Tag: education

Anal health

Top tips for more pleasurable bottoming

Bottoming can (and should) feel amazing—and there’s a lot you can do to improve your experience.
By Jason Wong, PT, DPT
June 7, 2019   6 Minute Read

For all of you out there who have never bottomed because you thought your partner’s penis was “too big,” or that anal sex was too painful with any partner, or that  “I just can’t do it”—there’s something you should know.

Bottoming can (and should) feel amazing—and there’s a lot you can do to improve your experience. Here’s what to know about your physical ability, how to coordinate your mind and your body, how to prepare for sex, and more.

True/False quiz about the way your butt works 

Here’s a quick True/False quiz about pelvic health and anatomy. How many answers do you know?

  1. My external sphincter (butt hole) can stretch/relax
  2. I get to control when my external sphincter stretches/relaxes
  3. I can squeeze my external sphincter muscles anytime I want to
  4. My anal passage is too small to bottom
  5. Breathing helps my anus relax
  6. There is always feces (poop) just inside my external sphincter
  7. I cannot bottom if I didn’t douche

Were there any you weren’t certain about? We’ll cover each of these ideas in this article. And, the answers to the quiz will be at the end.

The anatomy of your butt 

anal anatomyBeing informed about your anatomy—knowing where things are located in your body—is an important first step for anyone having anal sex.

During anal sex, the penis (or dildo, or whatever) is inserted into the anus, past the external and internal sphincter muscles, and into the rectum. The rectum is connected to the sigmoid colon, which is where poop is collected and stored by your body before you are ready to take a poop.

It can take 2-10 hours until it fills up and you have to defecate. That means there’s quite a bit of time in between when you eat and when your colon fills (although there are several factors that may affect this).

External and internal sphincters: relaxing & stretching 

When we talk about stretching the muscles for anal sex… what muscles are we talking about?

The external and internal sphincters (your butt hole) need to stretch open, or relax, to allow entry. You can control your external sphincter (skeletal muscle) consciously, while the internal sphincter (smooth muscle) is not under voluntary control, and may need some additional coaxing to relax. This is one difference between smooth muscle versus a skeletal muscle.

When people experience pain during anal sex, a simplified reason may be that the external sphincter is not relaxed before their partner’s penis goes in.

Nerve endings 

Nerve endings produce sensations through light touch or pressure by transmitting information from an external stimulus to your brain. Around your anus, there are many nerve endings that can produce pleasure (or pain).

Foreplay can help you begin enjoying the sensations around your anus, and also help to relax your sphincter.

Try this exercise at home:  When you’re alone or with a partner, use light touch or feathering around your anus to help relax. Use different types of touch, different types of pressure, and explore what feels good. Keep going for as long as you enjoy it.

Some people can be overly sensitive around their anus, and can benefit from desensitization exercises. To help desensitize, apply deep, broad pressure (a flat hand) around your anus to help calm your nerve endings down first.  Then lighten up the touch, like above, and see if you can ease your mind and learn to enjoy the touch around your anus.

The pelvic floor 

The term “pelvic floor” is most often used when speaking with women around issues related to pregnancy. Everyone has a pelvic floor, however, and it is intricately linked with how you pee, how you poop, your “core stability,” and erectile function (for people with a penis). The pelvic floor itself refers to the muscles that support the organs in the pelvis.

Will most people feel the muscles in the pelvic floor? Not likely. But just as you feel the motion of your knee extending (this sense of your body moving is called kinesthetic awareness or proprioception) and can identify your quadriceps performing that motion, you can become aware of the muscles of the pelvic floor.

The pelvic floor has 3 states of motion: neutral, contracted or lifted (often known as a Kegel), and bearing down. These are also associated with different states of mind: very relaxed, normal day-to-day, and high stress or anxiety.

When preparing for anal sex and bottoming, it’s best for to be relaxed—and to also begin to play with constriction, relaxation and bearing down with the pelvic floor muscles.  

The shape of your rectum 

Your rectum isn’t a straight tube—there’s a bend in your rectum called the “anorectal angle.” Imagine for a minute a long balloon that is twisted at a 90-degree angle about 10 centimeters from the end of it. This is the shape of your rectum, that allows poop to be held back until you’re ready to go to the bathroom.

During anal sex, it’s best if the anorectal angle relaxes slightly so that the rectum becomes more linear. Help make this happen by using your pelvic floor muscles to bear down during sex.

Your rectum: Is there poop in it?

One thing people assume is that there is feces (poop) just inside their internal sphincter (their butt hole) in their rectum. Generally, this is false! Your poop is stored in your colon until you’re ready to use the bathroom. When you’re sitting on a toilet, poop travels from your colon through the rectum and out your anus. Some people still prefer to douche their rectum before anal sex (more on this later), but you should know that even if you don’t douche there may not be any poop (depending on the consistency) in your rectum.

