Does anal cause prolapse? 

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Two nice young men came up to me after a talk I gave and asked, does having anal sex lead to rectal prolapse.  They were asking if putting things into the asshole would cause the rectum, just inside the anus, to turn inside out, to come out, to telescope, to prolapse.  I'd recently seen a video of very rough anal sex in which the recipient's anus was clearly misshapen from regular pounding, but is that the eventual outcome for all anal?  For everyone?  Are my intestines going to fall out?

I'm all about prevention, so this video is how to prevent prolapse, but I want to make an early note that rectal prolapse is treatable.  There are surgeries to repair the tissue and I don't want anyone to feel unreasonable fear or shame around changes to their bodies.  Now let's go over what anal sex entails and how all of this works.

Anal sex can include anilingus, which is stimulating the asshole with one's mouth, digital play using the fingers on or inside, or fisting, inserting the whole hand.  There's also penetration with a penis, multiple penises, dildos, plugs, beads.  I've seen penetration with a bucket.  Bucket!  This is pretty amazing and people are really creative, so does a ny of this cause prolapse?  

Rectal prolapse is when the lowest part of the large intestine, the rectum, drops from its usual position.  Sometimes it moves but stays inside.  Other times a portion extends out the anus, and then there are cases where the whole rectum, around 10 centimeters, protrudes out.  Based on my research, we don't know the exact causes, but here are some factors believed to contribute to rectal prolapse.  Chronic or long term problems with bowel movements.  Painful pooping, constipation, diarrhea, lots of straining.  Aging.  Typically around age 40, the pelvis starts to noticeably loosen.  What?!  Mhmm.  Muscles and ligaments in the pelvis can become weaker with time, so it's important to do kegels, contracting the pubic (?~1:49) muscles regularly to tone your groin.  Other factors related to prolapse: diabetes, cystic fibrosis, pinworms, whipworms, chronic obstructive pulmonary disease, hysterectomies, childbirth, hemorrhoids, basically surgeries, conditions, and/or illnesses that affect the area and alter how everything does or doesn't hold its place.  The last big factor for prolapse is injury.  Ding ding ding ding ding ding!

If the anal sex you're having damages nerves, ligaments, and/or muscles that support and control the rectum, a possible result is rectal prolapse.  To be clear, that does not mean anal sex itself is a cause of rectal prolapse.  It means that damage that might occur during anal sex could be.  So how do we have anal and prevent damage?  One method is kegels.  If you're able to control muscle tightening and relaxation, then this could really counteract the weakening of the rectal tissue.  Check out my video on kegels!  It can also reduce fecal incontinence, where the anus leaks because it's stretched out and unable to clench closed.

Number two, most important tip I can give you, is to listen to the body.  If you can feel the anus and anything hurts, stop.  Really, I'm not just advocating for your butthole.  I'm advocating for your sex life.  Stop if it hurts and then try some of these things so that it doesn't hurt when or if you try again.  

Three, therapy.  Stigma about anal, homosexuality, sodomy, shit, sex in general, can get all up in your head and cause the body to resist penetration.  Unpack that.  Are any of these ideas serving you?  What do you want to keep in your psyche and what needs to be replaced with better ideas?

Four, talk this out with your partners, too.  You may find that good conversation can help a lot.  Build trust.  Talk about STIs, protection, safe words, clean up afterward.

Five, lubrication.  My go to is lubricated in condoms because they make penetration easier, clean up easier, and decrease the microscopic tearing that increases the risk of infection and prolapse.  These are also options.  Just remember, the anus might think it's leaking if you introduce lube without coaching.  Maybe start dry with a gloved finger, then go in with a wet one.  Also, if you use latex condoms, don't use oil-based lube.  Oil deteriorates latex.

Six, increase arousal.  If you're not turned on, anal can feel like a colonoscopy.  Maybe you're into that, but is your rectum?  Work with your physiology to prepare your anatomy.  As your body becomes aroused, genitals engorge with blood, things elongate and shift in position.  The anus can actually pucker.  (?~4:08)  

Anodyspareunia is the clinical term for pain from receptive anal sex.  Most people experience it, but you don't have to tolerate it.  Talk about your fear of rectal prolapse . Get professional guidance and care.  Work yourself into a frenzy of sexual desire and practice a healthy lifestyle where you exercise, eat poop-friendly foods, and listen to what your body needs.  

If after all of this you experience rectal prolapse, it wasn't necessary from anal sex and there are solutions.  Talk to a doctor, arrange surgery if you need to, be careful with your bum, and stay curious.

Thank you to everyone who supports Sexplanations.  If you would like to join me and other Sexplanauts in giving the world free sex education, please go to patreon.com/sexplanations and subscribe.

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We are done!  We are done!  We are doooone!