The Ultimate Guide to Anal Sex for Women

Taking Care of Your Ass

Many people assume that if you regularly engage in anal sex, you are more likely to develop anal ailments. Several common myths perpetuate this idea; myths about receptive anal sex partners getting hemorrhoids or anal fissures, having their rectums “stretched out,” or becoming incontinent and having to wear adult diapers. In fact, the opposite is true quite frequently—people who practice safe, gradual, pleasurable anal sex have rectums that are as healthy as, and possibly healthier than those of people who don’t have anal sex. Although it sounds surprising at first, the fact is that if you learn to exercise and tone your pelvic and sphincter muscles and regularly relax them during penetration, you are improving those muscles. The more you pay attention to your anus and rectum, the less alienated and anxious you will feel about it. The more you experience anal pleasure, the less likely your anus and rectum will be a source of tension—and tension is a leading cause of anal health problems. People who have more awareness of anal muscles and practice relaxing them are less likely to have recurring anal tension, difficult bowel movements, or problems like straining.

Your rectum and anal canal are used to expelling feces, not being penetrated by fingers or penises. Like everything else new, anal sex takes some getting used to. Right after having penetrative anal sex, you may feel like you need to have a bowel movement. In some cases, you do, and you should sit yourself on the toilet. In other cases, your rectum is simply adjusting to the experience of anal penetration; remember that the contractions of anal muscles experienced during anal sex and during orgasm are similar to the contractions of those muscles during a bowel movement. If you feel like you. have to go to the bathroom, by all means, go. You may find that it was a false alarm; if you do have a bowel movement, you may also have a little irritation, soreness, and/or diarrhea or loose stool. When feces come down the anal canal they can mix with lube, making things a little runny. Some women feel minor bladder irritation and burning during urination after anal sex. All of this is temporary, and your urination and bowel movements should quickly return to normal. If problems persist or you have pain, extreme irritation, or bleeding, see a doctor.

In general, if you want to take care of your anus and rectum, make sure you do the following: eat enough fiber-rich foods; practice good hygiene habits; do not strain to have bowel movements; get enough exercise; and manage and reduce the general stress in your life. If you have anal penetration when it is uncomfortable or painful, it can lead to more muscle tension and damage to the delicate tissue of the anal and rectal walls.

Anal Ailments

Several factors contribute to the majority of all ailments of the anus and rectum: a lack of fiber and other deficiencies in your diet; chronic anal, rectal, and intestinal muscle tension; and general stress and tension. Safe, responsible anal sex in and of itself does not cause problems; however, sexual activity can exacerbate existing conditions. If you are experiencing recurrent constipation, diarrhea, itching, burning, irritation, pain, or bleeding in the anus or rectum or during bowel movements, you should see a doctor. Problems like constipation, intestinal disorders, hemorrhoids, anal fissures, or blood clots can usually be easily diagnosed and treated; however, if they are left untreated, they can lead to more serious complications and health problems.

Anal Sex and STDs

It is important for women to have knowledge about our bodies, including our vaginas, clitorises, breasts, and rectums. You are your best source of information; you know your body and its uniqueness better than anyone else. When you experience anything unusual—including rashes or sores, persistent itching, irritation, abdominal or pelvic pain, burning or pain during urination, any unusual discharge, irregular bleeding or cramping, or discomfort or pain during sex—you should see a gynecologist or other physician promptly. In many cases, you may have a simple, easily curable infection, but you could also have a sexually transmitted disease (STD). For many women, STDs may occur without any symptoms at all, so the only way they can be detected is through medical exams and laboratory tests. Therefore, all sexually active women should have checkups, pelvic exams, and pap smears on a yearly basis.

It is equally important to find a gynecologist or other physician you respect, trust, and feel comfortable talking to about your sexual health and practices. I’ve been to gynecologists who assume I’m heterosexual and ask me the requisite “What form of birth control do you use?” I’ve been to others who don’t ask me anything about my sexual practices, partners, or concerns. Your gynecological visit is no time to play “Don’t Ask, Don’t Tell.” If they don’t ask, it’s your responsibility to tell. While a regular exam at the gynecologist should include a pelvic exam, pap smear, breast exam, and rectal exam, many doctors do not perform rectal exams unless patients specifically present rectal symptoms. If you regularly engage in anal sex of any kind, you should inform your doctor, be frank about your practices, and request a rectal exam, even if you feel fine.

Sexually transmitted diseases can be rectal as well as vaginal. If you are diagnosed with an STD after a vaginal exam and didn’t have a rectal exam, you should return for a rectal exam. Because of the close proximity of our vaginas to our anuses, it is easy for women to spread infections from one orifice to the other. And if you had unprotected vaginal and anal sex, then the STD virus is likely to be living in both places; better to be safe than sorry. Most STDs can be treated and cured fairly easily with antibiotics if they are caught in their early stages. Untreated STDs can lead to more serious complications, including sterility, cancer, and, in some cases, death. So, please, take care of yourself.

Here are some of the most common STDs in America, their symptoms, and their treatments. I specifically discuss STDs that can be transmitted through anal sex and how the STDs affect your anus and rectum, since this book is primarily concerned with anal sex and health. Again, most women who contract an STD never exhibit symptoms until their condition becomes serious. You shouldn’t attempt to self-diagnose an STD; use the following information as a guideline rather than a substitute for regular visits to the doctor.[57]

Anal warts (like genital warts) are spread when your anal area comes into contact with the affected area of an infected partner. Anal warts begin as small pink bumps around the anus and in the anal canal; they tend to spread rapidly, forming clumps of bumps that may be itchy or painful if they are irritated. Their incubation period is usually one to six months. Anal warts are treated by removing them from the skin by applying chemicals to them (usually acids), burning them with an electric needle (electrocautery), or freezing them with liquid nitrogen (cryotherapy).[58] Even after visible warts are removed, the virus that causes them—the human papillomavirus (HPV)—can remain in your body, and the anal warts can recur.