If you’re going to be having anal sex, I think it’s important to be comfortable with the idea that yes, shit, comes out of your butt. If you’re afraid of that idea, you can stick with oral sex or you can work on getting comfortable with the idea that it might happen. If you’re overly worried about poop showing up during sex, you’re going to shock your system into an anxiety-ridden state that can negatively affect the sex you’re having (I know this because it used to happen to me).

Your state of mind 

Our anal control consists of both voluntary and involuntary muscles. If you’re afraid, anxious, worried or fearful, your sympathetic (“fight or flight”) nervous system takes over—which can result in a very negative experience your body will remember.

This is why it’s important to take time to relax, prepare yourself, and get into the right frame of mind so that you’ll enjoy the sex you have.

We’re all different

Keep in mind that our bodies are all built differently. It’s very common as a practitioner to see minor variations in anatomy without blinking an eye. IT IS NORMAL. My anus is in a slightly different position than yours. My prostate angle is different than the guy to my right. My flexibility is different than the person to my left. You get the picture. This means that we all may enjoy slightly (or vastly) different sex positions and ways of bottoming.  Cookie cutter sex doesn’t always work. Be willing to communicate and try different positions with your partner until you figure out how to enjoy it together.

Getting ready for entry 

Now that we’ve covered our anatomy, let’s talk about getting into position and getting ready to bottom.

Some people like to douche before anal sex. It usually takes several hours for food to migrate into the lower bowels, so don’t worry if you’ve eaten just before you want to douche. Unless you have an irritable bowel, food won’t be coming out too soon.  Keep in mind that caffeine and foods high in fiber can accelerate mobility to the lower bowels, though. Leave some time before sex (maybe an hour) if you’re going to douche.

We’ve already talked about relaxation. The mind body connection is vital in creating positive experiences, so being aware of what state your mind is in will express how your body reacts. It’s best if you are fully relaxed—and that includes your anus. Taking deep breaths can help, but mostly, trust with your partner is paramount.

Placing some lubrication around the external sphincter can reduce the risk of tearing. (Tearing can increase risk of HIV and STI transmission.) Lube can also help with comfort!

As your top begins inserting, bear down. What, what?!

That’s right. Push out as your top pushes in. When you bear down through your pelvis without tightening your external sphincter (this is where the pelvic floor muscle control comes into play), it will allow your anorectal angle to be more linear because your pelvic floor muscles will be relaxed. If your partner has a bigger or thicker penis or dildo, continue bearing down until you feel comfortable. Bearing down allows the muscles to elongate and adapt to changing sizes. The top will feel less resistance and it will be easier for them to enter you.

The rest is easy as long as it’s enjoyable. Stay relaxed and enjoy the ride the best you can!

Change positions as much (or as little) as you’d like.  Remember, you now know how to control your external sphincter muscles and your pelvic floor muscles, so you can control the pressure around your partner’s penis at any time.  What I mean by this, is that you can constrict their penis and apply a pressure from within (at the internal sphincter with a light Kegal) and also more near the base (via the external sphincter with a firmer Kegal). Vary the tempo and duration of the contraction as he penetrates you and sex can be elevated to a new experience!

True/False quiz answers 

  1. My external sphincter (butt hole) can stretch/relax: True
  2. I get to control when my external sphincter stretches/relaxes: True
  3. I can squeeze my external sphincter muscles any time I want to: True
  4. My anal passage is too small to bottom: False
  5. Breathing helps my anus relax: True
  6. There is always feces (poop) just inside my external sphincter: False
  7. I cannot bottom if I didn’t douche: False

 

About the author

Jason Wong, PT, DPT

Jason Wong, PT, DPT is a practicing physical therapist for the past 11 years. He graduated from the University of Southern California with his Doctor of Physical Therapy degree in 2008. He has worked with multiple patient populations including orthopedic joint replacement, sport injuries, work injuries, post-surgical rehabilitation both inpatient and outpatient, neurological rehabilitation inpatient, fall recovery training, incontinence, pregnancy pains and more.  He is a certified clinical instructor, has his certification as a kinesiotape provider, and certified in Applied Functional Science. He enjoys using his knowledge and skills as a physical therapist to connect people and to spread the gospel of great body mechanics to the masses.
Sexual health

“Rammed hard and fast”: Here’s what you said about pain during anal

You told us—pain during anal sex can be mind-blowing. Here’s what you shared in our anonymous pain & sex survey.
By Douchie
July 19, 2018   4 Minute Read

Do you like getting jackhammered till your hole is raw? Do you take pleasure in your partner’s pain—turned on by their moans during rough sex?

