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Anatomy

Anal sex 101

History, anatomy and recommendations for a safe and pleasant practice

by María Fernanda Ojeda, Colaboradora Reviewed by Dra. Judith Elena Martínez Acosta, Colaboradora
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The ways in which humans live and experiment with their sexuality are broad and diverse. To practise safe and pleasurable sex, trustworthy information is essential because it enables us to make informed decisions that feel right for ourselves. In that sense, every sexual practice requires the mutual consent of the people involved.

In this article you'll read about anal sex practices in depth, including its history, some useful recommendations, and the possible risks involved. 

Anal sex in history

There is vast evidence that anal sex has been practised throughout history. In Latin America, several sculptures of human figures that depict vaginal, oral and anal sexual activities have been found. These figures belonged to pre-Hispanic societies that lived on the continent before the conquest and colonisation by the Spanish (1).

For example, in northwest Mexico, where Tlatilco culture once thrived, representations of human figures engaging in sexual intercourse have been found, dated from the year 1000 B.C. (1). In the north coast of Peru, there have been discoveries of human sculptures practicing oral, vaginal and/or anal sex. These miniature figures belonged to the Mochica culture and date back to the year 700 A.C. (1). In Colombia, a small ceramic sculpture from the Tumaco-La Tolita culture has been found that depicts a man with anal dilatation (1).

Europe also has records of anal sex that date back to Ancient Rome. Even though the Romans were open to diverse sexual practices, there were restrictions on anal sex that depended on the status a citizen had in society. Even during Roman times, passivity in men—being anally penetrated by another man— was seen as a feminine and reprehensible act (2).

In the Middle Ages, anal sex was condemned under the influence of the Catholic church, as sex was considered to be an act between a man and a woman, for reproductive purposes only. However, it has been speculated that the clergy, who were supposed to be celibate, performed anal sex intercourse (3).

Nowadays anal sex is not considered as reprehensible, but there are still taboos that stigmatize this type of sexual practice. For example, it's widely believed that only homosexual men have anal sex encounters, ignoring the experiences of lesbian and heterosexual couples.

It's also important to highlight how the massification of pornography has contributed to the popularization of anal sex.

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The anatomy of anal sex 

To understand anal sex in depth, it's important to first acknowledge which body parts are related to this practice, in order to understand their functions and characteristics. These body parts are:

  • The anus,

  • the rectum,

  • and the anal sphincter.

The anus is the hole at the end of the digestive tract, through which defecation material is evacuated. It is composed by skin layers with several nerve endings that make the anus especially sensitive (4).

The rectum is the final part of the digestive tube and is located above the anus; it's a less sensitive zone. The anal sphincter is a muscular ring that keeps the anus closed. It is controlled by the autonomic nervous system, but it's also possible to contract and relax it voluntarily (4).

How to have safe anal sex

After learning the body parts directly related to anal practices, it's necessary to highlight some topics that help you have a pleasant and safe sexual encounter.

Anal sex practices carry bigger risks of HIV infection, in comparison with vaginal or oral sex (5).

The anus and rectum zones are particularly sensitive due to their fissures and wounds, through which STIs can be transmitted more easily, which is why anal sex carries greater risks than other sexual activity. That’s why it is very important to use condoms from the beginning through to the end of anal penetration (5).

Three recommendations for a pleasant anal sex intercourse

For enjoy anal sex intercourse, the following are necessary (3):

  • Lubrification: the anus and rectum don't release any sort of fluids that facilitate penetration, therefore lubrification is essential for anal sex. Water-based lubes are recommended, so as to not affect the quality of the condom and also to prevent ruptures in the internal tissues of the rectum. The lube must be applied before penetration on the erect penis or sex toy, and also in the anus (3, 5).

  • Distension: the relaxation of the anal musculature and the anal sphincter. It's recommended to slowly introduce one finger or the tip of the penis or sex toy to open this part of your body smoothly and gradually (3).

  • The initial penetration must be slow to allow for anal musculature relaxation and to avoid anal fissures (3).

Don't hesitate about condoms. The correct use of condoms is fundamental for a safe anal sex practice, just as much as the use of lube. Recent years have seen an expansion of different types of lube, some with analgesic effects that relieve pain during penetration and even lubes made of CBD oil—one of the main components of cannabis (9).

It's also recommended to avoid excessive use of anal douches (enemas), which is the practise of introducing liquids inside the rectum through the anus to remove intestinal content for the sake of cleaning (8). The constant use of douches and enemas can cause mucosal lesions and create an environment that enables the transmission of STIs.

For oral-anal sex (cunnilingus, rimming), it's recommended to use a latex barrier or to practise good external hygiene of the anus (6).

Some final recommendations include lubing up your fingers before anal insertion and always avoid bringing your finger into contact with the mouth or vagina after anal play. If you are going to share your sex toys with other people, it's important to put condoms on them (6).

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Risks of anal sex practices

The rectum and anus areas are sensitive and can become wounded during penetration, which can facilitate bleeding and the spreading of germs. The mucosa of the rectum has a remarkable absorption capacity, which can increase the spread of infections (5).

Besides HIV, anal sex can lead to the contagion of other STIs like gonorrhea, hepatitis (A, B and C), syphilis, and genital herpes—the two last caused by skin-on-skin contact. In addition to this, anal sex intercourse without condoms can spread parasites like Giardia, intestinal amoebae and E. Coli bacteria through stool remains. These can cause infections in the small intestine and usually have symptoms like diarrhea. (3, 5).

HIV risk reduction

Proper condom use is the most important recommendation for safe anal sex practices, but there other habits and measures to avoid STIs transmission.

To avoid HIV contagion there is a range of medication and therapies available, like:

  • Pre-exposure prophylaxis (PreP): treatment indicated for HIV negative people with higher risk of contracting HIV. The risk can be reduced by up to 90%. Additionally to PrEP, there must also be in place other preventative methods, like condoms (5).

  • Post-exposure prophylaxis (PEP): used in emergency situations, must be taken up to 72 hours after a sexual encounter. In this treatment, antiretroviral medication is taken to prevent an infection right after possible exposure to the virus (5).

  • Antiretroviral therapy (ART): used in case of an existing infection and aims to reduce the viral load in the blood. The ART treatment can reduce the risk of contagious in a negative-positive HIV couple by up to 96% (5).

Human sexuality is constituted by a broad spectrum of experiences that vary a lot according to the preferences and choices of every individual. Among sexually active couples, self-care and mutual respect, along with trustworthy and accessible information are fundamental for safe and pleasant sexual practices.

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