When Sarah was a teenager she was prescribed a numbing mouthwash to put under the strapping tape on her knee to make it less painful to tear off. 

“Me being the genius that I was put a whole pile of it in my ass before having anal sex,” Sarah says. 

“It seemed smart at the time but the issue was I couldn’t feel anything. He couldn’t feel anything. We were both numb and then there was blood everywhere,” the 21-year-old says. 

“Afterwards we realised how fucking stupid that was.”

Sarah, who asked Re: not to include her real name for privacy reasons, says the anal sex led to a small tear in her anal tissue which made it painful to go to the toilet days later. 

“There are a lot of numbing products out there designed for sex which do have a place in certain scenarios but when it comes to having anal sex you need to make sure you can feel it, otherwise how will know if something has gone wrong?”.

The rise of heterosexual anal sex 

There’s been a rise in popularity of anal sex among heterosexual couples and it’s leading to more women experiencing health problems such as fecal incontinence, sexually transmitted infections as well as pain and bleeding, according to a United Kingdom study.

“Women are at a higher risk of incontinence than men because of their different anatomy and the effects of hormones, pregnancy, and childbirth on the pelvic floor,” the two surgeons who published the journal article say.

“Women have less robust anal sphincters and lower anal canal pressures than men, and damage caused by anal penetration is, therefore, more consequential.”

In Britain, National Survey of Sexual Attitudes research found the number of 16-to 24-year-olds engaging in heterosexual anal sex has risen from 12.5% to 28.5% over the past few decades. 

The surgeons say despite this, many doctors are reluctant to talk to women about the risks of anal sex because they do not want to come across as judgemental or homophobic.

But as the number of people practicing anal sex grows, failing to offer advice in a medical setting leaves people vulnerable to missed diagnoses, futile treatments, and further harm from a lack of medical attention or guidance, the surgeons say.

Re: spoke to four people about their experience with anal sex. They asked us not to include their names for privacy reasons.

Sarah has a history of prolonged rectal bleeding and has a tear on her perineum, the area of skin between her anus and vagina. 

She says at one point she was hospitalised from excessive rectal bleeding but when she got to the hospital, anal sex was never brought up by nurses or doctors. 

“I got asked a full series of questions about my sexual history. When was my last period? Did I have a regular partner? When was my last STI check? But they never asked about whether I had anal sex.”

“When I get regular STI checks, I never get asked about anal sex then either - only ever vaginal or oral,” Sarah says.

“I think it is so important for this to be openly talked about because sometimes it can be hard to bring up because there is that stigma there.”

Dr. Sue Bagshaw says everyone should have anal sex education regardless of gender or sexuality. Photo: Supplied.

Youth sexual health expert Dr Sue Bagshaw says when she is training medical students she tells people to ask: “who put what where, and was it covered?”

“It's irrelevant what your gender is or what your sexual orientation is. Packaging people into boxes and labelling them can mean some people get left without education that could be relevant to them,” she says. 

Her advice for people having anal sex is to “use lots of lubricant, way more than you would use with vaginal penetration because anal tissue is way more delicate. Use condoms as you would anyway to prevent STIs and do lots of foreplay beforehand”.

“If someone is feeling coerced or uncomfortable their body is usually more resistant and if you have resistance when those muscles and tissue stretches, it's going to cause problems.”

Hannah, 48, identifies as non-binary and says they started having anal sex because they were worried about the risk of pregnancy and anal sex feels less dysphoric for them.

“With anal sex, I don’t have to separate female sex from female gender. Assholes are like opinions, everyone has one. A bum isn’t gendered.”

Hannah first tried anal sex in the shower with their partner and says they didn’t have any issues. 

The problems started when they asked other people for advice. 

“Most of the people we knew were all cisgender male so I was getting advice from well-meaning guys but people who really had no experience.”

“The advice they gave me was when my partner enters I need to bear down like you are passing a bowel movement. I did that and it hurt, so I always assumed that I was just doing it wrong.”

That’s why Hannah decided to go to a sex store to ask the staff for advice. 

“That was when I learnt how terrible that advice was and that you need to do the opposite,” Hannah says.

“The person told me it was going to feel weird but to take it really slow and use lots and lots of lube. I also learnt you should only do it if you feel confident in being able to communicate with your partner what you want.”

Most of Vanessa’s experiences with anal sex has been from casual sex encounters. 

