Anal sex

Written by Dr John Dean, specialist in sexual medicine and Dr David Delvin, GP and family planning specialist

Drugs and anal sex

Muscle relaxant drugs (amyl nitrate, butyl nitrate, glyceryl trinitrate) have been tried to make anal intercourse easier or more comfortable. We do not recommend this. Amyl nitrate 'poppers' sold in small bottles for inhalation, are popular in the gay community and have a reputation both for enhancing the intensity of orgasm and helping relax the anal sphincter. There is no real evidence to support these assertions and its use is not recommended by medical authorities. It is important to remember that amyl nitrate is a potent drug with many side effects, including facial flushing, headaches, dizziness and low blood pressure, which may lead to faintness and loss of consciousness. Amyl nitrate, when taken with Viagra , may cause a catastrophic drop in blood pressure with potentially fatal consequences. Other nitrates may have the same effect. All erection-inducing drugs, including Viagra , Cialis and Levitra tablets , can be very dangerous if you are using nitrates.

Local anaesthetics, such as lignocaine (lidocaine) cream or even locally applied cocaine, have been used to reduce anal pain during intercourse. Again, we strongly advise against this. By numbing the anal skin there is a real risk of causing serious injury to the anal sphincter through over-vigorous thrusting. By following the steps above it is possible to gently dilate the sphincter for comfortable intercourse. The purpose of pain is to make us aware that we are causing injury and, therefore, local anaesthetics should be avoided. Another problem with local anaesthetics is that they may make the penis of the insertive partner numb. This may lead to problems with erection, orgasm and ejaculation.

Fisting

This involves the insertion of the whole hand or forearm into the anus (or indeed the vagina) for sexual stimulation.

With adequate relaxation it is physically possible and may be acceptable and enjoyable for some couples. But the diameter of the hand or forearm is so much greater than that of the penis there is an increased risk of anal injury.

Good anal relaxation in the receptive partner and care by the insertive partner are essential.

In practice, anal fisting is very rarely used by heterosexual couples.

Rimming

Rimming involves oral contact with the anus for sexual stimulation. In order to reduce the risk of transmission of infection, good anal hygiene before sex and good oral hygiene after sex is essential.

Sex aids and anal sex - a cautionary note

Some couples like to use some form of sex aid for insertion into the anus. Some individuals may use them for solitary sexual stimulation.

The same principles apply as for genital insertion in that anal relaxation is essential. Sex aids must be kept clean and and washed carefully between use. Condoms may be placed over sex aids as an additional precaution.

One additional risk from the use of sex aids in anal sex is that of losing the aid into the rectum.

Most medical school pathology museums have a wide selection of novel foreign bodies recovered from the rectums of both men and women, ranging from vibrators to milk bottles.

Human ingenuity seems to know no bounds in this area, but it is incredibly foolish to insert potentially breakable objects into the anus and terrible injuries may result.

If you do lose a sex aid into the rectum you should attend the Accident and Emergency department of your local hospital as soon as possible, however embarrassing it may be. The situation will only get worse if it is neglected and the object may break or become more difficult to recover.

In general, you should only use a sex aid which is designed for the anus. Butt plugs and anal vibrators have a broad base which makes it very difficult to 'lose' them inside the rectum.

Vaginal vibrators are not designed in this way, and can easily slip inside and buzz their way up the colon. Some have been recovered by surgeons from far inside the abdomen. If they are still vibrating when the patient arrives at the hospital, they produce an interesting but alarming phenomenon called 'the rotating umbilicus sign'. Don't let this happen to you.

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