We heard you loud and clear: Our community survey got hot and heavy last month with a variety of responses to our questions about pain and anal sex. I can’t wait to fill you up with a hot-off-the-press load of info about what makes our community tick when it comes to pain between the sheets.

“I had a sub who liked rough anal sex and that didn’t want me to use a lot of lube.” –Survey respondent

About the pain & anal sex survey

First, a few words about the survey. We shared this 15-question anonymous survey with our social media followers, on our website and in our newsletters—to reach a convenience sample of people connected to San Francisco AIDS Foundation. The 412 people who took the survey likely felt they had something to say about pain and sex. (In other words, the sample isn’t representative of our entire community or San Francisco.)

“Pain can be enjoyable, if your partner knows how to keep it at the right level.” –Survey respondent

Who participated?

A total of 412 people took the survey. Most identified as male (85%). Cis-women, trans men, trans women, genderqueer people, gender non-conforming, gender non-binary and genderfluid people also took the survey.

About 80% of people identified as gay/homosexual. Other sexual orientations reported were bisexual (9%), straight/heterosexual (8%), asexual (1%), and “other” (mostly pansexual and queer).

Most people (96%) reported that they have anal sex (or have had anal sex in the past). For people having or who had anal sex, 52% reported being “versatile” (being the top and bottom), 29% reported being the bottom (the receptive partner during anal sex), and 15% reported being the top (the penetrative partner during anal sex).

Do you experience or cause pain?

Most people (86%) who bottomed said that they had at some point experienced pain when bottoming. 9% said they had never experienced pain, 1% said they “didn’t know,” and the rest said the question was not applicable.

Most people (64%) who have ever topped said that they have had a partner stop them during sex because it hurt too much. (One person cheekily replied, “Yes, due to my size,” to this question.)

Do you enjoy the pain?

About half of people (51%) said that they have never enjoyed pain during anal sex. More than 100 people (36%) said that they have enjoyed pain during anal sex.

What kind of pain do you like?

This is where it gets juicy: More than 100 of you wrote in to explain what you like, and why! Generally, responses to the type of pain you enjoy fell into the following categories:

  • Enjoying pain as the result of being dominated (“I enjoy the pain because it puts me in a submissive head space. I feel like I’m being used for someone else’s pleasure.”)
  • Enjoying pain as the result of pinching/twisting/hair pulling/flogging/restraint (that is part of sex but not from anal penetration)
  • Enjoying rough sex (with pain as the side effect) (“Fast, deep ‘pounding’ can feel good from time to time.”)
  • Enjoying the feeling that you’re being pushed to your body’s limits (“I like to be pushed to the edge of pain, so that the intensity is high and my senses feel like they’re on overload.”)
  • Being aroused by a partner’s pain / submission (“I like to make my bottom moan while I rough fuck him.”)
  • Enjoying pain after sex as a reminder of a hot session (“After, the anal soreness makes me think of him and the sex.”)

Do tell. This is getting good.

We asked how people would explain pleasurable pain during anal sex to someone who has never felt it before.

One person described it as “like getting a tattoo: It hurts, but you know you still love it.” Another person compared it to popping a painful pimple: “The first few seconds can sting, but the sense of relief and endorphins rush immediately afterwards floods out the momentary ‘pain.’” A few other people compared it to the pain you experience when working out. “It hurts because it’s a muscle being stretched. When you first work out, your muscles hurt because they’re being stretched, but you feel good. Similar good feeling but exponentially better.”

Other notable responses to what you enjoy from pain during sex include:

“A mixture of pain and pleasure, where the pain heightens the degree of pleasure/relief experienced.”

“A little pain is cool. It feels like I’m taking it all in. Like I don’t give up and love it.”

“Butt burning good. Then the relief of him cumming and lubricating my butt with his hot load.”

“A painful erotic distraction that allows the pleasure senses to grow in the background for an epic climax.”

“I would say that pain during sex can be great—heightening all the sensations—if you trust your partner.”

“Sometimes a little pain leads to great pleasure.”

Our favorite response was from the person who said, “Here, let me show you.”

Preventing pain

We also asked for your tips on how to prevent pain during anal sex. Most people mentioned the importance of using plenty of lube before and during anal sex. “[Use] LOTS of lube from the jump and add more maybe even if you don’t think you need it,” said one respondent. Another said, “Too much lube is almost enough.”

