Dr Philippa Kaye, GP with a particular interest in women’s and sexual health
It is a subject that many people will feel uncomfortable reading about: anal sex.
Some reading this might think it’s something extreme or, to put it delicately, extremely niche.
But it’s not. The National Survey of Sexual Attitudes in Britain reported recently almost 30 per cent of 16 to 24 year old take part in heterosexual anal sex.
And this came as no surprise to me. As a GP with a special interest in womens’ health, I often speak to female patients of a wide variety of ages on the subject.
Often, it’s when things have not gone quite according to plan.
Common problems include anal fissures, which are small crack in the anus that can be extraordinarily painful and bleed.
In the worst cases, woman can be left with continence issues due to damage to the muscles that help us ‘hold on’.
And then there are sexually transmitted infections (STIs): younger women, sadly, have told me of partners who insist condoms aren’t needed for anal sex, as there is no pregnancy risk.
But of course, the risk of catching everything from the more simple-to-treat gonorrhoea to trickier, incurable genital herpes and even, albeit rare, HIV, which is still out there.
My biggest worry, however, is that there are many women out there who don’t come forward for help and advice if they’re suffering from anal problems, due to embarrassment.
I’m not alone: a recent editorial in the British Medical Journal discussed the importance of doctors having open conversations about anal sex in order to meet the needs of women.
However it’s important to point out, I’m not in any way suggesting that if you want to have anal sex, you don’t. Quite the opposite.
My message is, if you want to, you can enjoy anal sex safely.
And, with this is mind, here’s my simple guide to the measures you can take to make it less painful and decrease the risk of injuries…
Anal sex can mean anything from external touching to penetrative anal sex with a finger, sex toy or penis, according to Dr Philippa Kaye
Prepare, start slow and don’t forget the lube
Anal sex can mean anything from external touching to penetrative anal sex with a finger, sex toy or penis. Whichever way you want to do it, follow these steps.
Preparation: There are many ways people prepare for anal sex, but it’s not always required.
Although the rectum is where a stool is stored just before you go to the toilet, it isn’t continuously full unless you’re constipated (keeping your gut healthy with plenty of fibre and exercise is the best way to prevent this, but if it’s a real problem you may need to talk to your pharmacist).
I have seen some guides online suggesting that we need to prep for anal sex by using laxatives and anal douching — using a small squeezy device that fills the rectum up with water to clean the area. But these things are really not necessary.
In fact, anal douching can irritate the lining of the rectum and is associated with higher risks of contracting an STI.
I totally understand some people do prefer to douche prior to anal sex, but if you are going to do this you should leave at least an hour after douching to try and allow time to recover from any irritation.
Others choose to use a toy first to check for stool, but this isn’t required either.
Start slowly: To avoid injury it is important to start slowly. You might decide to do this by using sex toys or dilators of increasing size to gradually work your way up to it.
You can do this ahead of time — some people suggest building it into your daily routine, in the shower.
But if you are using sex toys such as butt plugs be sure to use a toy with a flange so it cannot get sucked inside and can be easily removed.
3. Use a condom and lube
Although there isn’t a risk of pregnancy with anal sex you should always use a condom.
That’s because condoms prevent both transmitting and catching sexually transmitted infections.
I also tell patients to use an appropriate lubricant as the anus cannot produce the same amount of lubrication as the vagina can.
It’s best to use a silicone based or water based lubricant as oil based lubricants are not compatible with condoms.
If you are having both vaginal and anal sex you should always use a new condom after anal sex before vaginal sex. This helps to avoid transferring bacteria from the rectum to the vagina which can cause problems, including bacterial and yeast infections.
But if you experience pain or if anal sex is causing bleeding then you should stop and have any concerns assessed by your doctor.
There is absolutely no need to bleach your anus, no matter what Kourtney Kardashian or anyone else suggests
Please, don’t be self-conscious of how ‘it’ looks
Anal bleaching — cosmetic treatments that aim to lighten the appearance of the skin of the anus — apparently soared in popularity after Kim Kardashian’s sister Kourtney admitted to doing it.
But there is absolutely no reason to think this is needed.
It is natural and normal that the skin around the anus and in between the buttocks is darker than the rest of your skin.
That’s because activities which we do daily increase friction in the area, such as walking or even sweating and friction increases pigmentation.
I totally understand, some people feel it makes them more confident.
If your partner is pressuring you to lighten your anus, it may be time to consider either explaining to them that it is natural, or putting some distance between you.
Although it’s in the name, it absolutely does not involve bleach: bleach can severely damage the skin causing chemical burns.
The creams and lotions used are not dissimilar to chemical peels for the face, but applied to the anus.
This lightens the skin by breaking down the skin pigment, melanin, and reducing the number of cells which produce it.
Lasers can also be used to break down pigmentation and lighten the skin.
Some products can cause a burning sensation and if it’s used incorrectly it can lead to skin damage and infections.
There are also risks that if the product is applied to the wrong place or too much is used it can affect the skin of your genitals.
In some cases it can go inside the anus leading to scar tissue and strictures, which is the narrowing of he anal canal, developing which can lead to pain on going to the toilet.
Even if the treatment does work the difference may be minimal and inly a few shades lighter. You would also need to keep repeating the treatment as it isn’t permanent.
My advice? Avoid.
Some bleaching products can cause a burning sensation and if it’s used incorrectly it can lead to skin damage and infections.
… and if you’re planning to go totally bare down there
This isn’t so much of a social media trend as a fashion one which has been around for a few years now.
Many people remove the hair from around the genitals, perineum, around the anus and in the cleft between the buttocks by waxing or other forms of hair removal.
But whether it is a Brazilian, Hollywood wax, or more permanent laser hair removal, there is actually a purpose to the hair which you are removing.
The skin around the anus produces secretions which are trapped by the hair, which helps increase lubrication and decrease friction in the area.
Remember every time you even take a step there is friction due to the movement.
In addition these oily secretions help the good bacteria which make up the microbiome on your skin around the anus. The hair also helps wick away moisture from sweat.
Really though, my fellow women, spare yourself the pain of the wax.
Everything you need to know about anal STIs
Anal sex whether it is penetrative with a penis, finger, sex toy or anal oral sex can have a risk of transmitting STIs.
But anal sex which involves penetration actually has a higher risk of transmitting STIs than other forms of sex.
That’s because the thin lining of the anus can be damaged and the trauma increases the risk of infection.
If you are sexually active its recommended that you visit a sexual health clinic for screening at least once a year — more frequently if you have symptoms.
At a screening you will be asked about the type of sex that you are having, such as oral, anal and vaginal so that appropriate swabs can be taken.
If you are sexually active its recommended that you visit a sexual health clinic for screening at least once a year — more frequently if you have symptoms
Oral anal sex can not only pass on STIs but also other bacteria such as E coli which can cause gastroenteritis.
STI’s include bacterial infections such as chlamydia, gonorrhoea and syphilis, viral infections such as genital herpes and genital warts, as well as hepatitis, HIV and parasitic infections including pubic lice, also known as crabs.
Discharge from the anus, rectal bleeding, itching, pain and discomfort when sitting or going to the toilet are all symptoms of STI’s. You may also notice lumps, blisters or sores in the area.
Remember it is possible to have an STI and not have any symptoms.
To make anal sex safer use condoms and water or silicone based lubricant and don’t forget regular sexual health screening.
Depending on where you live in the UK you may be able to get free self testing kits sent to your house eg from www.sh.uk and HIV tests from www.freetesting.hiv
