babyland
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Always your choice
Basic Information
Anal intercourse is not only practiced by gay men but by heterosexuals as well. To have anal intercourse safely requires education and a commitment to put into practice with your partner the facts that you have learned. After all, anal sex is the highest risk sex act for risk of HIV infection. Also, other STDs (sexually transmitted diseases) and other injuries can occur so understanding how to have healthy anal sex is imperative.
First it is important to understand that the anus and rectum are two distinct sites, both in regions of your colon. The colon is normally six feet in length and anal intercourse affects the last few inches. The anus is lined by cells much like those of your skin and has nerve endings that feel pain. The rectum on the other hand is more closely akin to your colon and does not have the nerve endings that give sensation like the anus. Sphincter muscles are in your anus and lower rectum. These muscles control bowel movements. Understanding how these muscles work is a key to having healthy and painless anal intercourse.
The sphincter muscles are both external and internal. The external sphincter muscle is controlled by you and you have the ability to either tighten or relax it. One normally tightens it to keep gas from passing or loosens it in order to have a bowel movement. However, the internal sphincter muscle you have no control over. You cannot make it tighten or relax. It rests against your colon wall and injury can occur when a penis, sex toy, fingers or other objects of insertion causes an involuntary contraction of the internal sphincter muscle. Thus your internal sphincter muscle relaxes and tightens involuntarily, i.e. relaxes involuntarily when bowel movement enters your rectum and tightens involuntarily when an object enters from outside the body. Since you have no control over relaxing this muscle you can feel pain or an injury like an anal tear or fissure can occur when your closed sphincter muscle is penetrated, especially in an abrupt or rough manner. With sensitivity and communication between you and your partner the risk for injury and disease caused by anal intercourse can be minimized. To avoid injury you and your partner should understand the role of the internal sphincter muscle during anal sex--that is, that it can tighten only for a certain length of time or it tires and loosens on its own. That is why careful, low insertion of the penis is important. The best way to insert the penis inside you (or dildo or sex toy for that matter) is to slowly and cautiously lower yourself onto your partner's penis until you feel some pain or discomfort. The penis is gently pushing on your internal sphincter muscle and usually within a minute this muscle will stop contracting and relax. When it has relaxed you can continue to insert the penis. In most instances you will no longer feel pain since the muscle is stretched and you will be able to accommodate the member. You want to avoid spasms and be able to relax your sphincter.
When having anal intercourse it is important that the anoreceptive partner uses a good amount of lubricant on the outside of the anus and that the penetrator wears a latex condom with a water soluble base. (See separate article for information on use of a condom.) Lubricants should not be oil-based but water-based. Even in the area of foreplay, condoms are recommended because precum can drip onto the skin and come into contact with breaks in the skin. Fingers in the anus as a form of foreplay can be more dangerous than the insertion of a penis because fingers are more likely to cut the skin and a possible bacterial infection may follow because of bacteria found in feces. Fingers inserted in the anal opening should have well-trimmed nails and be free of cuts that could be problematic in transmitting STDs. Latex gloves are an option to help reduce injury or transmission of STDs.
Dildos--preferably made of latex--should be soft with a tapered end both because this will help the sphincter muscle to relax and since eight inches from the opening of your anus the colon turns sharply. Dildos that are not soft may not be able to make the turn and spear your colon wall, rupturing the colon, requiring immediate surgery so that deadly bacteria does not spread.
Putting large objects such as large, hard dildos or fists into your anorectal area is not recommended as it can cause incontinence by injuring the internal sphincter muscle.
Colon perforations are rare but very dangerous. If you should insert an object in your anus and not be able to retrieve it, you must go to a doctor or an emergency room and have it removed, even if it is an embarrassing situation to you since by not removing it colon perforation is a possibility. Do not try to remove it with an enema as that only moves it further into the colon.
By the way, giving yourself an enema before penetration is not particularly advisable since the large amount of water may not be fully washed out before sex. Sometimes a mini-enema with an ear syringe is advised. Remember that anal sex is the most viable way not only to transmit the HIV virus but to pass other STDs on as well (gonorrhea, syphilis, herpes, hepatitis, chlamydia).
