Baltimore OUTloud | Lesbian Gay Bisexual Transgender Community News Maryland

Health

Clean Anal Sex? Enemas and Douching

by Eva Hersh, MD

Dear Dr. Eva,

I'm a 19 year old guy who used to think of myself as a top, but I'm starting to enjoy being on the bottom, and I'm not so sure if I'm doing the right thing to be prepared for clean anal sex. My boyfriend and I are very sexually active. We like to have sex twice a day, and I usually use a Fleet enema before we have sex. Is it okay to use enemas this often? If it is dangerous, is there any other way to be ready for clean anal sex?

Thank You,

A New Bottom

Dear Reader,

Thanks for asking an important question.

First, the idea of "clean anal sex" is a bit of a contradiction. The colon (lower intestine or bowel) is a tube filled with feces (poop). Whenever a person has a bowel movement, feces move down the tube. The rectum is the last part of the tube. It always contains at least a little bit of feces. Unless a person is constipated, there is only a small amount of feces in the rectum until just before a bowel movement.

Unfortunately, both enemas and douching can be dangerous to your health. Enemas of any kind irritate the lining of the bowel. The bowel contains bacteria, which help digest food. The bowel lining keeps bacteria out of the bloodstream. After an enema or douche, these bacteria, which are not harmful when they stay inside the colon, can be released into your bloodstream and can cause serious illness. The irritation and damage to the colon lining caused by enemas and douching increase a bottom’s risk of becoming infected with HIV, hepatitis, herpes, Chlamydia and other infections.

Enemas have other risks as well. Using enemas more than once a week can interfere with the chemical balance of the body, and cause dangerous changes in blood levels of potassium and sodium. In severe cases, these imbalances cause seizures. Over time, people who use enemas can become so constipated that they cannot move their bowels at all without an enema.

If you haven’t already, please discuss this issue with your boyfriend. You may be more concerned about cleanliness than he is. He may not be bothered by a small amount of feces. Using a towel will protect the sheets, and a condom (which you are using every time, right?) will keep his penis clean and protect you from infections.

To make anal sex as clean as possible, it’s important to avoid constipation. If you can, move your bowels before

sex. Generally, people move their bowels more easily after eating. This is because eating causes the intestines to contract, moving feces towards the rectum. So (assuming you are not constipated), if you have moved your bowels that day and avoid eating for a few hours before sex, there should not be much feces in your rectum.

If you are prone to constipation, you can correct this by drinking more water and increasing your fiber intake. Dietary fiber is found in fruits and vegetables, beans, and bran cereals and breads. Alternatively, you can use fiber supplements like psyllium seed, sold as Metamucil and other brands. Prunes, prune juice, and other dried fruits are also effective. Avoid using laxatives, since they decrease the muscle tone of the bowel, leading to worse constipation.

Before sex, wipe your anal area with a moist cloth to remove any residue. It’s better to clean with a cloth rather than toilet tissue, which tends to shred and leave bits attached to the skin.

Always use a condom for anal sex.  To avoid damaging the anal opening, use water-soluble lubricant every time-these days you can get it at any pharmacy or large grocery. Avoid condoms with nonoxynol-9, because this chemical irritates the colon lining.

Douching and enemas cannot actually clean you out, and they will increase your health risks. Enemas are one habit you should give up. If you still have questions or concerns, please write to me again.

Dr. Eva