Sex and Relationships

Sexual Dysfunction

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Answers to questions about sex therapy and sexuality

ASK THE SEX DOC Questions about Anal Sex #1

ESSENTIAL SAFETY INFORMATION FOR ASS PLAY: Because of the anatomy of the anal sphincters (circular muscles), any object that gets narrower as it goes in can slip rapidly into the rectum. Make sure that you have an ironclad grip or that the object gets wider further down. It's kind of embarrassing to go to the emergency room to have that light bulb (etc.) removed. (Use a search engine to find "foreign rectal objects")

Several questions about hygiene and technique

Can a man have an orgasm from anal stimulation?

Is prostate stimulation using a dildo a sign of being homosexual?

How do you relax the anus to receive an erect penis?

What do you do if you have followed all this good advice -- dilation, relaxation, etc., and it STILL hurts?

How long does it take before you contract HIV from anal sex?

Is Oral/Anal contact unhealthy?

The following are several questions from one inquirer. I presume that what some are curious about others might also be.

Q:  What are the chances of fecal matter coming out after a rectal syringe cleaning?

A: That depends on how thorough the rinse was and on the consistency of the fecal bolus. If relatively well connected when passed, the first rinse might come out clear (indicating an empty rectum). If the fecal matter is loose and poorly connected ("pasty"), there is a good chance that some will continue through the large intestine, probably facilitated by anal/rectal stimulation. Even a two-quart enema won't guarantee the total absence of all fecal matter. What will? Abstaining from any solid food for 36-48 hours -- clear fluids only. But you better believe that all those porn stars don't give up the good food!

Q:  Is it OK to ejaculate up the ass?

A:  Considering that in most porn flicks you see the guy withdraw and spurt semen all over his partner, some observers might assume that that is how you're supposed to have sex! YIKES! Yes, it's perfectly OK to "come" in someone's ass, but the recipient needs to be prepared that passing gas ("farting") might be an unexpectedly wet experience

Q:  What is the easiest and most comfortable way of GIVING anal sex?

A: Easiest is when the anus is dilated. Some lovers during one event will .use several things to dilate the anus, from small diameters to larger ones. When the size of the penis is reached, the last dilator is replaced with an erect penis. Most COMFORTABLE: With the recipient in TOTAL control of initial penetration.

Q:  If she is tight, do I tell her to relax the anus?

A: No, no, no, no, no. This is not under voluntary control. Asking her to "push out like you're trying to fart" will exhaust the extent of voluntary control efforts (modest at best). Progressively gradual dilation is needed.

Q: Can a man have an orgasm from anal stimulation alone?

A:  Yes, but not simply from stimulation of the anus alone (except in rare cases). It is possible to "cause" an orgasm by massaging the prostate gland, but it needs a certain pressure and rhythm. Some men report that the strongest orgasm they had from prostate stimulation was their first -- probably because of the novelty effect. Others have reported that it took two to four trials before they became orgasmic, which I attribute to a combination of the learning curve of feeling what feels best, irrational thoughts about the implication for homosexual behavior, getting over the concern about the stimulating device coming out with fecal matter on it, and last but not least, the skill of a partner (which cannot exceed the quality of communication of the man being stimulated).

NOTE:  Most of the time I shorten the "question" to its essence. I am reproducing the entire text of the following question because it articulates information that amplifies the answer.

Q:  I am a 36 year old male and have been happily married for over 9 years. My wife and I have a great relationship and have very good and satisfying sex together. Occasionally, though, I am left wanting for something a little extra in the way of foreplay. I enjoy being stimulated rectally and frequently stimulate myself (after an enema) by using a dildo during masturbation. With the combination of the prostate and the base of the penis back there, in my estimation this is akin to a male version of the "G" spot. My assumption is that it is not abnormal for a heterosexual man to enjoy stimulation rectally (nor admit it if they are NOT homophobic). I would very much like to have my wife participate (assist me) in this activity in our sex life. I have spoken with her about this a few times and she thinks this is abnormal or homosexual behavior. Am I correct or is she? Do you have any other advice you might offer regarding this subject? Please help. Thank you. B

