In our Ask a Clinician series, Adryan (they/them) dives into commonly asked questions from our community and beyond related to virtual healthcare topics and much more especially as they relate to the queer and transgender communities. Disclaimer: any information in this column is purely educational and is not to be used as medical advice.
For our fifth installment, they interviewed FOLX clinician Terra (she/her), FNP-C drawing upon her experience providing full spectrum LGBTQ+ specialized reproductive and sexual healthcare in rural communities. We specifically discussed anal sex and what you can do to make it less painful.
Can I get hemorrhoids from anal sex?
No, you cannot get hemorrhoids from anal sex! Hemorrhoids are swollen blood vessels that develop in and around the anal opening. They are caused from rectum straining from exercise, childbirth, or even a bowel movement. Hard stools that get stuck in the colon cause people to strain to push out and create pressure down there. That pressure creates bulging blood vessels or hemorrhoids.
If you have existing hemorrhoids or anal fissures, anal penetration can further irritate them or make them bleed, burn, or otherwise feel uncomfortable. When prepared properly, you should not get hemorrhoids or anal fissures from anal sex.
Additionally, you can absolutely have anal sex with hemorrhoids, too. Lots of lube, preparation, and communication are vital for fun times.
Can you provide some more guidance about hemorrhoids when bottoming?
Avoiding constipation is the best way to avoid getting or treating hemorrhoids. Stay hydrated by drinking plenty of water daily, which is around six or eight glasses or more depending on your weight. Avoid straining when using the bathroom. Eat a high fiber diet of 20 to 30 grams per day. Following a high fiber diet full of vegetables, fruit, and complex carbohydrates can help prevent constipation and straining when using the bathroom.
Most, if not, all people have hemorrhoids of some kind. If you’re concerned that you may have a hemorrhoid that is bothering you, see your healthcare provider for assessment first. It’s best to get an assessment if you’re newly symptomatic to ensure a proper diagnosis. If you have signs of serious bleeding, itching, new growths, pain, and/or burning, know to get it checked out for sexually transmitted infections like genital warts, HIV, or Herpes simplex. These symptoms could also be signs of diseases like Chron’s, ulcerative colitis, rectal cancer, and/or colon cancer.
If you’re diagnosed with hemorrhoids, know that most don’t cause symptoms and aren’t dangerous. Some hemorrhoids require surgical removal, however the majority simply exist. If you have itchy or uncomfortable hemorrhoids, try a sitz baths. I recommend filling a bathtub with six to eight inches of warm comfortable water and soaking for 10 to 30 minutes to help relieve discomfort. For itching, you can also use some over-the-counter medications or herbal remedies, including but not limited to witch hazel pads, topical hydrocortisone cream short term, or phenylephrine/Preparation H.
How can I make anal sex less painful?
Having enough lubrication is absolutely vital for anal play. Experiment with yourself and/or partner(s) to find your favorite lube. Use unscented, silicone-based lube for maximal time and comfort. You can use a lube like coconut oil by using a small amount and warming it in your hands before playing. However, if you’re using condoms, make sure to use water-based lubricant or silicone-based lube; avoid oil based lubes with latex condoms as oil can damage condoms.
Start exploring with smaller sex toys like small butt plugs or vibrating toys (with plenty of lube) or external stimulation to warm up first, specifically around the perineum and anus and working your way up. Make sure to read all the safety instructions before using them; for instance, all anal sex toys need to have a flared base to avoid… getting stuck. It also can be a fun exploration to figure out which different positions you can try with toys to better figure out which sex positions could be more pleasurable with a partner.
Also, know what kind of items to avoid: glass objects, metal objects with sharp edges, objects that haven’t been cleaned, objects that have been exposed to potential dirt or infectious agents, etc. Toys or fingers can be used on yourself first, then add your partner later if desired.
What can help me relax more prior to having anal intercourse?
If you’re feeling anxious before engaging in anal play, or in your sex life generally, some things you can do to prepare to make you feel more relaxed include: taking a warm bath or shower beforehand, breathing techniques, and avoiding a large meal within an hour or two of sex. These things can also help you unwind before having other types of sex.
Taking a warm bath or shower can help relieve tension and also help you feel your best.
Relaxation techniques can include diaphragmatic breathing and pelvic floor drops, which help relax your pelvic floor. Focus on inhaling as you gently “drop” or “expand” your perineum and anus. Imagine you’re very, very gently expanding or “dropping” your perineum area as if to urinate and fill your belly with air; as you exhale, come back to center as your perineum relaxes and returns to center. You can do this breathing before sex, during, or after to help you feel more relaxed.
Also, set the mood in the room. Put on some music. External play/stimulation first by yourself or partners can help your body feel more relaxed and turned on. Foreplay and communication ahead of time are essential to pleasure.
It’s also important to set boundaries with someone you’re having any kind of sex with for the first time. (Boundaries and communication are also just as important with ongoing partners!) Before exploring anal play with a new partner, communicate that you want them to start slow, check in with you about likes/dislikes as well as pressure and sensations. Communicate with your partner about protection against STIs. Ensure you are on the same page whether it’s PrEP, condoms, dental dams, or testing. This can help with trust as well as reduce anxiety. You can create a safe word together if things become too intense. Importantly, stop if anything becomes painful in a way that isn’t pleasurable.
FOLX now offers virtual healthcare visits for sexual health related concerns. Schedule a visit with an LGBTQ+ specialized clinician today.
FOLX Health is the first digital healthcare company designed by and for the LGBTQIA+ community. Our services include virtual primary care, gender-affirming hormone therapy including estrogen and testosterone (HRT), mental health care, sexual and reproductive health care, preventive care, and fertility consultations. FOLX memberships give you access to LGBTQIA+ expert clinicians, peer support, thousands of LGBTQIA+ resources, and more. Whether you’re lesbian, gay, bisexual, transgender, queer, gender non-conforming, or nonbinary, you can find LGBTQIA+-specialized health care that helps you meet your wellness goals. FOLX Health is health care that's queer all year. Get all the benefits of becoming a FOLX member and sign up today!