Sex & Relationships: Is anal sex safe?

“Anal sex is a common human sexual behavior for women in hetero and same-sex relationships. This is not a rare activity!” says Stacy Tessler Lindau, M.D., professor at The University of Chicago Medicine, who also runs the site WomanLab.org.

Let's just get right to it: Anal sex can be totally safe-and all taboos about it really need to go away (like, yesterday).

“Anal sex is a common human sexual behavior for women in hetero and same-sex relationships. This is not a rare activity!” says Stacy Tessler Lindau, M.D., professor at The University of Chicago Medicine, who also runs the site WomanLab.org.

While she says that research on the whole "is anal sex safe" question is limited, more than 20 percent of women ages 20 to 39 have had anal sex. “Given that it’s so common, it seems that most people do find pleasurable and safe ways to have it,” she says.

That said, there are some factors that may get in the way of safe anal sex. So, whether you're interested in trying it for pleasure, to shake up your sex life, or because a medical reason means you can’t have vaginal sex-here's what you need to know:

Is it possible to injure your anus?

There's certainly a risk of tearing, especially if you're new to anal sex. But there are some simple things you can do-like starting with a small butt plug and working your way up to a penis, or using lube-to minimize the chances. (Check out our Ultimate Anal Sex Guide for all the tips.)

Also keep in mind that using something like an enema in preparation can cause inflammation or trauma to the mucosal barrier of the rectum, increasing the risk of injury during anal sex, says Landau. Go ahead and poop before, but don’t feel the need to go crazy flushing out the pipes.

Can you get an infection from anal?

Yep, there's no skirting around it: Poop comes out of your anus, and feces are filled with bacteria that can cause a vaginal infection, should stool travel to your lady parts. (That’s why you wipe front to back.) One infection associated with anal sex is bacterial vaginosis.

To prevent this, if you’re on the receiving end, make sure that your partner wears a condom. If you move from anal to vaginal sex, have him take off the condom and put on a new one, recommends Lindau. “This will reduce the transmission of bacteria,” she says. Even if you’re in an exclusive relationship and don’t typically use condoms, she recommends wearing one for safe anal sex. You can then take it off for vaginal or oral.

And if you're into oral-anal stimulation, you can use a dental damn over the anal area which “still allows sensation to come through and reduces exposure to bacteria,” says Landau.

Are there any more serious long-term risks?

Having unprotected anal sex with a man increases your risk of HIV transmission. Abrasions or small tears during anal sex likely make transmission of the virus easier, says Lindau. (Again, condoms are your friend here.)

Another possible problem is fecal incontinence, when stool leaks out unexpectedly. Research from 2016 found that anal sex was associated with a slightly higher chance of fecal incontinence (FI) in women (we're talking 2 percent). According to the study authors, "anal intercourse could dilate and eventually stretch the internal and external anal sphincters leading to damage of these structures."

Um, GASP.

That said, the study didn't look at how often the subjects had anal sex, so there's really no way of confirming how much it ups your risk of FI. If you're truly concerned, doing kegels can help strengthen your sphincter (who knew?).

Regardless, don’t be afraid to talk to your doctor if you notice this happening-whether related to anal sex or not. 

Are there any signs I shouldn't have anal sex?

To protect yourself from any problems related to anal sex, follow this rule: If it’s painful, stop. It’s as simple as that, says Landau.

She also advises you try anal with a safe partner who you can easily communicate with. When you’re on the same page, you can both have a good, safe anal sex experience.