When 26-year-old campaign manager Ellie first had anal sex, she was 22 years old. Her boyfriend (of the time) was really into it, and although she had reservations and knew very little about how it would be done and how it would feel, she wanted to please him.
“I was young, and I didn’t want to come across uncool," she tells GLAMOUR. “I let him take control really as I knew nothing about [anal sex] and he’d seen a lot of porn and he was clearly confident.”
She continues, "I ended up quite injured and embarrassed, though. It just wouldn’t go in. He tried and tried, and I don’t know if I couldn’t relax properly or if I’d done something wrong, but it just didn’t happen.”
Ellie says she could tell her now ex-boyfriend was disappointed, but they quickly moved on and watched a film. “I was so uncomfortable. I could feel a burning pain in and around my bum and I just kept trying to ignore it and watch the TV, but it was so painful it was like it was actually loud.”
Ellie says she felt tender and sensitive around the area for around three days and experienced some light bleeding but she never spoke to a medical professional, nor her partner. “I didn’t tell anyone. I was so embarrassed. I especially didn’t want to tell [my boyfriend]. It was embarrassing enough not being able to do it. I didn’t want him to also have to take me to hospital.” She’s not attempted anal sex since, feeling “completely put off” by this experience.
The popularity of anal sex is on the rise. Whether it’s exposure on shows like Fleabag, Sex And The City and Girls, or the abundance of anal sex in pornography positioned like an obvious course in the everyday person’s sex menu, we’re big into butt sex now.
Anal sex was long considered an activity for homosexual, and bisexual men, particularly as [cisgender] men have a prostate in their anus, which stimulates orgasm. But research from the National Survey of Sexual Attitudes shows that people of all genders and all sexualities are into it. They found that the proportion of 16 to 24-year-olds engaging in heterosexual anal intercourse in Britain has risen from 12.5% to 28.5% over recent decades. And across the pond, 30% to 45% of Americans have performed anal sex at some point.
Evan Goldstein, renowned anal surgeon and founder of sexual health practice Bespoke Surgical, tells GLAMOUR: “We’re seeing more and more people of all sexual identities enjoying the pleasures it provides. Having another sexual activity to add to your repertoire heightens not only your own body awareness and orgasms, but also increases the satisfaction for your partner(s).”
He adds that anal sex may be growing in popularity more rapidly in recent years because, the more we talk about anal sex and the more we’re exposed to it, the more we start to build interest in safely exploring anal play of all kinds, whether that’s with fingers, toys, or pegging.
“It’s not a coincidence that we are also seeing anal sex being represented in pop culture, whether that’s on The White Lotus, Broad City, or Uncoupled, which helps normalise anal pleasure, slowly breaking down the stigma and/or bias that once surrounded the topic,” he explains.
It’s also hard not to go back to anal once you’ve had a positive experience and unlocked that type of pleasure for the first time. As Goldstein says, “When someone experiences an anal orgasm, they hit a spot they never knew they had, and I find people want to keep hitting that spot again and again. If something feels so good that it sends shivers down your spine, why wouldn’t you keep doing it?”
But earlier this year, surgeons Tabitha Gana and Lesley Hunt warned in the medical journal Young Women and Anal Sex, that anal sex was causing a number of health problems for women from faecal incontinence problems to bleeding around the anus, and anal sphincter injuries.
The report nails this problem down to a few factors: women’s anuses are built differently to men’s and there are different risks to be aware of, and people aren’t talking enough about those differences and the safety precautions they come with (especially clinicians.)
In the report, Gana and Hunt said: “Women are at a higher risk of incontinence than men because of their different anatomy and the effects of hormones, pregnancy and childbirth on the pelvic floor.”
The report continues: “Women have less robust anal sphincters and lower anal canal pressures than men, and damage caused by anal penetration is, therefore, more consequential – the pain and bleeding women report after anal sex is indicative of trauma, and risks may be increased if anal sex is coerced.”
Anal sex comes with risks for everyone, especially women. “I think more women report anal trauma as a result of improperly performed anal sex,” Goldstein explains. “Bad technique and the lack of sexual education leads many people to experience some form of trauma.”
That’s why we need to dispel myths, remove stigma and bias, and provide the necessary information for people to have safe anal sex and minimise traumatic events.
He adds that improperly performed anal sex can cause incontinence issues for anyone. This stems from the loss of some or all muscular function that maintains normal coaptation and bowel function.
“This often relates to technique. Most people think they can go from nothing to something huge and the insertive partner just rams their penis or strap-on into the anus,” he explains.
In reality, women need to train their anuses for anal sex. “I recommend starting first with an anal dilating protocol. This gets someone to understand their own anatomy, all the while strengthening the surrounding tissue and working the pelvic floor muscles accordingly.”
