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Bleeding During Anal Sex: What's Going On?

Dec. 16, 2011
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I've been in a same-sex relationship for four years now. We have anal sex. Our problem is that my boyfriend always bleeds every time we do it. He has been diagnosed before with hemorrhoids. What is the best way that we can continue having anal sex? What's the best lubricant to use? Or is there any drug that he can take before, at the onset, or after anal sex to prevent his anus from bleeding?

Since bleeding from the anus could be a sign of a medical condition besides hemorrhoids, I consulted with Mark P. Behar, PA-C, a health-care provider who specializes in sexual health and sees many male patients with same-sex partners. Mark works at Milwaukee Health Services Inc. and volunteers at Brady East STD (BESTD) Clinic.

Mark says, "Everyone has hemorrhoidal veins in the rectum, and when they are chronically irritated, they are considered the affliction known as "hemorrhoids." [Note from Laura: Read my earlier column about hemorrhoids and anal sex here]. Hemorrhoids may bleed, itch and swell, but so do other anorectal problems like fissures, fistulae, abscesses, warts, herpes, other STDs, etc. So, most importantly, the first thing to do is to accurately diagnose the problem so that you know exactly how to treat or manage it.

"This requires evaluation by someone skilled at examining butts and using an instrument known as an anoscope to look inside a couple of inches to make sure there isn't something else going on. The quickest, easiest and least expensive way to do that is by going to the Brady East STD Clinic, open Monday and Tuesday nights for a free exam. If an STD is found, such as genital warts, then these must be effectively treated before you can hope to have sex without any bleeding.

"Bleeding of any kind from the anus or rectum may also signify that something's wrong 'higher up' in the colon, and may need to be investigated with a colonoscopy. Your health-care provider will assess your family history, diet and age, and make recommendations for further testing.

"Once your partner is either treated or found to be free from an infectious cause, then management for the acutely flared hemorrhoids is in order, usually with a prescription steroid rectal suppository and something to prevent constipation. The best lubricant for anal sex is one that is nonirritating and pleasing to both partners. This can range from a water-soluble jelly like K-Y to a silicone-based lubricant (many brands). [Note from Laura: The most popular water-based gels for anal sex at the Tool Shed are Maximus or Sliquid Ride, and the most popular silicone lubricants for anal sex are Pjur Gel or Gun Oil.] Absolutely do not use mentholated or anesthetic-type lubricant! If you wear condoms, avoid any petrolatum-based product, as this can break down the condom and cause it to fail.

"Lastly, make sure the initial entry of your penis into his anus is slow and gentle. The easiest position is for the active ('top') partner to be lying flat on their back and the recipient ('bottom') to be sitting on top. That way, the bottom can adjust the speed and angle of entry more comfortably. Once you both 'warm up,' then you may switch to a different position."

Mark and I both wish you and your partner good luck in resolving this issue.

Want Laura to answer your questions in SEXpress? Send them to
laura@shepex.com. Not all questions received will be answered in the column, and Laura cannot provide personal answers to questions that do not appear here. Questions sent to this address may be reproduced in this column, both in print and online, and may be edited for clarity and content.

Laura Anne Stuart has a master's degree in public health and has worked as a sexuality educator for more than a decade. She owns the
Tool Shed, an erotic boutique on Milwaukee's East Side.


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