While sometimes taboo, anal sex is a form of intimacy that can be enjoyed by people of all genders and sexual orientations. Now, the act seems to be on the rise among heterosexual women in particular.

A British study, published on August 11, 2022, in BMJ, pooled data from the National Survey of Sexual Attitudes and Lifestyle. The researchers found that anal sex among heterosexual people ages 16 to 24 has more than doubled in recent decades, going from about 13 percent to nearly 30 percent. In the United States, rates are even higher: About 36 percent of women and 42 percent of men ages 18 to 44 reported having anal sex at least once, per the CDC (PDF).

That’s not surprising, according to experts. “Any place on the body where there are nerve endings can be an erogenous zone,” says Shannon Chavez, PsyD, a sex therapist based in Beverly Hills, California. “Anal sex has nothing to do with your sexual orientation. It is a variation of sexual play that can be highly pleasurable for different bodies, regardless of sex and gender.”

If you’re interested in exploring anal play, there are a few things you should know to ensure you’re having safe, pleasurable sex — no matter how you’re choosing to do it.

Start Slow
Since the sphincter muscle takes time to relax and stretch, going slow is key to comfortable anal play, and you may want to start on yourself, says Megan Fleming, PhD, an American Association of Sexuality Educators, Counselors, and Therapists (AASECT)–certified sex therapist and clinical instructor of psychology at the Weill Cornell Medical College in New York City. That way you can go slowly and explore what you like.

Whether you’re solo or with a partner, “start by using your finger and rimming the anus, then continue to massage and stimulate around the anus with your hands,” she says. “When you feel open and relaxed, insert a clean finger or small sex toy that has a flared base.”

A flared base — meaning the end of the sex toy is significantly wider than the tip — provides a solid grip and allows you to move a toy in and out safely, according to Planned Parenthood. If you use a toy without a flared base for anal play, the toy could slip all the way into the anus and get stuck.

Use Lots of Lube
Julia Bennett, MPH, director of digital education at Planned Parenthood, emphasizes the importance of using a lubricant when exploring or having anal sex.

“The anus does not make enough lubrication on its own for comfortable anal sex, so it’s important to use lots of lube and go slowly,” she says. “If it’s painful or uncomfortable, you shouldn’t keep going.”

Alyssa Dweck, MD, a gynecologist in Westchester County, New York, recommends using a silicone lube since this type is “super slick” and lasts longer than a water-soluble lube — although you should be aware silicone lube typically isn’t compatible with silicone sex toys.
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Going slowly can help the sphincter muscle relax and make anal play more comfortable, she adds. You may also need to add more lube throughout.

Safe Sex Measures Are Even More Important
Bennett also warns that hygiene is extra important with anal play, especially oral-to-anal contact, which can transmit parasites and hepatitis.

Due to the nature of the area, and the potentially high amounts of bacteria and parasites it can contain, anal sex can carry a higher risk of infection from not only sexually transmitted infections (STIs), but other infections, such as giardia or shigella. For those reasons, condoms are extra important when having anal sex. According to the Centers for Disease Control and Prevention (CDC) more than 90 percent of anal cancer is caused by HPV, an STI that around 40 percent of men in the United States have and for which there is no screening for men.

Bennett recommends using water- or silicone-based lube with latex condoms, since oil-based lube can break down latex. She also recommends putting lube both on the inside and outside of the condom to increase sensation. If using an internal condom, take the inner ring out for anal sex.

Bennett says it’s also crucial to clean all toys or body parts with soap and water if you and your partner or partners are wanting to switch between anal sex and vaginal or oral sex. You should also use a new condom if switching from anal to another type of sex.

“As a rule, never put anything that has been in an anus directly into the mouth or vagina. Essentially there are poop particles that you want to keep away from the vagina or mouth,” she says.

To ensure the area is clean before you get started, Dr. Dweck recommends simply washing the area with soap and water. Some people prefer to use an enema to get any waste out of the rectum before engaging in anal sex. Dweck says that while this is perfectly safe, it isn’t necessary. She also cautions against cleaning with scented wipes that can irritate the area.

What to Do if There’s Bleeding
According to Dweck, bleeding during or after anal sex can happen for many reasons, but the two most common reasons are hemorrhoids and anal fissures.

Hemorrhoids are enlarged and swollen veins around the outside of the anus or in the lower rectum. Although they can be uncomfortable, Dweck says if bleeding during or after anal sex is caused by hemorrhoids, it usually stops on its own and is nothing to worry about. Also, using plenty of lubricant can help prevent bleeding if you do have hemorrhoids, she says.

Anal fissures, on the other hand, are superficial cuts in the anus, Dweck says. “They are painful, so most people don't want to engage in anal when they have them.” Anal sex can also cause tearing, according to the Cleveland Clinic.

If you do bleed during or after anal sex, Dweck says to wait until the bleeding stops and then wash with soap and water if that is comfortable to ensure the area is clean. She also recommends a sitz bath, which can be helpful anyway for someone who needs hemorrhoid relief.

