Trying out anal sex for the first time can be a stressful experience for anybody. There are a lot of questions, and answers aren’t always easy to come by.
Pervasive stigma may keep some from even asking—never mind answering—questions about anal sex. But finding reliable info becomes even harder when you’re extra sensitive down there due to a medical condition. That’s the reality for many people living with inflammatory bowel disease (the umbrella term for Crohn’s disease and ulcerative colitis), which affects 6 million people globally.
As someone with Crohn’s disease, I’ve struggled with this for years. I was diagnosed with the autoimmune condition—which causes inflammation in your intestines that can lead to bleeding, diarrhea, weight loss and other complications—at the tender age of 16. This was long before I even identified as queer or considered how it would affect my sexual health.
But when I finally began to explore my queerness in college, I felt like I had nowhere to turn for answers about my IBD. Google produced virtually no reliable medical advice on the subject, and whenever I got close to asking my (presumably straight, male) gastroenterologist about the risks of anal sex, I’d chicken out.
I’m willing to bet many of my fellow IBD patients have had the same experience. With that in mind, I’ve (finally) asked some experts the hard questions for you, and I’m here to share their answers.
Is it safe to have anal sex with IBD?
Well, it depends. The first thing to consider is the level of disease activity that you’re currently experiencing.
“If patients are very sick, especially if they’re having symptoms due to specifically rectal or colonic disease activity, maybe receptive anal intercourse is something they want to avoid,” says Jordan Axelrad, a gastroenterologist and assistant professor at the New York University’s Grossman School of Medicine.
That’s because disease activity, especially if you’ve recently had surgery, makes the area more susceptible to trauma and infection (and not just sexually-transmitted ones), Axelrad explains. If that’s the case for you, he suggests you “put the brakes on temporarily until the disease has cooled off a bit.”
But if you’re in remission? There’s not much to worry about. “Generally there would be no extra precaution required if patients are well,” Axelrad says. (It goes without saying that you should still follow safe sex practices and regularly get tested for STIs.)
Remember, however, to keep an eye on your symptoms after you’ve had sex to make sure it doesn’t cause a flare-up. Otherwise, you shouldn’t let your disease stop you.
“The misconception is [inflammatory bowel disease] has to be a total nonstarter for sex, and that’s not the case,” Axelrad says.
How do I communicate with my sexual partner?
Communicating with sexual partners generally can be hard enough (have you been on Grindr lately?). But what are you obligated to tell your partner about IBD?
Axelrad says that some patients, especially those with an ostomy or major surgical scars, will need to have the conversation early on. His rule of thumb? If it’s going to come up during sex, you need to talk about it, because it will affect the safe-sex practices you need to use and will be essential for all parties to having a pleasurable experience.
Will, 35, is a queer man who has struggled with ulcerative colitis and colon cancer, and began blogging about his experiences in 2014. He says he wasn’t always so willing to talk about his diagnosis, and for years it limited his sex life; his anxiety would stop him from seeking sexual partners or advocating for what he needed and wanted during sex.
Over time, Will has learned to be very communicative during sex. That means letting his partners know about his limitations upfront, as well as talking about what feels good and what feels painful. It also means being honest if he’s having a flare-up and can’t be the bottom. Many of the men he’s encountered don’t understand IBD—they assume it means he can’t control his bowels, or that sex will make his symptoms worse. But those misconceptions are starting to fade as more people talk about the disease, he says.
“I think the biggest thing is being honest and open and communicative about your needs and limitations, and not feeling less than or that you’re broken, and not feeling limited,” Will says. “Because you just have to explore within your physical limits and be creative. And that’s what took me the longest to realize.”
What about douching? And sex toys?
From a medical perspective, Axelrad says douching really isn’t necessary in the first place.
“Overuse and the methods that may be used can be harmful in certain ways,” he said. Douching too frequently, or using products with additives on areas where there’s active inflammation, can lead to bleeding and increase the risk of sexually transmitted infections, according to Axelrad.
That goes for everybody, not just IBD patients. (Here’s a rundown of some common myths about douching and why you probably don’t need to do it.)
If you are going to douche, however, you’ll need to be extra cautious if your disease is active. If you notice blood or experience pain, that’s your sign to stop and maybe take a break from bottoming in general.
When it comes to sex toys, Will recommends trying out butt plugs or other shapes that are graduated, and therefore more gentle; they can be a good way to practice and have more control. “Those are less traumatizing than the dildos you see on the internet,” Will says.
Sex toys can also be a solution if you’re not able to bottom at all. Using a fleshlight with your partner, for example, can be one way to have sex without anal intercouse. “There are different ways to maintain intimacy, even when you can’t take it,” Will says.
Breaking the silence
According to Axelrad, sexual function is a highly under-studied topic in general, especially among gastroenterologists—and even more so when it comes to queer sex practices.
“We need to do a better job as clinicians of having these conversations with people,” he says.
I, for one, still have not asked my own gastroenterologist about this topic. It’s easier to ask these sorts of questions as a journalist than a patient, I suppose. Both Will and Axelrad said the silence is beginning to thaw, and that there’s more appetite among doctors and patients to understand and potentially treat these issues.
“There has to be that mutual comfort to talk about things openly,” says Axelrad. “For some reason, we’re comfortable talking about bloody diarrhea but we’re not comfortable talking about sexual practices.”
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