Like Ellie and so many other women, Kiara Lord understands the risks of anal sex all too well. The 30-year-old escort and porn actress tells GLAMOUR: “I think pretty much everyone experiences pain with anal sex at some point. I’ve had problems during and after.”
Kiara tried to have anal sex for the first time at around 17 or 18 years old but “simply couldn’t open up”. When she became a porn performer, she wanted to try again. But she jumped in at the deep end and attempted several anal scenes, one after the other.
“I tried to do anal scenes in porn, and it was a traumatic experience. First, I felt a burning sensation, as a matter of fact so strong I had goosebumps, not the good kind.”
She continues, “The stretch was also painful, I felt like my skin was tearing apart. If the penis went deep it really hurt too and I had the feeling of diarrhoea coming (although it didn’t). After these anal scenes I've had some blood coming out of my anus and it was really swollen and sore.”
Like Ellie, Kiara never saw a medical professional about her injuries. “I felt like I could deal with that on my own, and I'd ask my co-workers if they've experienced the same before and they would all agree that this is normal when you do porn.”
Now, Kiara’s experiences with anal sex have improved, but she still only enjoys it 50% of the time. “I only [enjoy anal sex] if I'm really attracted to my partner and feel relaxed enough. I like it because it's a different kind of sexual experience. The thought of anal sex turns me on as well, it's sort of a bad girl vibe, but there are simply better days for anal sex. When the anal sex is enjoyable I never need any aftercare. If it's a rough anal scene, then I put ointments on my anus after and rest for a few days before having another anal sex session,” she explains.
Goldstein explains that women’s anal skin is more fragile and trans men on hormones can have thinner skin on their anus, too. This, combined with the lack of preparation, can cause bleeding in anal sex. This tearing (called an anal fissure) is why dilation with anal toys is so paramount to the success of minimising injury.
The key to overcoming pain in anal sex among women, he says, is being educated on anatomy and proper mechanics to help minimise these risks while enhancing your pleasure. The more we communicate with one another, and the more clinicians open up to discussing anal sex with their patients, the better anal sex we’ll all have.
There are a few common mistakes people make around anal sex, which Goldstein says tend to stem from misinformation they find in porn or on the internet:
“People don’t pre-dilate and they try anal sex for the first time without any prior preparation. The anal skin and muscle need time to stretch, strengthen, and relax in order to accommodate toys and penises being inserted. They also tend to think anal sex will be messy and require douching, but it doesn’t.”
And despite being incredibly important to all types of sex (especially anal sex), lube is often forgotten too. Goldstein often sees patients who think the anus self-lubricates like the vagina and they either use no lube, or just use spit for anal play. “This is a recipe for disaster because without enough lubrication, you’re more susceptible to tearing and bleeding, and you’re also more susceptible to STD transmission,” he says.
Women also commonly believe they need to be submissive and relinquishes all control during anal sex, like Ellie. “Actually, I always recommend the bottom take the lead,” Goldstein says.
Kiara says: “It's good to know as much as possible about [anal sex]. Most importantly women should not try or have anal sex for the sake of pleasing their partners. It should be enjoyable and fun. It's okay not wanting to do it. I wish I wasn't so stressed out about doing anal sex then. It doesn't make you less cool. Anal sex is optional, just like everything else.”
Ellie wishes she’d been confident enough to speak to a medical professional about her pain. “I was so scared of being judged and looking stupid that I put myself in danger. I also wish I’d done more research and preparation before trying anal sex in the first place,” she says.
Goldstein says clinicians need to speak with patients about anal sex more openly. “Doctors should absolutely be speaking with their female patients about anal sex and safety. Educated conversations are paramount to the success of anyone who engages in anal play. Most physicians simply don’t feel comfortable asking questions about their patients’ sex lives, and patients, too, often don’t feel comfortable talking about it either.”
He continues: “Anal sex is immensely enjoyable if done properly, and people are finally feeling comfortable enough to talk about it and explore their bodies, but who is helping educate people about the ins and outs of anal play? It’s so important for me and other medical professionals and brands to think: how do we meet people where they want to be sexually, and provide them with the wherewithal to not only engage safely, but also minimise any potential complications?”
What this issue boils down to, is good old communication. ‘Communication’ gets thrown around in sex-positive discourse like a surface-level buzzword, but it’s paramount to happy, healthy sex.
And this isn’t just about communication between partners, which is obviously important. Communication is life-saving when its extended to talking about anal sex with friends, partners, and medical professionals (especially when things go wrong) opens us up to easier conversations, being able to teach each other how to do anal sex carefully, treatment when necessary, and better, more pleasurable sex.
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