This page accompanies the talk Through the Backdoor: A Frank Guide to Anal Pleasure, Safety, and Risk. It is intended as a reference resource for attendees and anyone seeking evidence-based information on anal sexual health. The information provided is for general informational and educational purposes only and does not constitute professional medical advice, diagnosis, or treatment.
5 Rules for Safe and Pleasurable Anal Sex
Rule 1 — Communicate First
Talk about it before you’re in the moment. Discuss what you want to try, what your limits are, and what “stop” means. During sex, check in verbally and watch body language — tensing, breath-holding, or pulling away are stop signals even without words. The receiving partner’s comfort sets the pace throughout.
After sex: mild soreness is within normal range. Persistent pain, bleeding that doesn’t resolve, or changes in bowel function warrant a visit to a healthcare provider. You are allowed to say “I had anal sex and something doesn’t feel right.” That is a legitimate medical concern.
Rule 2 — Prepare Your Body and Your Mind
Physical preparation — using the bathroom 30–60 minutes beforehand, washing the external area, and avoiding high-fiber meals or caffeine immediately before — reduces anxiety and supports comfort. Solo exploration with fingers or small toys before involving a partner builds body knowledge and helps identify what feels comfortable.
Psychological preparation matters equally. The internal anal sphincter is involuntary — it only releases when relaxed. Anxiety activates the sympathetic nervous system, which tightens the pelvic floor. Feeling safe and genuinely aroused is not optional; it is the physiological precondition for comfortable anal sex.
Rule 3 — Lube Generously
The rectum produces no natural lubrication. Lube is not optional — it is safety equipment, every time without exception.
Water-based lubricants are compatible with condoms and easy to clean up, but dry out faster and require reapplication. Silicone-based lubricants last longer and are condom-compatible, but degrade silicone toys. Oil-based lubricants degrade latex condoms and should not be used with them.
Always avoid: numbing or desensitizing agents (such as lidocaine or benzocaine), which remove the pain signal without removing injury risk; glycerin, which can cause irritation; and hyperosmolar lubricants, which can damage rectal epithelium. Many common drugstore lubricants are hyperosmolar — look for iso-osmolar formulations when possible.
Rule 4 — Slow Down and Let Arousal Lead
Begin with external touch — light touch, feathering, or massage around the anus before any penetration. Fingers should precede larger objects. Use deep, diaphragmatic breathing with longer exhalations than inhalations; this shifts the autonomic nervous system toward relaxation and helps release pelvic floor tension.
During entry, the receiving partner should bear down — push outward, similar to the motion of a bowel movement — while the inserting partner angles slightly downward toward the tailbone. Together, these movements work with the natural anorectal angle rather than against it. The “knocking” technique — placing the tip of the toy or penis against the opening and waiting for the muscle to relax before entry — prevents the most common cause of pain and injury.
What you should feel: pressure or fullness. Sharp or increasing pain is a stop signal, not something to push through.
Rule 5 — Receiver Leads, Always
The receiving partner has direct physiological access to what is happening. Receiver control lowers anxiety, reduces pelvic floor tension, and prevents injury. In practice: the receiver controls pace, depth, and when to pause or stop. The inserting partner follows; they do not lead.
Positions that give the receiver maximum control — such as being on top or side-lying — are recommended for anyone new to anal sex or with a new partner. Every object used anally must have a flared base, handle, or retrieval loop. The rectum’s muscular contractions and negative pressure can draw objects inward; objects without a flared base are a documented cause of emergency presentations.
The DOs and DON’Ts
DOs
- Communicate before, during, and after — establish what stop means, check in during sex, watch body language
- Prepare your body and your mind — bathroom beforehand, solo practice, ensure genuine arousal
- Use generous lubricant and reapply — more than you think you need, before it feels necessary
- Slow down, breathe, and let arousal lead — external touch first, exhale on entry, use the bearing down technique
- Let the receiver lead — receiver controls pace, depth, and when to stop
- Use only toys with a flared base, handle, or retrieval loop
- Use condoms — anal sex carries the highest STI transmission risk of any sexual activity; condoms matter more here, not less
- Ask for a rectal swab specifically at STI testing — standard panels do not include it automatically
- Stop at sharp pain, burning, or increasing discomfort — see a healthcare provider if bleeding does not resolve
DON’Ts
- Don’t rush or skip warm-up — the internal sphincter cannot be forced open; rushing is the most common cause of pain and injury
- Don’t use numbing or desensitizing lubricants — pain is information; removing the signal does not remove the risk
- Don’t use any object without a flared base
- Don’t skip lubricant or underuse it
- Don’t treat consent as one-time — a yes at the start does not cover the whole experience
- Don’t skip condoms because there’s no pregnancy risk — STI transmission risk is the relevant concern
- Don’t go anal-to-vaginal without changing condoms — rectal bacteria can be transmitted to vaginal tissue
- Don’t assume a standard STI panel includes rectal STI testing — ask specifically
- Don’t push through pain
STI Testing — What to Ask For
A standard STI panel at most clinics does not automatically include a rectal swab. Rectal gonorrhea and chlamydia are frequently asymptomatic — meaning most people who have them do not know it, and will not be diagnosed without a specific rectal swab.
“I’d like a full STI panel, including a rectal swab.”
A complete STI screen for someone who has anal sex includes:
- Urine or urethral swab — gonorrhea and chlamydia (urogenital); usually included in standard panels
- Rectal swab — gonorrhea and chlamydia (rectal); ask for this specifically — it is often not included
- Oropharyngeal swab — gonorrhea and chlamydia (throat); relevant if you give oral sex
- Blood draw — HIV, syphilis, hepatitis B, hepatitis C; usually included in standard panels
- Anal Pap smear — screens for HPV-related dysplasia and early cellular changes associated with anal cancer; recommended for people living with HIV, immunocompromised individuals, and those with a history of anal sex with multiple partners
The CDC recommends STI screening at least annually for sexually active people, and every three to six months for people with multiple partners or those on PrEP.