You can also spread warts from your anus to your vagina and vice versa—another reason for regular rectal exams. If you have anal warts, you should also be checked for vaginal warts.

Women diagnosed with anal warts should have regular exams even after they are removed to monitor recurrences and prevent complications.

Hepatitis is an inflammation of the liver that has several different strains; I am going to address hepatitis A and hepatitis B because they are the most common and the most relevant to anal sex and health. The hepatitis A virus is found in the feces of an infected person, so it can be spread by unprotected anal penetration and especially unprotected oral-anal contact. The hepatitis B virus is found in all bodily fluids of an infected person, including semen, saliva, vaginal secretions, blood, feces, and sweat. People with hepatitis may experience a variety of symptoms, including low energy, loss of appetite, depression, body aches, nausea, diarrhea, abdominal pain, rashes, swollen glands, fever, chills, dark urine, weight loss, and, if the condition has become serious, jaundice. Some people can be carriers of hepatitis and not have any symptoms; others can develop chronic, recurring hepatitis. People who are at risk of contracting hepatitis B can be vaccinated against the virus.

About 150 million people in the United States have been exposed to the herpes virus.[59] Genital herpes can be transmitted through sexual contact, including vaginal, oral, and anal sex; the herpes virus can also enter the body through mucous membranes or cuts in the skin. Within a week of exposure, people with herpes usually first experience a tingly or burning sensation in the genital area; then they develop bumps or blisters in the affected area, which can be itchy, sore, and/or painful. Women can also experience flu like symptoms, swollen glands or lymph nodes, a vaginal discharge or yeast infection, and painful urination. Initial sores usually heal in one to three weeks without treatment. There is no cure for herpes, and symptoms can recur during outbreaks. These outbreaks can be brought on by stress, a compromised immune system, or prolonged exposure to the sun; they can last for up to three weeks. Although a person is most contagious during an outbreak, transmission of the virus can happen during nonactive periods as well (especially the two weeks after an outbreak) and with or without visible blisters or other symptoms. Sores can appear not only on but around the genitals, and condoms and dental dams will protect only the area they cover, so partners should limit their activities accordingly during outbreaks. In recent years, people with herpes have successfully used a drug called Zovirax™ (either ointment or pills) to control and treat symptoms.[60]

Rectal gonorrhea is transmitted exclusively through sexual contact. Symptoms appear within three to seven days of exposure and include soreness or burning during bowel movements and an anal discharge. Up to 80 percent of women who have gonorrhea have no symptoms, and this is even more true in cases of rectal gonorrhea than vaginal gonorrhea.’ Rectal gonorrhea is treated with antibiotics, including penicillin, tetracycline, and ceftriaxone.[61]

The symptoms of chlannydia, which is transmitted through sexual contact, present one to three weeks after infection and are very similar to those of gonorrhea, including bowel movement discomfort, anal burning, soreness, and discharge; women may also experience swelling and soreness of the lymph nodes and rectal bleeding. Two-thirds of women, however, have no symptoms.[62] Chlamydia is also treated with antibiotics like doxycycline and azithromycin. Studies show that 45 percent of people with gonorrhea also have chlamydia, so people who’ve been diagnosed with one disease should definitely be tested for the other.[63]

Much less common today than in the past, syphilis is transmitted through vaginal, oral, and anal sex or through mucous membranes and cuts in the skin. It can have an incubation period of two to eight weeks. Ten to ninety days after exposure, people with syphilis experience the primary stage of the virus. A round ulcer (called a chancre) erupts in the affected area. The area in and around the chancre may ache or burn—or not. People may also have swollen lymph nodes. After the chancre hardens, heals, and disappears, the secondary stage begins. The secondary stage is marked by a general skin rash that may be itchy and painful. You may also experience fever, swollen glands, aching joints, headaches, nausea, and/or constipation. This stage is when people are most contagious.

The third and fourth stages, latent and tertiary, are very serious and can be deadly if untreated. Syphilis is treated with antibiotics, usually penicillin, doxycycline, or tetracycline.

HIV, the virus that causes AIDS, is carried and transmitted through bodily fluids and most concentrated in blood, semen, menstrual blood, breast milk, and vaginal secretions. HIV is transmitted in several ways: through unprotected sexual contact with the bodily fluids of an infected person, by sharing needles with an infected person (through intravenous drug use), by receiving infected blood (through a transfusion), or from mother to baby via amniotic fluid, during delivery or breast-feeding. Current literature confirms that it’s easier for women to get AIDS from men through sexual intercourse than vice versa.[64] This is because the tissue of the vagina is more susceptible than the tissue of the penis to trauma, tears, and minute sores, which provide infected semen a direct route to the bloodstream—and this is even more true of the tissue of the rectum. Also, semen has a higher viral load than vaginal fluid.

Women can transmit the virus to their women partners through unprotected oral and digital stimulation, especially if there are cuts or sores (which may or may not be visible) in their mouths or on their hands. They can also transmit the virus by sharing sex toys without using condoms or disinfecting them.

Finally, intravenous drug use is the riskiest route of all.