“Over the years I noticed that it was starting to get a lot more frequent, people would either request it or they would just kind of go there,” the 23-year-old says.

“It was almost always initiated by the person who wants to do the penetrating but who isn't very experienced or educated.”

Vanessa says at one point she had to stop someone from anally penetrating her to vaginally penetrating her straight afterward. 

Vaginal penetration right after anal penetration could lead to bacteria from the anus ending up in the vagina which can cause infections like bacterial vaginosis, yeast infections and urinary tract infections (UTIs). 

This is why it’s important to have different sex toys that are for butt play and vaginal play. 

Vanesaa, who is bisexual, says she didn’t get any guidance about anal sex from health professionals. Instead, she mainly learnt about anal sex from her queer friends. 

“That’s when I first started to realise how much preparation is involved like douching and using toys to build yourself up,” she says.

A douche is a device used to create a stream of water into the anus or vagina to flush out bacteria, faecal matter or genital fluids for hygienic reasons.

Douching is not recommended for people with vaginas as it can upset the balance of healthy bacteria in the vagina, increasing the risk of vaginal infections and STIs. Vaginas are great at cleaning themselves and create a natural acidity that protects people from infections and irritations. 

“I think there's a lot more open discussion around sex and consent in queer spaces compared to heterosexual spaces. There needs to be more resourcing for women, especially women doing heterosexual anal sex because there are power dynamics at play.”

Vanessa’s advice for anyone doing anal sex is to make sure you already have the confidence to tell someone what you like and don’t like while you are having sex. 

“Women aren't encouraged to articulate what they want in the bedroom, whether it’s more lube or saying that does or doesn’t feel good to me. So sometimes women just choose to stick through it.

“That’s why I'm not surprised to hear that there's been UTIs and tears and things like that. With anal, it’s so important to know how to communicate when it’s happening because it is risky.”

When Amy, 24, was a sex worker she says she learnt anal sex was something men wanted so much they were willing to pay for it. 

“I found anal sex particularly risky during sex work because a lot of the men didn’t know about the preparation that is involved to do it properly - they just thought ‘I’m hard, I’ll shove it in and let’s go.’

“A lot of the time, they would get kind of annoyed that it's a longer process than just sticking it in.”

Anal sex isn’t something Amy does regularly but it is something that she enjoys when she has warmed herself up to it. 

She says after having a tear injury from anal sex when she was 16, she knows how important it is to take it slow. 

“You have to listen to your body and make sure you feel relaxed. I find that I am more relaxed when I have douched and feel really clean. Doing lots of foreplay also helps me get relaxed and comfortable too.

“You also need to make sure you are using lots of lube that is designed for anal sex with condoms because obviously, that area doesn't lubricate itself naturally. Adult stores are a good place to get advice about this.”

Amy also recommends starting small by using a finger or a small sex toy on your own.

“I feel like it would be a lot less stressful to figure out if you like it or not when you do it alone, rather than if you're with someone else. Knowing what you want is the most important.”

• Use lots of lube that is designed for anal sex with condoms. Sex store staff are very knowledgable and can help you find the right one.
• Use condoms and make sure these condoms are also suitable for anal sex. 
• Seek advice from trusted resources or sex and health professionals. The Burnett Foundation, previously known as the NZ AIDS Foundation, has a reliable guide to anal sex. Adulttoymegastore and Burnett Foundation are also holding Booty Basics 101 on August 25, a free webinar on how to have fun with anal play.
• You can start small with anal play by experimenting with a finger or a small sex toy on your own or with someone else to get a feel for it. 
• Make sure you are comfortable communicating what you do and do not like during sex. Because anal is more risky, it’s really important you are able to communicate how you are feeling and only do it if you are comfortable. 
• If you want to, you can douche beforehand to make yourself feel clean and ready.
• Do lots of foreplay you enjoy beforehand to get your body feeling relaxed and comfortable.
• Avoid vaginal penetration right after anal penetration as this could lead to bacteria from the anus ending up in the vagina which can cause infections like bacterial vaginosis, yeast infections and UTIs.
• Go slow and be patient. Make sure to listen to your body the whole way through. 

Update (19/08/2022): This story was updated to include: "Douching is not recommended for people with vaginas as it can upset the balance of healthy bacteria in the vagina, increasing the risk of vaginal infections and STIs. Vaginas are great at cleaning themselves and create a natural acidity that protects people from infections and irritations." 

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