Other people said:

  • Be patient with your partner and learn to listen and communicate during sex (“Don’t be afraid to be a bossy bottom.”)
  • Relax
  • Go slowly
  • Make “aaaah” rather than “ooooh” noises (somebody please try this, and report back!)
  • Use poppers
  • Stretch your hole first with fingers and toys
  • Practice with dildos first
  • Try different angles and positions
  • Don’t douche too much before sex
  • Find a partner with a small penis (“Find partners who are not well hung”)
  • Minimize or abstain from drugs and alcohol (“They can improve numbness which can be good at first, but intoxication does not lead to great, memorable sex.”)

“Also- remember that there’s a LOT of fun that can be had besides anal, so if it’s not gonna work, it’s OK to move on! No stress—this should be fun!” said one person.

Douchie's Guide to Butt Health

Douchie brings butt health & happiness out of the closet so you can care for your butt in the way it deserves. Get info about everything from douching to fissures with this series on all things anal. Visit sfaf.org/butthealth.

About the author

Douchie

Douchie brings butt health & happiness out of the closet so you can care for your butt in the way it deserves.
Sexual health

Q&A: What causes bleeding & pain from your butt?

Pierre-Cédric Crouch, PhD, ANP-BC answers our burning questions about butt pain. Here’s what to do if you notice pain, swelling or blood.
By Douchie
July 19, 2018   3 Minute Read

Maybe you’ve had this happen before: You wipe your butt and notice red streaks on the toilet paper. Or you wipe up after bottoming and you see blood on the towel. What’s going on?

Bleeding and pain can be symptoms of something minor like hemorrhoids to something more serious like lymphogranuloma venereum (LGV). To learn more about what to do if you experience bleeding from your butt, I asked San Francisco AIDS Foundation director of nursing Pierre-Cédric Crouch, PhD, ANP-BC, ACRN some “burning” questions I had.

Q: Thanks for answering my questions, Pierre! What are some reasons a person might bleed from their butt?

Pierre: You can bleed for a lot of different reasons. It could be something as simple as hemorrhoids or an anal fissure (get the details on anal fissures). But other things can make you bleed too: genital warts, ulcers, herpes, even having a painful bowel movement. You can also get bloody discharge from lymphogranuloma venereum (LGV).

Q: I’ve never heard of LGV before. Tell me more!

Pierre: LGV is a sexually transmitted bacterial infection that is caused by a type of chlamydia bacteria. It’s more common in men than women, and people who are living with HIV seem to be more likely to get it. When you get tested for chlamydia, your test would be positive if you have LGV but your provider would have to order a special test to see if it’s LGV. You don’t need to test specifically for LGV if you aren’t having any symptoms.

Because the infection affects the lymphatic system, it can cause swelling and redness in the groin area and drainage through the skin from the lymph nodes in the groin. It can also affect the lymph nodes around your butt if you have anal sex, and you might experience bloody discharge from your butt.

Q: Yikes! Sounds awful. Can LGV be treated?

Pierre: Absolutely. We treat LGV with antibiotics. If you have symptoms, the treatment lasts for three weeks (which is longer than we treat other types of chlamydia).

Q: You mentioned hemorrhoids potentially causing bleeding. Besides looking unpleasant, are hemorrhoids a health concern?

Pierre: Hemorrhoids are swollen veins that happen inside the rectum or on the anus. Straining when you poop can cause them, as can anal sex. Sometimes they are not serious and go away on their own. But sometimes they don’t go away—in those cases, you can get them treated.

I know some healthcare providers take the position that if your butt functions, it’s fine. They think ‘who cares what your butt looks like if you’re able to use it?’ But that view doesn’t support the health and happiness of people who bottom. Having a pretty butt is important!

Q: I love hearing about pretty butts! But for now, let’s move on to other possible causes of pain and bleeding. What about anal sex? Can people experience pain and bleeding from anal sex?

Pierre: Yes—anal sex can be another cause of pain and bleeding. No matter what you do if you bottom, if your partner is really rough, it’s going to hurt. Or if you haven’t bottomed in a long time, and you don’t take enough time to loosen yourself up, you can tear or strain a muscle. And that can cause bleeding.

Q: When should people seek help for pain or bleeding?

Pierre: If you have painful rectal bleeding, talk to your healthcare provider! I think people may delay seeking care because they are embarrassed or don’t want to talk about their butt. You have to remember that healthcare providers are used to hearing about this kind of stuff. Nothing is going to shock us. We’re here to help you feel and be healthy.

Douchie's Guide to Butt Health

Douchie brings butt health & happiness out of the closet so you can care for your butt in the way it deserves. Get info about everything from douching to fissures with this series on all things anal. Visit sfaf.org/butthealth.

