Anal sex
Anal intercourse has been described in literature since ancient times. Although it is the subject of numerous laws and moral considerations, it remains a historical and current reality of human behaviour, both among people of the same sex and of different sexes.

This article is based on the clinical observations of the proctologist and is intended to be used for informative and educational purposes.

Anatomy
Decreased basal tone and patulous (incompletely closed) anus may be seen in individuals who routinely engage in anal intercourse. However, this finding is inconsistent and may be related to other causes, including previous surgery, rectal prolapse or obstetrical trauma.

Good practices
The practice of anal intercourse requires certain precautions:

• Rectal cleansing using an enema is common and is safe if done carefully.
• The use of a commercial lubricant is imperative to minimize the risk of trauma. A lubricated condom can also be used.
• One can choose between silicone-based and water-based lubricants.
• Oil-based lubricants or petroleum jelly are not recommended since they can damage condoms and diaphragms.
• Condom use is also recommended, especially if there is a risk of sexually transmitted infection.
• Finally, it is important to be gentle so as not to damage the tissues of the anorectal region and the muscles responsible for continence.

Risk of infection
The anal mucosa is fragile and easily traumatized by abrasive use. The risk of sexually transmitted infection (STI) is therefore a very real one, especially in the absence of good practices and condoms.

Trauma and incontinence
There are several possible causes of fecal incontinence, including:

• Obstetrical trauma (tear, use of forceps)
• Surgical trauma (e.g.: following a procedure for anal fistula)
• Anal disease such as severe rectal Crohn’s disease
• Distension of the sphincters due to complete rectal prolapse
• Neurological damage (spinal cord injury)
• Senility

Diarrhea is an aggravating factor in incontinence.

Anal intercourse is not a cause of fecal incontinence, except in the case of violent and brutal penetration with tearing of the sphincters.