Anal sex

What is anal sex?

Anal sex is penetration of the anus, with a penis, fingers, or a toy. It shows up on almost every sexual checklist, usually listed separately for giving and receiving. Unlike vaginal sex, the body makes no fluid of its own, and that shapes almost everything about how it goes in practice.

How common anal sex is

Less often than its visibility suggests. In Rutgers’ Monitor Seksuele Gezondheid 2023, among 12,551 Dutch people, anal sex was part of the last time they had sex for 8 percent. For comparison: penis-in-vagina sex was for 85 percent and oral sex for 58 percent.

That figure says something useful. Anyone wondering whether they are the only one who has never done it is, by a wide margin, in the majority. And anyone who does do it belongs to a group small enough that few ordinary conversations touch on it, which is why so much nonsense circulates about it.

Why anal sex takes more preparation

The difference from vaginal sex is anatomical, not moral. The anus has two sphincters, one of which you can’t consciously relax, and the wall of the rectum makes no lubricant of its own. Without plenty of lube, small tears form in the mucous membrane.

Those tears are exactly why the risk profile is different. Patel and colleagues calculated in AIDS a risk of 138 HIV infections per 10,000 exposures for receptive anal sex, the highest of all the sexual acts they studied. That same study shows how much of that can be taken off: with condom use combined with treatment of the partner who has HIV, the risk dropped by 99.2 percent.

Why people do it

The appeal runs along two lines that have little to do with each other. The first is physical: the sphincters are full of nerve endings, and in men the prostate sits along this route. The second is psychological: it is an act that calls for surrender, and that makes it weigh heavier for many people than other things.

• For the one receiving, the payoff is often that something happens you have to let yourself go for; it doesn’t work if you stay tense, and that makes it an exercise in letting go.
• For the one giving, the payoff lies in the pace it forces. Anal sex rewards patience and punishes haste, and that changes the whole arrangement.
• For a couple, the return is usually the conversation around it, because this is not something you let happen without noticing.

It is not pleasant for everyone, not even after practice. Anal sex that keeps hurting is not something to push through. It is a signal to stop.

How people go about it

The usual route is slow and does not start with penetration. First with the hand and lube, then with one finger, then with a butt plug or several fingers, and only much later with more. Plenty of couples get no further than that and are perfectly happy with it.

What separates the careful approach from the sloppy one is not experience but pace. Anyone who wants to reach penetration in a single evening is almost guaranteed to be doing it wrong; anyone who takes three dates over it usually is not.

Toys belong in the same category of caution. Dahlberg and colleagues counted in International Journal of Colorectal Disease that sex toys were involved in 41 percent of cases of objects left behind in the rectum, with a 17 percent chance of abdominal surgery against 4 percent for other objects. Anything that goes in anally should have a wide base or a cord.

Misconceptions about anal sex

“It’s supposed to hurt.” No. Pain is the signal that there is too little lube, that it is going too fast, or that the receiver is not relaxed. Pushing on through pain produces tears, and tears are exactly what raises the STI risk.

“With a condom it’s as safe as vaginal sex.” Not quite. The figure of 138 per 10,000 from Patel and colleagues’ study is the starting point without protection; a condom takes a lot off that, but the starting point is higher than for other acts.

“This is something for gay men.” The Rutgers figures cover the Dutch population in general. The 8 percent is made up of people of every gender and every orientation.

What I see myself

This is the topic I get the most questions about before anything happens, and almost never during.

Technique is rarely the question. It is about being dirty: whether it is gross, whether it smells. Whether I would mind. Asking that costs people more than the act itself. My answer is always the same. We take it slow, stopping is not a failure, and most people need two or three tries before it becomes pleasant.

And one practical thing I see a lot: people bring too little lube. Almost always too little.

What you can do yourself

• Use more lube than you think you need, and top up as you go instead of afterward. Water-based with silicone toys.
• Start with a finger and keep it there the first time. There is no reason to reach penetration in a single evening.
• Stop at pain, not at blood. Pain is the first signal; blood is the second and comes too late.
• Only use toys with a wide base or a cord, so nothing can disappear.
• Get tested if you have changing partners. With this act that weighs heavier than with others.

More reading on anal sex

On this site the butt plug is worked out, the toy most people start with, and the page on consent covers what we agree beforehand. If you want to explore it slowly and without any rush, there is all the time for that with intimate togetherness.

Beyond this site, Rutgers’ Monitor Seksuele Gezondheid is free to read and the best Dutch data there is on what people actually do.

Sources

• Estimating per-act HIV transmission risk: a systematic review. Patel, Borkowf, Brooks, Lasry, Lansky & Mermin, AIDS 28(10), 1509–1519, 2014. Gives the risk of 138 HIV infections per 10,000 exposures for receptive anal sex and the 99.2 percent drop with condom use combined with treatment of the partner.
• Monitor Seksuele Gezondheid 2023. Rutgers, 2024. National monitor among 12,551 Dutch people; gives the 8 percent for anal sex with the last sex partner, against 85 percent for penis-in-vagina sex and 58 percent for oral sex.
• Retained sex toys: an increasing and possibly preventable medical condition. Dahlberg, Nordberg, Pieniowski, Boström, Sandblom & Hallqvist-Everhov, International Journal of Colorectal Disease 34(1), 181–183, 2019. Gives the share of sex toys among objects left behind in the rectum and the raised surgery risk.

Related terms

• Butt plug. The toy most people start anal sex with, and why that wide base is there.
• Anal training. Building it up slowly beforehand, so the first time does not have to hurt.
• Fisting. The far end of the same practice, with what has been measured about sphincter and incontinence.
• Pegging. The same act with the roles reversed, and where the sensation in men comes from.
• Strap-on. The tool that makes that happen, with the word’s history from 1959.
• Prostate massage. The form that is about pressure on one spot, not penetration.
• Anal beads, also filed as anal beads, and the anal hook are the other close neighbors. On the oral-anal side there are rimming and rimjob.
• Safer sex. Why a fresh condom goes on when you switch positions.
• Oral sex. The sister term from the same Rutgers table, with a very different risk profile.
• Sexual acts. The category above it, where this act sits at the bottom of the list at 8 percent.