About the author

Douchie

Douchie brings butt health & happiness out of the closet so you can care for your butt in the way it deserves.
Sexual health

A reality check (and resources!) on all things anal cancer

Before you jump to the conclusion that a bump on your butt is anal cancer, get the facts from two clinicians.
By Emily Land, MA
July 19, 2018   4 Minute Read

If it’s a bump, or some bleeding, it might be a hemorrhoid or a fissure from a particularly rough night. But pain and bleeding can also be a symptom of anal cancer—a much less common condition (but one that people may worry about more).

Before you jump to the conclusion that a bump on your butt is anal cancer, get a reality check from Joel Palefsky, MD, and J. Michael Berry-Lawhorn, MD, who are both anal dysplasia specialists. They have info about who’s at higher risk for anal cancer, what it’s caused by, and how you can take smart steps to get care if you suspect something is wrong.

What causes anal cancer?

Anal cancer is caused by the sexually transmitted infection human papillomavirus (HPV). Most sexually active people get HPV in their lifetime: It’s the most common STI in the U.S. (An estimated 79 million Americans are infected.)

Although HPV can be benign and not cause any health problems, in some cases, HPV can cause genital warts or lead to cancers of the cervix, vulva, vagina, penis, anus, or back of the throat. There are many different “strains” or types of HPV—some of those strains cause anal and genital warts, and some cause anal and cervical cancer.

Many people with HPV don’t know they have it and never develop any symptoms or issues. A subset of people who get HPV develop low-grade lesions (which are unlikely to progress to cancer) or high-grade lesions (which carry a small risk of turning into cancer). A subset of people who have these high-grade lesions may develop anal cancer, but this can take time, “sometimes decades,” said Palefsky.

Nearly all, “maybe 99%” of anal cancer is caused by HPV infection, said Berry-Lawhorn. “People that don’t have HPV infection don’t get these lesions.”

How common is anal cancer?

Over the last 10 years, the rate of new anal cancer cases has been rising on average 2.2% each year. Currently, the overall incidence rate of anal cancer is 1.8 per 100,000 in the U.S.

There are some groups of people with higher anal cancer risk, said Palefsky. Men who have sex with men (regardless of their HIV status), women who have had a history of high-grade cervical or vulvar lesions or cancer, and anyone who is immunocompromised—whether that is because of HIV or for another reason—is also at higher risk. Age is also a factor, said Berry-Lawhorn, with the risk of anal cancer going up as people get older.

For people living with HIV, incidence rates per 100,000 person-years are:

  • 131 for men who have sex with men
  • 46 for heterosexual men
  • 30 for women

The incidence rate per 100,000 person-years for HIV-negative people is about 2, which means that people living with HIV have substantially higher risk of developing anal cancer.

How can a person tell the difference between anal cancer and something like hemorrhoids?

“Hemorrhoids are extremely common and definitely more common than anal cancer,” said Berry-Lawhorn. “If you have pain, bleeding, something sticking out, you might go to your doctor and have hemorrhoid cream or suppositories prescribed. I would say, if your symptoms go away and feel better in a few days or a week or so, you’re fine. But, if symptoms persist for a significant amount of time, that could be a sign of anal cancer.

I’ve seen patients who report being treated for hemorrhoids for a year or more, but never examined by their health care provider … the “hemorrhoid” turned out to be anal cancer. It is possible to feel the difference when a digital anorectal exam [an exam where the clinician checks the anus with a finger] is performed.”

How do you screen for anal cancer?

Women and other people that have a uterus get checked for cancers and pre-cancer in the cervix with a procedure called a pap smear on a regular basis. They aren’t called “anal pap smears,” but there is a similar screening procedure for anal cancer, said Palefsky.

Called anal cytology, this procedure involves taking and analyzing samples of cells from the anal canal to look for pre-cancerous anal lesions. “Although this test doesn’t require much special training and set-up to do, but the follow-up to this test does. So we actually don’t recommend that people get anal cytology if they aren’t going to be able to see a specialist who is able to handle an abnormal result,” said Palefsky.

Colonoscopies are not a good way to find anal disease, said Berry-Lawhorn. “If you’ve had a colonoscopy recently, and everything was normal, that doesn’t mean you don’t have pre-cancerous or cancerous anal lesions.”

Advocate for a DARE every year

Palefsky and Berry-Lawhorn recommend that people receive a digital anorectal exam (DARE) every year. A DARE involves a health care provider feeling for the presence of cancerous lesions with their fingers.

“Instead of advocating for anal cytology, we recommend that people advocate for DARE,” said Palefsky.