A:  I am reminded of the statement: "When it comes to sexually explicit material, what I like is erotica, and what you like is pornography". Similarly, what I like to do in bed is profoundly pleasurable, and what you like is kinky. One of my colleagues rendered the opinion that anal sex for the 20 years starting 1990 is like oral sex during the 20 years after 1950. GIs returned from World War II after experiencing blow jobs while in France. After much cajoling, wheedling, and reassurance, women began to please their men orally (and vice versa) and the practice was elevated from something only a sleaze would do to something seriously avant garde. And so the prediction is that because of its publicity and gradual legitimacy, the acceptance of and participation in anal sex will become more wide spread. Anal activity for men, however, will probably be tied to the gradual understanding of homosexuality in society at large, with a better understanding of what behavior constitutes being gay. Any statement of this topic will be incomplete, but as a working definition, I suggest that you embrace the idea that being homosexual means wanting to be sexual with members of the same sex. It does not address the nature of the behavior!

There is a distinct percentage of virginal women who are delighted to have their lover kiss, suck, or bite lightly on nipples and clitoris, and who enjoy 1-3 fingers inserted intra-vaginally, and who really appreciate the ensuing orgasm. Does that make them lesbian? There are many women who really, really (not a typo -- I meant 2 "really's") enjoy anal intercourse as a variation on sexual activity (some tell me that for them it's because the angle of entry of the penis through the anus directs it straight to the G spot). Does that make them "gay submissive wannabe's?" Puhleeeze, people, get a grip! Are gays who engage in anal intercourse "more gay" or "more mature" than gays whose insertion preference is "only" blow jobs? You need to separate partner gender from activity.

I have had patients who enjoy role reversals -- he wears panties and a bra, and she straps on a dildo and seduces him. That no more makes her queer than it makes him queer. Get the point?

Freud postulated five psychosexual stages: oral, anal, phallic, latent, and genital. He further asserted that the child derives intense pleasure -- indeed, age-appropriate sexual pleasure -- from those locations: the mouth from sucking, and the anus from success in toilet training. That many people are eroticized anally is no surprise considering that there are almost as many nerve endings in the anus as there are on the head of the penis or in the clitoris. Similarly, there are people who are disgusted by things anal. After all, that's where "dirty" stuff comes out and where embarrassing bad smells come from. Yuck, yuck, ptooey, ptooey! And more than one woman has expressed bewilderment at why her lover gets really sexually excited bringing her to orgasm from oral stimulation alone when "smelly stuff comes out of THERE once a month, and that is so close to where the really bad smelling stuff comes out!"

It is the sexdoc's observation that heterosexual men who acknowledge the pleasure they derive from anal or rectal or prostate stimulation are more centered and grounded about their sexuality. The point about the relationship between anal or rectal stimulation and homosexuality is well-made by those who find enemas erotic. Enjoying -- deriving pleasure from -- an enema no more makes a straight guy gay than an event of heterosexual intercourse makes a committed gay man straight!

Sex partners often shy away from a new activity if they feel incompetent in engaging in it. So in regard to involving your wife, the first question I'd ask is if she has a clear idea of what you find pleasurable. "Make me feel good" provides insufficient direction for anyone! While clear communication is essential, you might find that starting with a demonstration is extremely valuable. Have her observe you masturbating while using a dildo rectally. Let her see the pleasure on your face, the depth, frequency, and timing of the anal thrusting, and the intensity of your orgasm. Also: consider inviting her to be the recipient of anal intercourse. Hasten to add that no, you don't fantasize that she's a guy! More than one person in this circumstance (men and women) who experiences what his or her partner likes has concluded "Wow! So this is what you've liked for so long. Look at what I've been missing!" Everybody wants to feel competent. Whether demonstrating this or any other sexual technique, be clear, precise, and explicit about what feels good and what doesn't (faster, slower, deeper, more lubrication, stop! Don't move!).

Many of my patients who are anally eroticized are embarrassed about it. I tell them that they should count their blessings because they have one more erogenous zone than their anally-anesthetized peers!

