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Anal Sex: What Women Need To Know

September 22, 2022

Anal sex is becoming more popular with heterosexual couples in the United States. About 30 percent to 44 percent of men and women have had anal intercourse, research shows.

But women who engage in anal sex are definitely at risk — and they may not even know. That’s why it’s important for OB-GYNs to discuss with their patients the health issues linked to anal sex.

Sexually Transmitted Infections (STIs)

Because of its association with alcohol, drug use and multiple sex partners, anal intercourse is considered a risky sexual behavior. According to one study, that’s largely because women are less likely to use condoms during anal intercourse than during vaginal intercourse.

The lining of the anus is thin and can be easily damaged, which makes it more vulnerable to infection. In fact, the same study found that one of the strongest predictors of eventual HIV transmission in heterosexual couples is a history of anal intercourse.

In addition to HIV, these diseases can be transmitted through unprotected anal sex:

  • Chlamydia
  • Genital herpes
  • Genital warts
  • Gonorrhea
  • Hepatitis B
  • Syphilis

Anal Injuries

Women who practice anal intercourse are at a higher risk of fecal incontinence (anal leakage) and anal sphincter injury (muscles that control bowel movements). That’s because women’s anal sphincters are thinner and the anal canal pressure is lower. Plus, the pelvic floor is affected by hormones, pregnancy and childbirth.

Women also may experience anal trauma, including pain and bleeding. This is especially true if anal sex is coerced, and the woman is not prepared physically. In addition, a woman must grapple with the psychological aftermath of being forced into a sexual act she has not consented to.

Urinary Tract Infections

Always use a new condom if you have vaginal sex right after anal sex. This is to avoid transferring bacteria from the anus to the vagina, which may lead to a urinary tract infection (UTI). These infections can affect several parts of the urinary tract, but the most common type is a bladder infection. Although it’s less common for your kidneys to become infected, this type of UTI is more serious.

In addition to your partner changing his condom, it’s important for you to urinate after vaginal sex and to have a bowel movement after anal sex. This helps expel any bacteria that may have been introduced into your body.

Symptoms of a bladder infection can include:

  • Pain or burning while urinating
  • Frequent urination
  • Feeling the need to urinate despite having an empty bladder
  • Bloody urine
  • Pressure or cramping in the groin or lower abdomen

Symptoms of a kidney infection can include:

  • Fever
  • Chills
  • Lower back pain or pain in the side of your back
  • Nausea or vomiting

Preparation Can Equal Pleasure

Use a lubricant to make the experience pleasurable instead of painful for a woman because, unlike the vagina, the anus does not naturally produce its own lubricant. Lubricants reduce friction, which can limit the number of tears in the skin. You should use only water-based lubricants because oil-based lubricants, such as lotion, can cause condoms to break or fail.

If you haven’t had anal sex and are unsure if you want to try it, you may want to experiment with different types of anal touch to see if you find them pleasurable. One study found that 35 percent to 40 percent of women enjoyed these types of anal touch:

  • Anal surfacing: Sexual touch by a finger, penis or sex toy on and around the anus.
  • Anal shallowing: Penetrative touch by a finger, penis or sex toy just inside the anal opening, no deeper than a fingertip or knuckle.
  • Anal pairing: Touch on or inside the anus that happens at the same time as other kinds of sexual touch, such as vaginal penetration or clitoral touching.

Talk with Your Doctor

Tell your doctor that you are engaging in anal sex so that you can be properly examined. As anal sex becomes more common, it is important that all women know the risks they face and how to protect their health if they choose to participate.

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