Anal Sex and STDs
It is important for women to have knowledge about our bodies, including our vaginas, clitorises, breasts, and rectums. You are your best source of information; you know your body and its uniqueness better than anyone else. When you experience anything unusual—including rashes or sores, persistent itching, irritation, abdominal or pelvic pain, burning or pain during urination, any unusual discharge, irregular bleeding or cramping, or discomfort or pain during sex—you should see a gynecologist or other physician promptly. In many cases, you may have a simple, easily curable infection, but you could also have a sexually transmitted disease (STD). For many women, STDs may occur without any symptoms at all, so the only way they can be detected is through medical exams and laboratory tests. Therefore, all sexually active women should have checkups, pelvic exams, and pap smears on a yearly basis.
It is equally important to find a gynecologist or other physician you respect, trust, and feel comfortable talking to about your sexual health and practices. I’ve been to gynecologists who assume I’m heterosexual and ask me the requisite “What form of birth control do you use?” I’ve been to others who don’t ask me anything about my sexual practices, partners, or concerns. Your gynecological visit is no time to play “Don’t Ask, Don’t Tell.” If they don’t ask, it’s your responsibility to tell. While a regular exam at the gynecologist should include a pelvic exam, pap smear, breast exam, and rectal exam, many doctors do not perform rectal exams unless patients specifically present rectal symptoms. If you regularly engage in anal sex of any kind, you should inform your doctor, be frank about your practices, and request a rectal exam, even if you feel fine.
Sexually transmitted diseases can be rectal as well as vaginal. If you are diagnosed with an STD after a vaginal exam and didn’t have a rectal exam, you should return for a rectal exam. Because of the close proximity of our vaginas to our anuses, it is easy for women to spread infections from one orifice to the other. And if you had unprotected vaginal and anal sex, then the STD virus is likely to be living in both places; better to be safe than sorry. Most STDs can be treated and cured fairly easily with antibiotics if they are caught in their early stages. Untreated STDs can lead to more serious complications, including sterility, cancer, and, in some cases, death. So, please, take care of yourself.
NOT SAFE: Unprotected rimming, unprotected anal finger-fucking, sharing anal sex toys without cleaning and disinfection or using a new condom; penis-rectum intercourse without a condom.
SAFER: Anal masturbation; rimming with a latex barrier; finger-fucking with a latex glove; cleaning, disinfecting, and using condoms with all sex toys; penis-rectum intercourse with a condom and withdrawal; fisting with a latex barrier; spanking or whipping that does not break the skin or draw blood.
Here are some of the most common STDs in America, their symptoms, and their treatments. I specifically discuss STDs that can be transmitted through anal sex and how the STDs affect your anus and rectum, since this book is primarily concerned with anal sex and health. Again, most women who contract an STD never exhibit symptoms until their condition becomes serious. You shouldn’t attempt to self-diagnose an STD; use the following information as a guideline rather than a substitute for regular visits to the doctor.[57]
Anal warts (like genital warts) are spread when your anal area comes into contact with the affected area of an infected partner. Anal warts begin as small pink bumps around the anus and in the anal canal; they tend to spread rapidly, forming clumps of bumps that may be itchy or painful if they are irritated. Their incubation period is usually one to six months. Anal warts are treated by removing them from the skin by applying chemicals to them (usually acids), burning them with an electric needle (electrocautery), or freezing them with liquid nitrogen (cryotherapy).[58] Even after visible warts are removed, the virus that causes them—the human papillomavirus (HPV)—can remain in your body, and the anal warts can recur.
You can also spread warts from your anus to your vagina and vice versa—another reason for regular rectal exams. If you have anal warts, you should also be checked for vaginal warts.
Women diagnosed with anal warts should have regular exams even after they are removed to monitor recurrences and prevent complications.
Hepatitis is an inflammation of the liver that has several different strains; I am going to address hepatitis A and hepatitis B because they are the most common and the most relevant to anal sex and health. The hepatitis A virus is found in the feces of an infected person, so it can be spread by unprotected anal penetration and especially unprotected oral-anal contact. The hepatitis B virus is found in all bodily fluids of an infected person, including semen, saliva, vaginal secretions, blood, feces, and sweat. People with hepatitis may experience a variety of symptoms, including low energy, loss of appetite, depression, body aches, nausea, diarrhea, abdominal pain, rashes, swollen glands, fever, chills, dark urine, weight loss, and, if the condition has become serious, jaundice. Some people can be carriers of hepatitis and not have any symptoms; others can develop chronic, recurring hepatitis. People who are at risk of contracting hepatitis B can be vaccinated against the virus.
• Get tested for HIV and STDs regularly, especially if you have unprotected anal sex with partners.
• Always use condoms, dental dams, latex gloves, and water-based lubricants for all anal activities.
• Learn how to use condoms properly (see chapter 4).
• For an extra measure of safety during penis-rectum intercourse, have your partner withdraw before ejaculation. Remember, semen from men who are HIVA- has a high concentration of the virus and is very infectious.
• Safe, slow, and gentle anal sex decreases the chances of trauma to anal/rectal tissue; keep in mind, however, that you may already have minute tears or sores in the rectal lining that you don’t know about.
• If you and your partner are both HIV+, you should still practice safer sex to avoid being exposed to a different strain of the virus or transmitting opportunistic infections.
About 150 million people in the United States have been exposed to the herpes virus.[59] Genital herpes can be transmitted through sexual contact, including vaginal, oral, and anal sex; the herpes virus can also enter the body through mucous membranes or cuts in the skin. Within a week of exposure, people with herpes usually first experience a tingly or burning sensation in the genital area; then they develop bumps or blisters in the affected area, which can be itchy, sore, and/or painful. Women can also experience flu like symptoms, swollen glands or lymph nodes, a vaginal discharge or yeast infection, and painful urination. Initial sores usually heal in one to three weeks without treatment. There is no cure for herpes, and symptoms can recur during outbreaks. These outbreaks can be brought on by stress, a compromised immune system, or prolonged exposure to the sun; they can last for up to three weeks. Although a person is most contagious during an outbreak, transmission of the virus can happen during nonactive periods as well (especially the two weeks after an outbreak) and with or without visible blisters or other symptoms. Sores can appear not only on but around the genitals, and condoms and dental dams will protect only the area they cover, so partners should limit their activities accordingly during outbreaks. In recent years, people with herpes have successfully used a drug called Zovirax™ (either ointment or pills) to control and treat symptoms.[60]
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1. For more information on STDs and anal sex, I recommend