Even though it's a very normal and relatively common way for people to ~do it~, anal sex is still shrouded in so much mystery. Sure, there are tips and confessionals to pore over—but as with most things, it's impossible to know what it's going to be like until you actually try it. Also as with most things, it's nice to be prepared and knowledgeable about all the possible outcomes that can result from going all the way south. Especially when that potentially entails blood coming from a place you never want to see blood coming from.
An unsexy and unfortunate possible side effect of anal sex—whether it's your first time or your 50th—is a bit of rectal bleeding. It can be alarming at best and horribly painful at worse, so to put your mind (and booty) at ease, two doctors explained everything that is and isn't normal about bleeding after anal sex, and how it can be avoided in the future.
So your butt is bleeding
First things first: While serious injuries caused by anal sex are rare, some mild bleeding after anal sex isn't. Partha Nandi, a gastroenterologist and health editor with WXYZ-TV in Detroit, said the most common reason for bleeding after anal sex is anal tears—small tears or fissures in the delicate anal canal tissue. Shilpa Ravella, a gastroenterologist in New York City, said the tears typically reside internally, because the "inner anal tissue can be more sensitive and prone to tears than external tissues." A lot of anal tears are so small that they don't bleed, and you often won't notice if you have one, but they can absolutely cause a bit of bleeding that lasts anywhere from a few hours to a few days.
Nandi explained that anal tears are usually caused by friction in an area that isn't used to friction. Since the anus, unlike the vagina, doesn't self-lubricate, Nandi said, "It's not unexpected that [anal sex] would cause bleeding." Does that mean you should never put anything up your butt hole? No! It just means you need to take some extra precautions, like, say, a little thing called a shit ton of lube. Anal tears typically take a few days to heal because there's a lot of motion and activity happening around your rectum on a daily basis (aka pooping and walking), but bleeding and pain should improve with time. If not, call your doctor.
Another common cause of bleeding can be an internal hemorrhoid you didn't know about until, poof, it burst during anal sex. Most people report that hemorrhoids make anal sex uncomfortable or painful, and because a hemorrhoid is literally an enlarged, swollen blood vessel, they can certainly cause anal bleeding after sex. Bleeding should subside within a few days.
When it's more than a little tear
Severe or prolonged pain is never something to be ignored—especially when it's radiating from your butt. While a new sensation (like something going up a place that usually only sees things going out) may be a bit uncomfortable at first, anal sex should never hurt (no sex should ever hurt). If you're experiencing significant discomfort or pain after anal sex, you should see a doctor. You should also see a doctor if your pain persists for more than a few days, or gets worse with time.
If the bleeding is significant—think a steady drip rather than a few drops here and there—Nandi said you should see a doctor soon. If pain persists for more than two days, try to be seen by a doctor within the next 24 hours, even if that means going to the emergency room rather than waiting on your GP's schedule to clear up. While serious anal sex injuries are incredibly rare, it's always better to err on the side of caution when you're talking about shoving something into an area surrounded by delicate tissue and organs.
Although, again, very rare, Ravella said it is possible for anal sex to cause a perforation in your colon. Nandi said this is typically caused by "vigorous" sexual activity. The biggest signifier that you have something more serious, like a perforated colon, will be the level of pain you're in. Symptoms of a perforated bowel or colon are extreme pain and swelling in the lower abdomen, fever, and nausea. A perforated bowel has the possibility of leaking bacteria-laden bowel contents into your stomach, which can cause a dangerous infection. If you're experiencing any of those symptoms after anal sex, you should see a doctor immediately.
Nandi emphasized that embarrassment over an injury caused by anal sex should never scare you out of seeing a doctor. Whether it's a little blood from an anal tear or extreme pain caused by something more serious, the peace of mind that comes from staying healthy and avoiding an infection far outweighs the awkward 10 seconds of explaining to your GP that your butt hurts. A doctor's job is always to care for you, never to judge you.
How to avoid bleeding
There's no way to overstate the importance of lube. Lube is your best friend in any sexual situation, but because the rectum doesn't self-lubricate in the same way the vagina does, it's especially crucial for all things butt. This include anything from full-on, penetrative anal sex to minor butt play with a finger or a toy. Don't ever force anything up into a hole that's already delicate and sensitive. Lube, lubricated condoms, and then even more lube are the biggest saving grace for easy anal sex.
The rectal sphincter is strong and small—attempting to jam anything through it too quickly is going to be painful. Ravella suggested proceeding "cautiously, and stop if the sex becomes painful." Nandi added it's not uncommon for people to jump into rough anal sex too quickly and experience tearing or bleeding because they didn't exercise enough precaution. It's not a sprint, it's a marathon back there. And you want to make to the finish line without any bleeding or discomfort.
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This article originally appeared on Cosmopolitan.com. Minor edits have been made by the Cosmo.ph editors.