Safer anal sex

During anal sex, the area of the rectum is stimulated. This often involves penetration with a penis, but it can also involve penetration with sex toys, fingers, or the tongue. Although many people associate anal sex with men who have sex with men, anal stimulation can be pleasurable for anyone – regardless of gender or sexual orientation.

Anal sex is often described as the highest-risk type of sexual activity. The lining of the large intestine does not produce natural lubrication, which increases the risk of small tears in the rectal wall. These tears can bleed and make it easier for infections to enter the body. Anal mucosa also absorbs bodily fluids more easily than, for example, vaginal mucosa or the foreskin, which further increases risk. Infections that can be transmitted include chlamydia, genital herpes, gonorrhea, syphilis, HIV, hepatitis A and C, and others.

The anal opening and its surrounding area may also contain harmful particles present in microscopic traces of stool, which may not be visible but can transmit various viruses and bacteria. If you decide to have anal sex, there are several ways to reduce the associated risks.

TOOLS

LUBRICANT
Lubricant is important for many types of sex, but here it is essential. The walls of the large intestine produce very little natural moisture. If the penis, toy, or fingers move inside the rectum without enough lubrication, small tears can occur, which may bleed and allow infections to enter. Rough friction can also worsen hemorrhoids, so people with hemorrhoids are generally advised to avoid anal sex.

Important: Not all lubricants are compatible with sex toys and condoms. Oil-based lubricants can damage latex condoms.

Silicone-based lubricants can damage silicone sex toys. “Homemade” lubricants (oils, creams, etc.) are not recommended. Saliva is also not suitable—it can transmit infections and dries quickly, increasing friction.

CONDOM
A condom is another essential protective tool. It can reduce the risk of transmitting infections and help ensure smoother penetration. If partners switch between types of sex (anal → oral, anal → vaginal), the condom must be changed each time, because particles from the anus can remain on the condom.

DENTAL DAM
Stimulation of the anus with the tongue or mouth should ideally be done using a dental dam — a square-shaped oral barrier designed for oral stimulation. The barrier is made of a soft material, either latex or polyurethane, and is intended to cover the vagina or the anal opening. To increase sensitivity, it is recommended to apply a sufficient amount of lubricant underneath it. During sexual activity, it is important to hold the barrier in place so it does not slip. In Slovakia, it is available mainly in online sex shops, usually costing between 3€ and 12€ per pack. However, it is also possible to make one at home from a regular condom. Cut off both ends of the condom (whether an external condom for the penis or an internal condom for the vagina), cut it lengthwise, unfold it, and it’s ready to use.

PrEP and PEP

PrEP (pre-exposure prophylaxis) is a medication that helps prevent HIV infection before a risky situation occurs — for example, during sex without a condom or with partners whose health status is unknown. When taken correctly, it reduces the risk of HIV transmission during sex by up to 99%. PrEP can be taken daily or situationally — for example, before a chemsex party. It is prescribed by an infectious disease specialist and is covered by all three Slovak health insurance companies: Union, VšZP and Dôvera. Condoms remain important because they also protect against other infections.

PEP (post-exposure prophylaxis) is used after a risky contact — for example, after sex with an HIV-positive person. It must be started within 72 hours, ideally as soon as possible. Treatment lasts 28 days and is prescribed by an infectious disease specialist. PEP is intended only as an emergency measure, not for regular use. In Slovakia, it is usually paid for by the individual (approximately 150€ 250€), except in cases of sexual assault or occupational exposure in healthcare, which do not need to be proven.

PrEP and PEP prescriptions are available at infectious disease clinics. In Slovakia, these include:

• Bratislava – Center for the Treatment of HIV/AIDS Patients, University Hospital Bratislava, Ladislav Dérer Hospital, Kramáre
  
• Nitra – HIV Clinic, Faculty Hospital Nitra
  
• Banská Bystrica – Infectious Disease Clinic I (HIV/AIDS Clinic), F. D. Roosevelt Faculty Hospital with Polyclinic
  
• Martin – Clinic for the Treatment and Monitoring of HIV/AIDS-Positive Individuals, University Hospital Martin
  
• Košice – Center for Monitoring and Treatment of HIV-Positive Individuals, L. Pasteur University Hospital Košice
  

HYGIENE

When using fingers for stimulation, hand hygiene is important — the person stimulating should have trimmed nails (watch out for sharp edges; using a nail file is helpful) and thoroughly washed fingers, including the areas under the nails. Long or sharp nails can damage the delicate walls of the rectum and increase the risk of infections.

The person being penetrated should also maintain hygiene. Before anal intercourse, it may be helpful to have a bowel movement 30–60 minutes beforehand. Some people prefer internal cleaning using an anal shower or enema (a water-filled bulb with a small tube inserted into the rectum). However, this technique carries risks — it can increase the likelihood of infections or irritation of the anal mucosa. If you still choose to do a rinse, it is recommended to use a small amount of water or saline solution (water + salt). The liquid should be at room temperature — cold water may cause cramping, and hot water may irritate or burn the intestine.

Insert a small amount of water into the rectum, hold it for about 10 seconds, and release it. It is recommended to rinse only the first 8 cm or so — stool is usually placed higher up and should not appear during sex. If the rinse goes deeper, parts of higher-lying stool may be released, but these should not move low enough during sex to be noticeable.

Many people fear the possibility of stool appearing during sex, but it is completely natural that cleaning cannot be 100% perfect. To reduce anxiety, you can place a dark-colored towel underneath you to hide any potential traces.

PRINCIPLES OF SAFER ANAL SEX

Lubricant and condoms are ready, everything is set for the first anal-sex experience. What else can make it comfortable and safe? As always, communication and mutual respect are essential. First experiences may not always go smoothly.

The anal opening may be too tight for penetration, so it is good to start gently and slowly. To relax the anus, stimulating the external area first is recommended. Before inserting a penis or toy, it may help to start with one or more fingers to gradually stretch the opening. Some people also use anal plugs, which can be inserted before sex (usually starting with the smallest size and gradually increasing).

Using a plug helps the muscles around the rectum get used to increased pressure, reducing resistance when a penis or sex toy enters the anal opening. This can lower the risk of pain during intercourse.

If the rectum becomes injured (for example, if there is bleeding), it is best to take a break from anal sex and possibly use stool-softening products so that hard stool does not further irritate the area.

Finally, consent is essential in every sexual experience. No one should pressure, force, or persuade you into anything. If you are unsure whether the other person wants to participate in sexual activity, it is always best to ask.