Consent Is Not a One-Time Conversation
The BMJ study also found that around one-quarter of young women report being pressured into having anal sex at some point. Pressuring someone in any sexual situation is not okay.

“Pressure is not pleasure and sets up expectations and anxiety around sex,” says Dr. Chavez, noting that anal sex is a personal preference that is different for everyone. “It is not necessary to enjoy anal sex to be sexually healthy and evolved.”

Chavez also makes clear that consent is not a conversation partners have once. Healthy and safe sex requires constant communication about everyone’s boundaries in the moment — which may be different than past interactions, especially if anal play is new territory.

“If anal sex is new to you, it may be difficult to know what boundaries are important right away. The boundary talk should be continual and necessary at each step of the way — before, during, and after play,” she says. “The consistent communication allows for space and safety as you are changing, reinforcing, or creating new boundaries.”

Talking to Your Heathcare Team About Anal Sex
Communication doesn’t end with your partners. Having open conversations with your healthcare providers about any questions you have is also an important part of any kind of sex.

“When it comes to speaking with you doctor, there are no bad or stupid questions, and I can pretty much assure you that there is nothing you can say that they haven’t heard or seen,” says Dr. Fleming.

Bennett recommends writing questions down before you get to your appointment so you’re prepared and have time to think about what you’d like to know. If you’re feeling uncomfortable, she recommends practicing asking the questions aloud.

“There is a lot of stigma around sex in general and anal sex is no different. Healthcare professionals are here to help you and there should be no judgment,” Bennett says.

What Is the Role of Intimacy and Sex in Your Overall Health?

When you think of the word “intimacy,” you may assume it means sexual relationships. But while one can boost the other, one doesn’t necessarily include the other. Intimacy on its own involves trust, acceptance, and an emotional connection with another person. Intimate partners care for one another and are unafraid to share thoughts, desires, and vulnerabilities.

In addition to romantic partners, you can have intimate relationships with friends, family members, and other people in your life.

Even without sex, intimacy can provide many physical and mental health benefits. “There has to be an evolutionary reason why people maintain paired bonding and intimacy when there is no sex involved. Indeed, we have found that there are biological advantages of being a dyad over an individual,” says Michael Krychman, MD, an obstetrician and gynecologist based in Southern California and also a clinical health professor at the University of California, Irvine.

Does Intimacy Always Involve Sex? And What’s the Difference?
The lines can get blurred at times, but you can have intimacy without sex and vice versa. “Intimacy is more of an emotional connection rather than a physical connection,” explains Dr. Krychman, who is a coauthor of The Sexual Spark. “As relationships increase in duration and [partners increase in] age, the sexual frequency may decline, but intimacy may increase.” But while sex and intimacy are different, they are interrelated, he adds. “They go hand in hand. Some partners need to feel loved and cared for to be [sexually] intimate, and some need to perform sexually to demonstrate that they love and care.”
What Are the Different Types of Intimacy?
It’s important to understand that there are four key forms of intimacy, says Krychman:

Physical, which means being in the same place at the same time and spending quality time together, like on a date night.
Emotional, which means sharing emotions and thoughts and connecting on a feeling level.
Sensual, which means physical touch and pleasure and other ways to physically connect that don’t involve sexual acts, such as hugging and kissing.
Sexual, which includes vaginal or anal sex, oral sex, and other forms of sexual contact.
Everyone is different, and we all desire these different forms of intimacy to varying degrees in our relationships, he says.

The Health Benefits of Intimacy: Less Stress, Better Sex
Intimacy, in all its forms, has a variety of health benefits for body and mind, experts say. Here’s a look at some of the different ways that intimacy can improve daily living.

Intimacy Helps You Reduce Stress and Stay Healthy
Chronic stress can cause a host of health complications, such as insomnia, muscle pain, high blood pressure, cardiac events, a weakened immune system, irritable bowel syndrome, and inflammatory bowel disease, among others. “When you are in a constant state of fight-or-flight, you use up a lot of necessary nutrients needed to maintain health. Intimacy helps reduce the stress and panic so that your body can replenish itself and maintain a good immune system,” says Barbara D. Bartlik, MD, a psychiatrist and sex therapist who works with Weill Cornell Medicine in New York City.

Intimacy Counters Loneliness and Reduces Risk of Mortality
Social isolation is linked with increased morbidity and mortality, according to one study (1), while another study found that in addition to higher mortality, loneliness can also impair executive functioning, sleep, and mental and physical well-being. (2)

“If you feel complimented, loved, and appreciated, that all contributes to good health. If you feel alone, isolated, stressed, abused, or taken advantage of, that has a negative effect on your health,” explains Dr. Bartlik, who is a coauthor of Integrative Sexual Health.

Intimacy Fuels a Better Sex Life
While sex isn’t necessary to achieve intimacy, intimacy can often lead to a better sex life, which in itself has health benefits. Your experience of sex will improve because you will be unafraid to express (and receive) what you desire, and willing and open to hear and care for your partner’s needs as well. The trust will allow both of you to grow and try new things that might enhance your relationship.