If you have one STD it is likely that you may have others and should be tested for them. Also, if you are a male having anal sex with another male, a discussion about HIV with an experienced, empathetic health care provider is important and indicated.
Symptoms
One of the most notable complications that can arise from anal sex is bleeding. This can happen at any time before, during or after anal intercourse. It can happen beforehand during foreplay (insertion of toys and fingers) and if you or your partner notice there is blood in your anal area there should be no penile penetration until healing occurs. If there is pain during bleeding a fissure may have occurred and if bleeding and pain persists a visit to your health care provider is recommended. Men who have hemorrhoids may experience bleeding on occasion but it is usually not associated with pain and usually manages to subside on its own. If you have fissures or any other anorectal tear or cut or wound do not attempt any kind of penetration until you are completely healed.
Of course you may have pain associated with an STD such as herpes. You may or may not have symptoms in your anus associated with STDs. (Please see articles on gonorrhea, syphilis, herpes, HIV, hepatitis and chlamydia for a description of symptoms.)
Perforation is rare but dangerous. Usually the first sign of perforation is pain but other symptoms may include:
swelling
fever
pelvic pressure
a darkening or reddening of the buttocks
Incontinence can occur for a number of reasons, the most serious of which may be repeated injury to the internal sphincter muscle but often incontinence will pass and is experienced by nearly everyone at some time, homosexual or heterosexual alike.
Diagnosis/Treatment
In diagnosing anorectal disorders and problems arising from anal intercourse between males it is important to have a frank and honest discussion of your sexual history with an understanding health care provider who is experienced in dealing with problems of anal sex between males and will be able to recognize signs and symptoms for what they are, unclouded by prejudice or a closed mind. Be sure when seeking treatment that you select a health care provider with whom you feel comfortable enough to share your sexual history.
If you are having anal intercourse it is important to maintain good hygiene. Certainly removing any fecal matter from the outside of your anal area with a Tucks pad is advised. Ear syringes rather than regular enemas are suggested for use because of the smaller volume of water that goes into your rectum and the probability that water and any kind of fecal residue will be more successfully evacuated than in the case of a douche or an enema. Remember that the anus does not lubricate itself and a water-soluble lubricant should always be used on the outside of your anus. If you have a tight sphincter muscle or feel that anal sex is too painful yet you would like to try it with your partner, rectal dilators may be suggested for use before anal penetration so that sphincter dilation occurs and you will be better able to accommodate your partner. Some men will be able to take the rectal dilators more easily than others and it is recommended that you go at your own pace and if any pain occurs stop immediately and wait until pain subsides before trying to use the dilators again. It is always best that you discuss the use of rectal dilators and a possible schedule of use for progressive dilation with your health care provider.
It is usually recommended that if you are the passive anal partner that a face down position is best because it is the position in which you will experience the least anal pressure. Also it is the best position if you have hemorrhoids which are more likely to bleed if your legs are positioned in the air as opposed to flat out with you lying on your stomach. If you are the anal receptive partner and feel pain at any time, it is important that you ask your partner to stop until pain subsides. If pain continues you should stop altogether and find out if there is an underlying cause or reason for the pain. Pain is letting you know that your muscles may be torn or damaged if they were stretched too quickly. When this happens there is usually bleeding which is too high up in your rectum to be seen. If your sphincter muscles have been traumatized or injured, treatments can include:
warm Sitz baths
muscle relaxants
stool softeners
painkillers
the use of Tucks or cotton balls on the outside of your anal opening (without skin irritants)
In situations in which a transmural perforation occurs, immediate surgery and IV antibiotics are often required. Do not delay in undertaking this surgery if it is deemed necessary, otherwise a colostomy may be required.
It is very important if you are going to have anal intercourse for you to be as educated as possible about the risks associated with it. Ideally you should have a partner with whom you can communicate directly about any possible pain or problems that may arise and a sensitive health care provider with whom you can confide and get answers to potentially embarrassing questions if posed to a homophobic or judgmental health care provider.
If you have any questions about anal intercourse and the injuries and STDS that can be associated with it, please see a knowledgeable, gay-friendly health care provider promptly.
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