How Risky Is an*l S*x? A Gynecologist Explains

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“First it was shocking, then it was having a cultural moment, now it’s practically standard in the modern bedroom repertoire—or so a quick scan of any media, from P0*n to HBO, will tell you,” the Goop editors wrote in the introduction.

While research suggests an*l isn’t quite as prevalent as pop culture might suggest—a 2016 study found that just 12.2% of American women had done it within the last three months—there’s no question curiosity about the backdoor position has grown.

To find out more, we spoke with ob-gyn Lauren F. Streicher, MD, director of the Center for s*xual Medicine and Menopause at the Feinberg School of Medicine at Northwestern University. There are a few risks involved with an*l that women need to know, she says.

“Let’s face it, the anus was not made for intercourse. It’s supposed to be a one-way passage,” Dr. Streicher points out. The v**ina, on the other hand, “has a thick, elastic, accordion-like lining designed to stretch to accommodate a man-hood, or a baby.”

Rectal tissue is thinner and doesn’t share the same elasticity, so there’s a greater chance it can tear, says Dr. Streicher, who is the author of s*x Rx. And tearing increases your odds of contracting a sexually transmitted infection.

Rectal gonorrhea, an*l chlamydia, and HIV are all real risks. According to the United States Centers for Disease Control and Prevention, “an*l s*x is the highest-risk s*xual behavior for HIV infections.” But an*l s*x is perhaps most likely to transmit the human papillomavirus (HPV). “Very few heterosexual men have HIV, but over half of men have HPV,” says Dr. Streicher. HPV can cause an*l warts and an*l cancer.

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What’s more, she points out, you’re probably not going to get screened for an*l STIs at your doctor—unless he or she specifically asks if you’re having an*l s*x (unlikely) or you specifically request those tests.

Then there’s pain, bleeding, and fecal incontinence. “Poop in your pants is not a nice thing to talk about,” says Dr. Streicher. She points to new research from a team at Northwestern University that found that women who considered an*l part of their regular bedroom behavior were more likely to say it changed the consistency of their stools, and report both urinary and fecal incontinence.

But if you’re interested in trying an*l s*x, or giving it another whirl with your partner, what’s the safest way? Use protection no matter what, says Dr. Streicher. “As a gynecologist, I tell people even if you are in a monogamous relationship, you should always use a condom for an*l s*x.” And if you have vaginal s*x after an*l, have your partner put on a new condom to protect against the likelihood of a urinary tract infection.