Please also see the only serious, scientific book I know of on this subject: Anal Pleasure and Health by Jack Morin, Ph.D.

And finally: heterosexuals who are unfamiliar with homosexual behavior impose a heterosexual analog onto gays and lesbians. If you believe the myth that the only "real" sex is penile-vaginal penetration, then of course, all gays must engage in anal intercourse, and one is the "woman" (passive receiver) and the other is the "man" (inserter). In fact, anal intercourse is a consistent activity (more than once a week) in only 19% to 44% of gay sexual encounters (depending on age, race, and other factors). In the same way that gays have sexual preferences like heterosexuals, some like to insert more often, some prefer to receive more often, some will alternate, and others do not engage in anal sex.

Any questions?

How do you relax the anus to receive an erect penis?

If you read ANY of this, you MUST read the "Caveats" paragraph, below.

It takes time. First consider that if you are concerned that your lover's penis is going to come out with fecal matter on it, you're going to be understandably uptight. So if anal intercourse is in the range of possibilities, you will want to flush your rectum if possible. We're not talking about the 2 quart red bag or the fleet enema! Experiment on your own when you have plenty of time. Most chain drug stores have a "rectal syringe" that is a rubber bulb that holds about a cup of liquid to which you attach a nozzle. I have had patients tell me that they also use disposable douches -- well rinsed of the original contents. The douche nozzle is larger than the tip of a rectal syringe, but many people are able to insert the douche nozzle rectally as their first dilation. At this point embrace the idea that your anus wants to be dealt with in a safe, comfortable way. Any time you assault it, whether with rectal syringe, finger, dildo, or penis, it will protect itself by clenching closed. Contract any muscle long enough and you have the build-up of lactic acid which begins to hurt like hell. Remember your last Charley Horse? Don't do that to your ass!

So in the privacy of your bathroom, with no fear of being interrupted, and with time on your hands, fill the syringe with lukewarm water. Screw the tip into the bulb, then put KY jelly (or a knock-off house brand -- they're just as good for this purpose) on the syringe, and on the tip of a finger to transfer the jelly to your anus and slightly inside. It is natural for your anus to react by clenching if it is touched with something that wants to go the opposite direction from fecal matter, so don't be surprised or disappointed when that happens to you. DON'T RUSH! Touch the tip of the nozzle to your anus. Take a deep breath in, exhale slowly, then bear down like you're trying to fart (and you might). The event of expelling gas (or trying to) from the rectum relaxes the otherwise naturally clenched anal sphincter muscle, allowing it to open. When relaxed, gently insert the nozzle of the syringe. Some people find it helpful to "pull up" (the sensation of stopping a fart in a crowded elevator) and "push down" (trying to fart) alternately each 3 seconds, and each time moving the syringe nozzle deeper and deeper until it slips past the internal anal sphincter and just slides on up easily.

At this point take another deep breath, let it out slowly, tell yourself to relax, and feel what it's like to have this small tube ever so slightly dilating your anus. Part of the clenching reaction is inspired by temperature. Notice that your body is warming up the syringe tube. Right now you are doing two things at once. One is learning to rinse your rectum so you are less concerned about hygiene. The other is how to insert something to dilate your anal sphincters with no discomfort. Poised over the toilet bowl, squeeze the syringe, transferring the warm water from the bulb to your rectum. Remove the nozzle, and expel the water and any fecal contents. Do this two or three times; the water should come out clear.

Now that you know how to rinse your rectum, do it once a week until it's a "been there; done that" sort of thing -- so you'll be comfortable doing it when you need to. NOTE:  This will not guarantee that you won't have some fecal matter present during anal intercourse. The stimulation of the anus sends signals up throughout the lower gastro-intestinal tract (a sensation many people find to be the best reason to receive anal intercourse) which sooner or later will inspire peristalsis (the regular rhythmic squeezing that transports food down your throat, through your intestines, and keeps it moving in the "right" direction) which will transport fecal matter from higher up to lower down and into the rectum.