HPV vaccination is recommended through age 26 for everyone, and up to age 45 based on shared clinical decision-making. If you have not completed the vaccination series, ask your provider at your next appointment.
PrEP — Pre-Exposure Prophylaxis for HIV Prevention
PrEP is medication taken by HIV-negative individuals to prevent HIV transmission. When used correctly, it is over 99% effective at preventing HIV.
Two options are currently available in the United States:
Daily oral pill (emtricitabine–tenofovir; brand names Truvada and Descovy): taken every day. Appropriate for most people.
Long-acting injectable (cabotegravir; brand name Apretude): administered by injection every one to two months. This option may be preferable for individuals with gastrointestinal conditions that affect oral drug absorption, or for those who find daily pill adherence difficult.
PrEP protects against HIV transmission only. It does not provide protection against gonorrhea, chlamydia, syphilis, HPV, or herpes. PrEP used alongside condoms provides the most comprehensive protection available.
To access PrEP, speak with your campus health clinic or a sexual health provider. Many clinics offer PrEP navigation services including assistance with insurance coverage and cost.
References
The following peer-reviewed sources informed the content of this talk and page. Full citations are provided for anyone who wishes to read the primary literature.
Prevalence and Behavior Data
Herbenick D, Bowling J, Fu T-C (Jane), Dodge B, Guerra-Reyes L, Sanders S. (2017). Sexual diversity in the United States: Results from a nationally representative probability sample of adult women and men. PLoS ONE, 12(7), e0181198. https://doi.org/10.1371/journal.pone.0181198
Source for prevalence estimates of anal sex behaviors and appeal data used in the talk. 2015 Sexual Exploration in America Study; U.S. nationally representative probability sample (N = 2,021).
Dodge B, Herbenick D, Fu T-C (Jane), Schick V, Reece M, Sanders S, Fortenberry JD. (2016). Sexual behaviors of U.S. men by self-identified sexual orientation: Results from the 2012 National Survey of Sexual Health and Behavior. Journal of Sexual Medicine, 13, 637–649. https://doi.org/10.1016/j.jsxm.2016.01.015
Source for anal sex prevalence data stratified by sexual identity (heterosexual, gay, bisexual men). 2012 NSSHB; nationally representative probability sample with oversampling of sexual minority men.
Chandra A, Mosher WD, Copen C. (2011). Sexual behavior, sexual attraction, and sexual identity in the United States: Data from the 2006–2010 National Survey of Family Growth. National Health Statistics Reports, No. 36. Centers for Disease Control and Prevention. https://www.cdc.gov/nchs/data/nhsr/nhsr036.pdf
Source for population-level anal sex prevalence data from the CDC National Survey of Family Growth.
Sex Education
Paramboukis O, Skuse G, Hartley S. (2021). Sex education in school, are gender and sexual minority youth included? A decade in review. Journal of School Nursing, 37(2), 86–97. https://doi.org/10.1177/1059840521998369 (PMC7986966)
Systematic review of school-based sex education in the United States. Source for the finding that curricula “do not include information on oral, anal, or manual intercourse or ways to practice safe sex with these types of sexual activity.”
Anatomy, Physiology, and Clinical Sexual Health
Dickstein DR, Edwards CR, Rowan CR, Avanessian B, Chubak BM, Wheldon CW, Simoes PK, Buckstein MH, Keefer LA, Safer JD, Sigel K, Goodman KA, Rosser BRS, Goldstone SE, Wong S-Y, Marshall DC. (2024). Pleasurable and problematic receptive anal intercourse and diseases of the colon, rectum and anus. Nature Reviews Gastroenterology & Hepatology, 21, 377–405. https://doi.org/10.1038/s41575-024-00932-1
Comprehensive review of the anatomy, physiology, and neurophysiology of receptive anal intercourse; diseases and treatments affecting anal sexual function; and management strategies for problematic anal intercourse. Primary anatomical source for the talk’s Section 1 content and the pelvic floor/radiation treatment discussion.
Technique and Pelvic Floor Health
Wong J, PT, DPT. (2019). Top tips for more pleasurable bottoming from a physical therapy doc. San Francisco AIDS Foundation, BETA Blog. https://www.sfaf.org/collections/beta/top-tips-for-more-pleasurable-bottoming-from-a-physical-therapy-doc/
Clinical resource from a physical therapist on pelvic floor mechanics, sphincter control, the bearing down technique, breathing, and positioning for anal sex. Source for the anorectal angle and bearing down technique content in Section 2.
Further Resources
The following organizations provide evidence-based sexual health information:
Scarleteen
Comprehensive, inclusive sex education for young adults. Covers anatomy, relationships, consent, and sexual health across all orientations and identities.
San Francisco AIDS Foundation
Sexual health resources with particular depth on anal health, STI prevention, PrEP access, and harm reduction. Includes clinical articles written by healthcare providers.
Planned Parenthood
Sexual and reproductive health information, STI testing locations, and PrEP navigation.
SIECUS
Sexuality Information and Education Council of the United States. Policy and advocacy organization focused on comprehensive sex education; useful for understanding the landscape of sex education in the United States.
National Coalition for Sexual Health
Provider and patient resources for sexual health conversations and screening recommendations.
About This Resource
This page was developed by Christopher Wheldon, PhD. Dr. Wheldon’s research focuses on HPV transmission and anal cancer risk, and on the effects of cancer treatment on anal sexual health and quality of life.
This page is for educational purposes only and does not constitute medical advice. If you have a health concern, please consult a qualified healthcare provider.