They recommend that the following people advocate for a yearly DARE:

  • People over age 25 living with HIV (all genders)
  • Men who have sex with men (regardless of HIV status)
  • Women and other people with a history of high-grade cervical or vulvar lesions or cancer
  • Anyone who is immunocompromised

To request a DARE, talk to your health care provider about your concerns. You can say things like: “I read that I may be at higher risk of developing anal cancer and I’d like to get checked on a regular basis for abnormal growths,” or, “I’d like to include anal health in my preventative health care plan, which is why I’d like to receive a digital anorectal exam,” or, “I’ve noticed pain/irritation/bleeding from my butt and want to make sure it’s not something more serious than hemorrhoids. Would you be able to perform a DARE or refer me to a provider who is able to?”

Get vaccinated!

There is a vaccine for HPV for people who are younger than age 26 (insurance companies only pay for the vaccine for people between the ages of 9 and 26 because people older than 26 have likely already been exposed to HPV).

If you’re older than 26, you may still be able to get vaccinated if you think there may be a benefit for you. However, if you’ve already had more than a handful of sex partners, “it’s probably not worth the cost [which can cost a few hundred dollars] since you’ve already likely been exposed to HPV,” said Palefsky.

“The vaccine is completely safe for people living with HIV,” said Palefsky. “It’s really important for all HIV-positive people between the ages of 9 and 26 get vaccinated.”

Resources

Anal Neoplasia Clinic, Research and Education (ANCRE) Center at University of California San Francisco provides information and anal health care for people in the San Francisco Bay Area. Find more information about ANCRE or call 415-353-7100.

Find out more about the ANCHOR Study, a pivotal study that will help inform the future of anal cancer treatment and care. The study is open to people living with HIV at 15 different sites across the U.S. who have high-grade precancerous lesions. ANCHOR stands for Anal Cancer HSIL Outcomes Research.

About the ANCHOR Study: People who are living with HIV and over age 35 may be eligible to take part in a paid study to prevent anal cancer. During a screening visit, you will be screened for pre-cancerous anal lesions. If lesions are found, you will be enrolled and randomized to either have the lesions treated or monitored every six months. Both groups will be followed for a minimum of five years. You will be compensated $100 for the screening visit. Call 1-844-HIV-BUTT or find more information at anchorstudy.org.

Get more info about HPV Vaccines from the American Cancer Society including benefits of the HPV vaccine, safety information, and payment information.

Douchie's Guide to Butt Health

Douchie brings butt health & happiness out of the closet so you can care for your butt in the way it deserves. Get info about everything from douching to fissures with this series on all things anal. Visit sfaf.org/butthealth.

About the author

Emily Land, MA

Emily Land, MA is a writer and the Vice President of Public Affairs at San Francisco AIDS Foundation.
Anal health

Anal fissures are treatable

By Douchie
July 19, 2018   3 Minute Read

Don’t suffer in silence if you’re experiencing sharp, stabbing pain when you bottom or when you poop. Painful paper-cut-like tears in your anal canal happen—they’re called anal fissures—and they’re treatable. Treating anal fissures is important because there’s a higher risk of HIV infection if you’re exposed to HIV during anal sex.

“Anal fissures aren’t something that we talk about much in the gay community,” said Pierre-Cédric Crouch, NP, the nursing director of the sexual health clinic Magnet at San Francisco AIDS Foundation. “People will bottom, their skin will tear a little, and it will hurt. And they will just think it is a consequence of having sex. People should know that anal fissures can be treated and that there are things you can do to help heal them.”

What is an anal fissure?

An anal fissure is a tiny tear in the anal canal.

They can bleed—a lot. The pain, potential embarrassment, and experience of seeing blood coming from the butt can be emotionally traumatic for many people, causing them to suffer in silence instead of seeking treatment.

Medical illustration of Anal Fissure
Image by A.D.A.M.

The opening of your anus (your butt) isn’t perfectly round, said Crouch. It’s shaped like an oval—and towards the bottom of the oval, the skin is pinched. Anal fissures tend to happen in that pinched area. Because the skin is pinched off, there isn’t much blood flow to the area. If you get a tear, the lack of blood flow can prevent it from healing.

“Some people—if they get a tear—will heal up on their own and will be fine. For others, the fissure doesn’t heal properly on its own. Every time they bottom, the fissure will break open again, and the fissure remains chronically open. This can be quite painful.”

What are anal fissures caused by?

Anal fissures are caused by trauma to the anal canal. Trauma can result from being constipated (straining while you’re trying to poop) or from bottoming/having anal sex. People can get fissures if they get pounded hard during sex or have a really large bowel movement.

What is the treatment for an anal fissure?

Small fissures can heal up on their own without any treatment. If you have a very large fissure, it can require a visit to a proctologist to do surgery. The small to medium ones are treated with a cream that dilates the blood vessels and stimulates blood flow to the fissure. This promotes healing.

