It’s time to state the obvious: Americans ― yep, even teens and college-age kids! ― are having anal sex. A 2017 survey of over 3,000 sexually active millennials found that 35% of women and 15% of men are engaging in anal sex at least some of the time.
But like most things involving sex, many people are loath to talk about the mechanics of it. Just look at how freaked out folks got when Teen Vogue published an explainer on the ins and outs of anal sex in 2017.
That’s a huge problem: Without proper knowledge of how to have safe anal sex, many young people are going into the experience with no knowledge (or worse, with porn as their teacher), leading to painful sex, and sometimes, anal fissures.
An anal fissure is a small cut in the thin, sensitive tissue that lines the anus. On a recent episode of the podcast “Next Question With Katie Couric,” which focused on teen sex, Couric said she spoke with a doctor who claimed more young people are coming in with anal fissures ― something health providers didn’t have to treat in such large numbers in the past.
Experts we spoke to said while there’s truth to that, it’s not the entire story. Lots of people do come in for anal fissures but it’s overwhelmingly due to poor diet (usually not enough fiber), constipation or large or hard bowel movements.
That said, sometimes a fissure is the result of anal play gone wrong, said Evan Goldstein, a surgeon and the owner Bespoke Surgical in New York and Los Angeles.
“It’s very common for me to see many anal ailments related to improper anal play, with fissures at the top of the list,” he told HuffPost. “People have this misunderstanding that you can go from nothing to something big really quickly, without any preparation. If this occurs, then a tear is almost definitely going to take place.”
Ouch. The good news is, knowledge is key and can prevent these types of injuries. Below, experts give the low down on anal fissures, how to avoid them, and some general advice on how to have safe, consensual anal sex.
What is an anal fissure, anyway?
According to the Mayo Clinic, an anal fissure is “a small tear in the thin, moist tissue (mucosa) that lines the anus.” As mentioned above, while anal sex is sometimes the culprit, anal fissures more often occur when you pass hard or large stools during a bowel movement. Symptoms include pain during or after bowel movements, bright red blood on the stool or toilet paper and/or a crack or small lump you can see around the anus.
As for how painful they are, one expert said it feels a bit like a paper cut, only down there.
“Sweat stings the area and bowel movements can be excruciating,” said Rachael L. Ross, a physician and sexologist in Chicago.
You may also experience spasms in the ring of muscle at the end of your anus (anal sphincter).
There’s relief, though. Ross said fissures can be treated by taking sitz baths: When you soak the rectal area in a tub of warm water ― two or three times a day for about 10 minutes ― you clean the anus, get your blood flow going and relax the anal sphincter.
“Besides that, sometimes you need numbing cream for bowel movements,” Ross said. “Then, of course, my recommendation would be to increase the fiber in your diet so that the bowel movements don’t require as much straining. And if the fissure was due to sex, to be more mindful of prepping for anal.”
You probably don’t even want to think about having anal sex again when you have a fissure, but we should note that you should avoid butt play while dealing with one. It’s important for your future sexual health; anal fissures can lead to an increased risk of sexually transmitted infections.
Anal fissures can also be open pathways to the bloodstream and they can be deep, which means they can get infected, said Carol Queen, a sexologist and the author of “The Sex & Pleasure Book: Good Vibrations Guide to Great Sex for Everyone.”
“A fissure can make contracting an STI more likely, and if that STI is HPV, there may be an increased risk of cancer, depending on the strain of HPV one is exposed to,” she said. “HIV would also be a heightened concern.”
Clearly, condoms are important when it comes to anal sex, but even with a condom, you might want to sit it out until it’s healed. Most anal fissures heal with home treatment after a few days or weeks, but if it doesn’t, head to your doctor.
How to have anal sex that doesn’t result in an anal fissure
Now that we’ve gotten the painfully descriptive part out of the way, let’s focus on how to avoid getting an anal fissure in the first place.
The primary thing that can induce a fissure is anything causing the anus to expand before it’s ready to do so. That includes a penis. Porn may depict anal sex as spontaneous and something you just slide into, but even porn stars will tell you that’s not how it happens in real life. Sudden penetration is a horrible idea and the quickest way to get a fissure.
Here’s what you actually need to do: First and most importantly, have a frank conversation about whether you both consent and want to have anal sex ― or if one of you is just going along with it because you feel pressured. If it’s the latter scenario, it’s not likely to be an enjoyable experience. (How would your partner like something pushed up his rectum? It’s not a light ask!)
Trust and genuine consent are vital when it comes to anal sex, said Alyssa Dweck, a gynecologist and female sexual health expert in New York.
“Relaxation and a feeling of safety, security and trust with your partner are essential if you want to do this,” she said.
Once you know you both are into it, start practicing. If you’re receiving anal sex, it’s smart to play around with a vibrator or anal toys, such as a butt plug, to get comfortable with the sensation.
