Health Risks from Anal Play?

I read your butt play article and I'm interested in whether there are any known health dangers. My girlfriend is a nurse and claims there's a high risk of some kind of cancer. What say you?

There are health risks associated with any type of sexual activity that includes skin-to-skin genital contact or exposure to another person's body fluids, since sexually transmitted infections (STIs) can be spread both of these ways. As we all should know by now, the risks for all of the health issues that I discuss below can be reduced by using latex or polyurethane barriers: condoms, "female" condoms (which can be used for anal sex by any gender) and dams. For butt play in particular, using a good amount of lube and treating the anus with gentle loving kindness are crucial to preventing health problems.

HIV, chlamydia, herpes, genital warts, gonorrhea and other STIs can be contracted through anal sex, just as they can through vaginal sex and (in some cases) through oral sex. Anal sex is considered to be a higher-risk activity than vaginal or oral sex, primarily because the lining of the rectum is delicate and more easily torn than the lining of the vagina. Tears in the rectal lining can create a point of entry for the bacteria and viruses that cause STIs.

Anal play can also carry a risk of bacterial infection outside of STIs. For example, men who have unprotected insertive anal sex (e.g., a man putting his penis in a partner's anus) may have a higher incidence of urinary tract infections because of bacteria from the anus getting into the urethra. Rimming (oral-anal contact) without using a latex dam as a barrier can put the person doing the licking at risk for Hepatitis A and a host of gastrointestinal diseases, and tears in the rectal lining can lead to infections from the bacteria from your poop.

Regarding cancer risk, my guess is that your girlfriend is referring to anal cancer that is related to human papilloma virus (HPV) transmission. HPV is an STI that is transmitted through skin-to-skin contact and can cause both genital warts and cancer. There are many different kinds of HPV, and several strains have been linked to cervical, anal, penile and possibly oral cancer. If someone engages in receptive anal intercourse (e.g., has a partner put his penis into his/her anus) with a person who is carrying one of these high-risk types of HPV, there is a small chance that the HPV infection could lead to anal cancer. HPV's association with cervical cancer is much more well-known, and the Pap smears that women get during their annual gynecological exams are designed to detect early pre-cancerous cell changes and treat them before cervical cancer fully develops and spreads. Although it's not as common to do anal Pap smears, people who have receptive anal sex can request them from their health care providers to screen for and treat anal cancer.

I would not say that anal sex comes with a "high risk" of cancer, as your girlfriend states. The American Cancer Society (ACS) estimates that there will be 5,290 new cases of anal cancer and 710 deaths from anal cancer in 2009. In the same year, ACS predicts 11,270 cases and 4,070 deaths from cervical cancer. An estimated 146,970 cases of colorectal cancer are expected in 2009, but anal sex is not considered a risk factor for this type of cancer. If you compare the number of cases of anal cancer this year to, for instance, lung cancer (219,440 estimated cases), the risk is actually quite small.

I also get asked fairly frequently whether anal sex can damage the rectum and lead to loss of bowel control (I think my favorite phrasing of this question was something along the lines of, "How many times can you have anal sex before it makes your poop sploosh out?"). There is no evidence that anal sex will permanently stretch out the anus or affect the functions of the sphincter and other anal muscles that regulate bowel movements. There is a risk of tearing the rectal lining, as described above, and if you already have hemorrhoids, anal sex may make them worse, but otherwise there is no danger of permanent damage.

I find that people often have a distorted view of the risks of particular sexual activities. Because many people don't think of cunnilingus or fellatio as "real sex," they also don't believe that these activities carry any health risks. Because anal sex is still considered a taboo activity, people believe that it must be very dangerous. In truth, all types of sexual activities have some degree of health risk, and anal sex has a higher degree of risk for some STIs like HIV. However, the health risks of anal sex can be reduced by using condoms, using lubricant, going slowly and paying attention to the signals that your body is giving you (pain = stop!), and communicating with your partner. There's no need to avoid anal play because of fears of health consequences.

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.