Nurse practitioners at Magnet, the sexual health clinic run by San Francisco AIDS Foundation, prescribe a medication called nifedipine that’s mixed into a paste with lidocaine. People are instructed to put a little dollop of the paste on their butt three times a day, for up to six weeks, but most fissures heal after two or three weeks. Lidocaine is a numbing agent so the cream desensitizes the area while also helping it heal.

Is the treatment expensive?

The medication costs about $40. People who are treated at Magnet who don’t have insurance are provided with treatment for free by San Francisco AIDS Foundation.

How do I get treated?

Talk to your health care provider! People shouldn’t suffer in silence, said Crouch. If you’re experiencing pain from anal sex, get it checked out by a queer-friendly health care provider.

If you’re in the San Francisco Bay Area, access treatment for anal fissures at the sexual health clinic Magnet, at Strut (470 Castro Street in San Francisco), a program of San Francisco AIDS Foundation.

Douchie's Guide to Butt Health

Douchie brings butt health & happiness out of the closet so you can care for your butt in the way it deserves. Get info about everything from douching to fissures with this series on all things anal. Visit sfaf.org/butthealth.

About the author

Douchie

Douchie brings butt health & happiness out of the closet so you can care for your butt in the way it deserves.
Anal health

Anal douching safety tips

By San Francisco AIDS Foundation
March 29, 2017   6 Minute Read

Anal douching isn’t something we talk about much in our community and we aren’t given many opportunities to learn about it. My high school coach taught sex ed. He said “Keep it in your pants, boys. Keep it in your pants.” Surprisingly, he never covered anal douching. Yet, we are all supposed to somehow know all about it. And, we succumb to societal pressure to pass white glove tests at all times of the day. #bottomstruggles.

At Magnet, we are asked a lot about how to douche safely. In a perfect world, we wouldn’t douche at all. But to be real, no one wants to leave a crime scene on their partner. There isn’t much research on regular anal douching before sex but we do know some things. Below, I’ll give you the low-down on what we know about what’s safe to do—and what you should avoid doing if you douche.

Use the right water.

Tap water is fine if you aren’t using it every day. If you douche too often with tap water, you can cause an electrolyte imbalance that using normal saline would prevent. Avoid it if you can but it’s not always easy to do so. And absolutely do not use olive oil, bleach, alcohol, or anything else that you find under your kitchen sink. These will cause significant harm to your butt.

I know you aren’t running a cooking show at home to make your own normal saline. And sometimes your big top daddy is coming over too soon to run to the store to get a Fleet’s. So what about tap water?

Using the right type of liquid to clean out your butt is important. Your body maintains a delicate balance of electrolytes to function normally. If you use the wrong liquid, you can cause imbalances that harm your body. One of the safer liquids to put up your butt is called “normal saline.” This is a water mixture that has the right amount of a sodium electrolyte to match what is in your body. You can get this stuff in a saline Fleet enema or you can also make normal saline at home by combining a half teaspoon of salt with a cup of water.

And while you are pouring the water, be sure to check the temperature. I can’t over-emphasize this one. The mucosal lining of your intestines and colon is much more sensitive to temperature than the skin on the outside of your body. You may be able to tolerate a hot shower, but you’ll burn your insides if you use that same temperature in an enema. Test the water temperature first with your hand and turn down the temperature until it feels lukewarm. Then turn the temperature down just a bit more. That’s what can go up your butt.

Get the right equipment.

OK, you got the right water and the right temperature. Now how are you getting it up your butt?

You’ve got a few different options if you’re looking for the right douching equipment. Here are the options I know about—and my recommendations for each.

Fleet enemas: These are your best bets for safe douching. Fleet enemas come in multiple versions so be sure to get the one that just has normal saline in it. They also have pre-lubricated nozzle tips which is less likely to cause tearing or other damage. The volume is also smaller so you are less likely to overdo it.

Shower shot: Nothing says that you are prepared to bottom more than installing a hose on your shower to rinse out your butt. These require you to be extra careful with your douching. It is very easy to have the water pressure on too high or have the water too hot. If you choose this option, be very careful. It is also very easy to have the water too hot, which can burn your insides. The nozzle doesn’t even need to go in your butt. You’ll find that just having it at the opening that you’ll get an effective rinse.

Anal douche bulb: If you walk into your favorite porn store, you’ll see a box with some muscled porn star holding a big douche bulb. These have a reusable rubber bulb that you can fill up with your home made normal saline. They are convenient but many of them have a hard plastic nozzle. Use lubricant on the nozzle for safer insertion.