Your task is to proceed from being able to comfortably receive the rectal syringe nozzle to taking in objects of larger and larger diameters until you approximate the girth of your lover's penis. In any given training session you might need to start small and progress to larger and larger objects. You can make only so much progress during each "training session". I suggest that you consider a three to seven day interval between sessions -- at least three so you don't irritate your anal tissues, and not more than seven so that your "reptilian brain" -- the part that remembers how to ride a bicycle and drive a car -- doesn't "forget" the last training session. During each session you may be able to comfortably "only" achieve the previous session's diameter. Or, during some sessions you will be able to proceed to a larger diameter. Be patient with yourself!

So finally you're ready to try anal intercourse with a real live penis. Be sure that both the penis and your anus are well lubricated (see notes on lubrication, below). If you're relaxed enough, try slow gradual penile insertion under your control -- side by side with you pushing back while the penis is stationary -- or you on top controlling how much you descend -- or you on your tummy with your lover descending based on your hand signal. It doesn't have to be one progressive movement! Try touch, withdraw, penetrate a little, withdraw, penetrate more, withdraw only partially, penetrate deeper, withdraw half-way, then proceed to in-and-out movements with progressive depth stopping if it feels uncomfortable before the penis is fully inserted. Consider simultaneous clitoral stimulation during anal intercourse. If you're not relaxed enough to start with penile penetration, insert your increasingly larger objects that you trained on, finally withdrawing the largest to be replaced by the penis. Any questions? DEAR READER:  Please e-mail any steps you would like to have explained in more depth. This makes sense to me, but I've been describing this for 30+ years to people whose facial expression I can see so if they look confused I can explain it more precisely. Please provide feedback (

NOTES ON LUBRICATION:  KY and other water-soluble lubricants will get tacky after awhile because the water evaporates. You don't need to add more lubricant -- just a few drops of water. The problem is that you have to interrupt the action to add the water. I suggest reviewing the notes on the main web page regarding lubrication and types of lubricants.

3/30/00  A guy writes and asks: "What's the down side of using vaseline for anal sex?  And I replied that it was too viscous -- too much friction, and that it would make the anus sore and discourage the receiving party from wanting to do it again.  I suggested ALBOLENE moisturizing makeup remover, and he replied:  Thank you for the information. You are 100% right about the sore ass, and unwilling partner. Abolene is much slicker and doesn't dry up and go away. I
showed this stuff to my wife. The next move was to the bedroom.  Thank you, thank you, thank you !!!  If you have anymore good advice about this subject, that will make this more
enjoyable for my wife, let me know.

My reply:  Experiment with different angles of penetration by rotating her pelvis or positioning your body so it is slightly higher or lower than hers -- to affect where the tip of your penis is pointing, more toward her head or more toward her feet.  If you find the right angle where she feels an endorphin rush when you are almost completely as deep as possible, that's likely the tip of the penis rubbing against her g-spot, and if you can last long enough (I suggest that she simultaneously stimulate her clitoris) she might have the most violent orgasm of her life.

CAVEATS (WARNINGS -- MUST READ !!!): Make sure the objects you choose have no rough tip or rough edges; make sure they won't break; if in doubt about cleanliness (e.g., a cucumber), cover it with a condom. And MAKE SURE IT WON'T SLIP UP INSIDE YOU!!! The anal sphincters (there are two -- an internal and an external) tend to try to contract all the time, and if you have something sloped from big to small, and if you insert the big end in first, and if it is slippery enough, it'll just zoom right in. There are web sites on "Foreign Rectal Objects" and there are medical articles written about the lawyer who came into the emergency room with a light bulb in his rectum. Anything you put in your rectum must have a safe removal mechanism, and a string sometimes just won't do (if the object turns sideways once inside! think about it!). Dildos -- rubber or silicone toys shaped like a penis -- are good trainers because they come in different diameters. Most are smooth but some have textured "veins" to "look like the real thing". Just in case you have any illusions of maybe trying them vaginally some day, I suggest that you cover them with a condom (actually for both rectal and vaginal use a condom-cover is a good idea).