“The anus has a very toned muscle, the anal sphincter, which is designed to keep things in most of the time,” Dweck said. “It’s almost like you have to train this muscle to relax to more easily insert a toy or a penis. Just ensure any toys for anal play have a wide base so it doesn’t ‘get lost’ inside.”
Anal fingering is also a smart way to ease into the real thing.
Prepping for anal sex the day of might include douching, meaning using water and an enema or syringe to flush out the rectal cavity before you get down to business. (That said, you don’t need to douche to have an enjoyable experience with anal sex, and some doctors even advise against it. Do your research beforehand in order to make the best, most informed choice for you.)
If you’re bottoming ― that’s what it’s called if you’re the one receiving anal sex ― it’s important to avoid being submissive when you’re first starting out, Goldstein said.
“This means choosing positions where you are in complete control of depth and thrusting speed,” he said. “It’s only once you know your own limitations as well as your partner’s capabilities that you can then explore other positions or kinks. Start slow and steady, and in a more controlled environment — you’ll thank me later.”
And lastly, don’t forget the lube. It’s the most important factor to having safe, enjoyable anal sex, said Kim Cavill, a sex education teacher and the host of “The Six Minute Sex Ed” podcast. (And no, saliva doesn’t count. The area around your anus is dry and tight, so you’ll need actual lube.)
“Keep in mind that not all lube is the same,” Cavill said. “Some lubes are water based, others are oil based, and some are silicone. Silicone lube generally costs more than water and oil based lubes, but that’s because it lasts longer. It’s important to remember that some lubes aren’t safe to use with latex condoms.”
In short, she said, “buy yourself the best quality lube you can afford and make sure it’s compatible with whatever sex toys or protective measures you want to take.”
No, not everyone is having anal sex — so don’t worry if you’re not interested
The Couric podcast suggested that young people’s increased interest in anal may be due to the popularity of porn depicting anal sex. PornHub data shows that from 2009 to 2015, the search volume for anal sex videos skyrocketed by 120%.
Obviously, though, anal sex was popular before it became a go-to search category on PornHub.
“I think anal sex among young people has always been popular, since there has been a goal for girls from a variety of conservative backgrounds to ‘preserve their virginity.’ Plus, it’s a way to avoid pregnancy,” Ross said. “What’s new, I think, is that there is a global fascination with anal sex, and I attribute the rise to a rise in anal-centered porn.”
Anal sex, of course, is a lot less mystifying to most gay men. But their experience doesn’t necessarily mean they’re avoiding anal fissures all the time.
“We’ve all had a severe lack of formal sex ed, especially as it relates to anal sex,” Goldstein said. “Gay men may think they know more because they engage anally more frequently, but from my experience as a surgeon, it doesn’t mean they’re any better prepared or knowledgable about it.”
All of this said, not everyone is keen to have anal sex. (Heck, even some gay men feel iffy on it. In a study of men who have sex with men published in the Journal of Sexual Medicine in 2011, more than 60% of respondents had not engaged in anal intercourse during their last sexual event.)
If you’re uninterested but your partner wants it, don’t feel pressured to give in because “everyone is doing it.” Clearly, everyone isn’t.
“I think right now, young people, particularly the young women, have a fascination with pleasing, and I believe the influx in younger people inquiring about anal sex is related to this fascination with pleasing their partner,” Ross said. “There’s this idea that you have to have a perfect sexual ‘report card.’”
“My partner really wanted to do it so I said, eh, fine” isn’t a strong enough reason to do it. Your consent ― enthusiastic, pumped-up consent ― is incredibly important.
“If you don’t want to, my advice is to say, ‘It’s OK that you’re into that, but I’m not. I don’t want to do that, it’s a hard no for me,’” Cavill said. “Make sure you use a serious tone of voice and assertive body language.”
If your partner doesn’t accept that clear boundary and continues to pressure you, that person is being coercive, she said.
“If the person engages in threats (‘Do this or I’m gonna get with someone else’), bribery (‘Do this and I’ll take you out to that restaurant you love’), blackmail (‘Do this or I’ll tell your mom about your ex’), whining (‘Please? Why not? Why won’t you say yes?’) emotional manipulation (‘If you really loved me, you would do this for me’), they’re not a good sexual partner,” Cavill said.
If your sexual partner coerces or forces you into having anal sex, you should reach out to someone you trust for help, or visit RAINN’s National Sexual Assault Online Hotline.
The bottom line about bottoming? It’s entirely your call if you want to do it, and you should try to make sure you’re healthy about it to avoid any injuries or infections. If you are game, trust in your sexual partner ― and lots of lube ― are essential.
Sex Ed for Grown-Ups is a series tackling everything you didn’t learn about sex in school — beyond the birds and the bees. Keep checking back for more expert-based articles and personal stories.
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