Baby mucous sucker: This may sound strange but some guys use a baby mucous sucker to douche. You can find them in your pharmacy’s baby section. They are similar to the anal douche bulb but they actually are a bit better because the tip of the nozzle is softer and more flexible than that of an anal douche bulb. You’ll use it the same way you do the anal douche bulb.

Get your butt ready.

Don’t be a rude top and just shove the nozzle of an enema bulb or nozzle of a shower shot up your butt without getting your butt ready first. It’s kind of like bottoming during anal sex—it might hurt if you’re not properly loosened up.

There are two rings of muscles in your butt. The external muscles you can control and relax on your own, but the internal sphincter only loosens up if it senses pressure. So take a finger, lube it up, and loosen up your butt before you try to push anything up there.

Lube it before you stick it.

While you have that lube out for your finger, be sure to lube up the nozzle of whatever you are putting up your butt. The anal douche and shower shot are generally hard nozzles that can easily cause tearing if you are not careful. Take a moment to put plenty of lube on the nozzle and insert it slowly so you don’t tear. And remember that unlike your ex, the shower shot can do a good job without going in.

Pushing a stiff nozzle into your rectum without lube can cause ripping and tearing. Not only will that be painful, it can increase your risk for HIV and other sexually transmitted infections. If you irritate the lining of your mucosal membranes in your colon, white blood cells (the kind of immune cells that HIV preferentially infects) congregate in the area to help repair your body. So if you are exposed to HIV there (i.e., your partner is living with HIV and cums in your ass) you’ll be more likely to be infected with HIV.

You are not that kind of catcher. Don’t spray too much in.

You don’t need the water to go very far up inside your intestines. The amount of water than an enema bulb can hold is sufficient.

If you’re using a shower shot, go easy. Start with the lowest water setting at first until you can judge the right level that doesn’t resemble you sitting on an active fire hose.

Stick it in and do it.

You’ll want to be close to your toilet or in your shower when you do this. Putting yourself in the right position can make it easier to insert the nozzle. Stand in front of the toilet and put your dominate leg up on the toilet. After loosening up your butt with a lube finger like a good top, slowly insert the lubed douche nozzle. Squeeze the bulb to slowly squirt in the liquid. Pull out the nozzle. If you can’t hold the liquid, sit down on the toilet immediately but if you can hold it, jump up and down a few times before sitting on the toilet. If you are in the shower, do the same thing by holding onto something sturdy and put your leg up on the edge of the tub but don’t do the jumping around part as you’ll probably fall.

Don’t douche too much.

You don’t want to overdo it. Even if you douche with the right water, the right temperature, and the right equipment, you can damage the lining in your butt that can put you at higher risk for getting an infection from your partner. There is no magic number of times that makes douching unsafe. But if you can, limit yourself to once a day and only 2-3 days per week.

Give yourself time before sex.

Most of the water will come out of your butt right way but don’t expect that you’ll be able to have sex right after douching. Allow some time for all the water you squirted inside yourself to come back out (and stay close to a toilet while you wait). You might need an hour or so to make sure it’s all come out before you’re ready for sex. Use this time to clean up your place, take your PrEP or your HIV meds, and get your lube and condoms if they are part of your sexual health plan.

Don’t use laxatives. Other bulking agents are OK.

Unless you need laxatives to treat constipation, don’t use laxatives as a way to prepare for anal sex. Laxatives irritate the lining of your intestines, and they’ll give you abdominal cramping which can end up ruining sex. Also, they might just end up forcing more poop out that wouldn’t have come out otherwise.

Other bulking agents like fiber supplements are OK to take. They might help you normalize your stool if you’re constipated or help you get all of your poop out at once. If you have loose stools or diarrhea, fiber supplements can help.

Be reasonable – remember, poop happens!

I think it’s time that we all realize and acknowledge that if you’re having anal sex, poop is going to make an appearance sometimes. You don’t go to the chocolate factory without getting sample. I’ve heard countless stories of people who bottom, and have a little bit of poop show up—only to have the top basically say, “sex is over, get out.” The bottoms are made to feel dirty or are shamed. And this just isn’t right. It’s like farting during sex. It happens!

My advice is “Don’t keep it in your pants boys” and douche in moderation if it helps you feel more prepared for anal sex.

Douchie's Guide to Butt Health

Douchie brings butt health & happiness out of the closet so you can care for your butt in the way it deserves. Get info about everything from douching to fissures with this series on all things anal. Visit sfaf.org/butthealth.

About the author

San Francisco AIDS Foundation

San Francisco AIDS Foundation promotes health, wellness and social justice for communities most impacted by HIV through sexual health and substance use services, advocacy, and community partnerships. Each year more than 21,000 people rely on SFAF programs and services, and millions more access SFAF health information online.