NEVER INSERT INTO THE VAGINA ANYTHING THAT WAS IN THE RECTUM WITHOUT BEING THOROUGHLY WASHED! Bacteria that are common in the rectum can cause very nasty vaginal infections. Wash with bactericidal soaps -- Safeguard and Lever 2000 work great. Look for "kills bacteria" on the label. Sex toys are best washed in warm water with one of these soaps then dried thoroughly. An hour in the sun also works well to kill bacteria but don't be surprised when you see your neighbors with binoculars, smirking. Enjoy!

What if it STILL hurts?

1/7/02 Q:  my boyfriend and I have recently been experimenting with anal sex, we've tried to use the artificial lubricants to make the experience most comfortable for both of us, but there is still more pain than I can handle, is there any certain position that is most comfortable and any position that is most uncomfortable?

thank you for your time,

A:   EVERYONE has a maximum diameter beyond which there is pain and beyond that there is tissue damage.  About a year ago I received an e-mail from a 28 year old man who said that when he was 16 he heard about anal penetration and he shoved something "too big" up his ass, without lubrication, and ever since, he has brown stains on his underwear.  He added that he is too embarrassed to tell this to any medical doctor and wanted to know from me (by e-mail) how to "correct" this problem.

If you're doing everything "right" -- meaning gradual dilation, relaxation, rinsing your rectum prior to ass play so you're not "up tight" about fecal matter on what gets inserted, and privacy as well as the absence of being judged in any negative way, and it STILL hurts, the operative questions are whether an object (such as a butt plug) of the same diameter as his erection also hurts -- if it does, your maximum diameter is smaller than his erection; if it doesn't, then something psychological is going on -- and whether you can simply accept that there is a size mismatch.

HIV from Anal Sex   For an excellent description of how fluid containing HIV in your rectum can infect you, go to this link

Dear Sex Doc: My boyfriend and I were virgins when we began to make love. I have been monogamous, and I am sure that he has not had any sexual contact with anyone else. We have been having vaginal intercourse for about a year and we are now interested in trying some new things. I have heard that anal intercourse is a major transmission route for HIV. How many times can we do that before one of us gets AIDS? 5/19/97

Dear Curious: Think of the Human Immunodeficiency VIRUS as a bunch of bugs that like to swim. If they're swimming in your bodily fluids (blood, sweat, tears, saliva, urine, vaginal secretions, and the moisture in your fecal matter) and they mingle with your boyfriend's bodily fluids (including "pre-cum" and semen), they might change swimming pools. But if NEITHER OF YOU has any HIV bugs in your body, they can't jump ship. Remember that using pre-used hypodermic needles or coming otherwise in contact with blood is an easy way for the virus to infect someone.

Is oral/anal contact unhealthy?


Dear Sex Doctor: My significant other, as part of foreplay, regularly requests that I orally stimulate her anal region. This drives her wild -- which is good -- but how healthy is this practice? I think I read somewhere that hepatitis C transmission occurs this way. Am I just being uptight?

ANSWER: Many people enjoy various kinds of anal stimulation. Called " rimming" in the sexual vernacular, oral-anal contact is practiced by lots of people. Technically, yes, this can be a transmission route for hepatitis, HIV, herpes and other nasty diseases. There is also the possibility of vaginal infection if vaginal-oral contact folllows rimming.

However, rimming has been known to send receptive partners into spasms of ecstasy and eternal gratitude. It's up to you to decide if the rewards outweigh the risks. To minimize risks, Jack Morin, Ph.D., author of Anal Pleasure & Health (Yes Press, 1986) states that " ... thorough washing substantially reduces the risk of infection."

Are you being uptight? No, it's smart to be cautious about sexually transmitted diseases.

On a closing note, however, be cautioned that even if you and your partner are free of sexually transmitted diseases, that you can contract, or give your recipient partner a urinary tract infection, from one of the flora and fauna that normally lives in the large intestine without harming the host: streptococcus faecalis. Women can give themselves the urinary tract infection by wiping from back to front after a bowel movement, and rimmers can ingest the bacteria from oral-anal contact.

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