr. Jennifer Caudle M.D., a family physician and assistant professor at Rowan University School of Osteopathic Medicine, tells Bustle. A review of data from the National Survey of Family Growth in 2016 found that in women who had anal sex recently — within the past three months — rectal chlamydia and gonorrhea were almost as common as UTIs. But these illnesses were often missed because a lot of sexual health checks for women only involve the front, not the back door.

Condom use can help prevent transmission of all STIs, and therefore are a must during anal (or any non-monogamous sex you’re having). And doctors now recommending that if you have anal sex, you tell the person conducting your next sexual wellness check about it.

3. Anal Sex Is Linked To Anal Cancer

One of the STIs anal sex puts people at risk of is human papilloma virus (HPV), which is linked with oral, cervical, and anal cancers, according to the American Cancer Society. Not all kinds of HPV are linked to cancer (and you can be vaccinated against those that are), and many strains are asymptomatic, but experts advise that HPV and its associated illnesses are one of the risks of anal sex.

"Even though [HPV] usually goes away on its own, in some cases it does cause cancer," Jill McDevitt, Ph.D., CalExotics resident sexologist and sexuality educator, tells Bustle. "HPV is considered the main cause of anal cancer." The CDC estimates that every year in the U.S., around 4,700 cases of HPV-associated anal cancers are diagnosed in women and 2,300 in men. A 2020 study published in Journal of the National Cancer Institute found that anal cancers have been rising in the past 15 years, in part because of higher HPV rates.

While McDevitt points out that pap smears — cervical screening for the presence of possible pre-cancerous and cancerous cells — aren't just well-known but routine, the case is not the same for anal pap smears. "Anal paps also exist," McDevitt says. "But there are currently no national guidelines for routine screenings, to my knowledge." You can still request an anal pap from your health care provider if you're concerned about contracting a cancer-linked strain of HPV.

4. Infections, Generally, Are More Prevalent With Anal Sex

Let’s not beat around the bush: The anus is a direct path to the bowels. Bowels are, of course, home to poop. Poop is a waste product that's bursting at the seams with bacteria and other not so fun stuff.

Once you subtract the STI part of the equation, it's time to think of the infections that come with E. coli — the bacteria that live in the bowels. Spreading E.coli to mouths or other orifices carries risks; for one, E.coli is one of the main causes of a urinary tract infection in women after anal sex, according to a 2015 study in African Journal of Reproductive Health.

This also means that going from anal sex to vaginal sex, without properly washing in between, may increase the risk of a partner with a vagina getting a UTI, as well as other possible unpleasant infections.

"A condom is the safest thing in terms of not sharing good old fashioned bacterial infections [during anal]," Laura Deitsch, a licensed clinical counselor and sexologist, told Bustle in a previous article. "If rimming is going to be part of your play (mouth to anus) be sure to clean really well around the area ahead of time."

5. There's The Potential For A Sh*tty Situation

Newton’s third law of motion states, “What comes up, must come down.” This applies to both gravity and poop coming out of your butt after anal. Puns aside, this sh*tty situation extends far past the possibility of anal sex with a side of poop. A 2016 study published in Journal of Gastroenterology found that anal sex may lead to fecal incontinence. While the research found that both men and women can experience fecal incontinence because of anal sex, it’s men who deal with it more.

For people who have any sort of gastrointestinal (GI) problems, then the dangers of anal sex become even more complicated. "Something else to note as far as the negative side of anal sex is for folks who have GI issues, like Irritable Bowel Syndrome (IBS) or Crohn's Disease," McDevitt says. "It can already be a painful area of the body, and anecdotally, many people who have GI problems struggle with anal sex."

While anal sex may have some negative side effects, some that may even be considered dangerous, experts say bottoming can have its benefits, and it’s good to be knowledgable about the dangers and how to manage them. "There is a downside to most things, including sex," McDevitt says. "It's about being informed and weighing risks, and ultimately doing what's best for you."

Experts:

Jill McDevitt, Ph.D., CalExotics resident sexologist and sexuality educator

Dr. Jennifer Caudle, MD, family physician and assistant professor

Laura Deitsch, DHS, MS, NCC, licensed clinical counselor and sexologist

Studies cited:

Deshmukh, A. A., Suk, R., Shiels, M. S., Sonawane, K., Nyitray, A. G., Liu, Y., Gaisa, M. M., Palefsky, J. M., & Sigel, K. (2020). Recent Trends in Squamous Cell Carcinoma of the Anus Incidence and Mortality in the United States, 2001-2015. Journal of the National Cancer Institute, 112(8), 829–838. https://doi.org/10.1093/jnci/djz219

Lema V. M. (2015). Urinary Tract Infection In Young Healthy Women Following Heterosexual Anal Intercourse: Case Reports. African journal of reproductive health, 19(2), 134–139.

Markland, A. D., Dunivan, G. C., Vaughan, C. P., & Rogers, R. G. (2016). Anal Intercourse and Fecal Incontinence: Evidence from the 2009-2010 National Health and Nutrition Examination Survey. The American journal of gastroenterology, 111(2), 269–274. https://doi.org/10.1038/ajg.2015.419

Martin, T., Smukalla, S. M., Kane, S., Hudesman, D. P., Greene, R., & Malter, L. B. (2017). Receptive Anal Intercourse in Patients with Inflammatory Bowel Disease: A Clinical Review. Inflammatory bowel diseases, 23(8), 1285–1292. https://doi.org/10.1097/MIB.0000000000001186

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