I was being interviewed on a call-in radio show originating from Albuquerque, New Mexico, a few days ago and was quite surprised that several listeners asked questions about anal intercourse. I am no moralist nor arbiter of human sexual behavior and, in general, follow the principle that behind closed doors, anything goes between consenting adults—as long as the behavior is safe and no person is injured. Along these lines, I must emphasize an important caveat: I draw the line at unprotected anal intercourse.


Risky Business

Anal intercourse is highly risky, even with the use of a condom. I am surprised at how many heterosexual couples experiment with this practice and how many enjoy it. Some are simply looking for new thrills; others, interestingly, are looking for an alternative to vaginal intercourse due to religious or cultural reasons.

This issue has especially come to my attention in the last 30 years because people who practice anal sex, or are tempted to, have become increasingly concerned about HIV/AIDS. As a physician, I must confirm that their concern is justified. It is no longer safe to think of anal intercourse as an occasional treat. HIV/AIDS is arguably the bubonic plague of the 21st century. All studies indicate that a primary mode of transmission is through anal sex. The anus is particularly vulnerable to tears in the delicate tissue membrane, which expose the perianal blood vessels as a port of entry for the deadly retrovirus. Unprotected anal sex should be off limits on the basis of the HIV/AIDS risk alone.

In addition, couples indulging in the practice should be aware that it brings other health risks as well. If the penis enters the rectum and comes in contact with fecal matter (which contains toxic bacteria, particularly E. coli), this can cause major infections in the prostate, bladder, or kidneys. If the infection spreads into the bloodstream, it can result in sepsis, an infection that causes the body’s immune system to attack the body’s own organs and tissues. Sepsis can be fatal. In addition, if the penis is inserted into the rectum and then inserted into the vagina, it can contaminate the nearby urethra with fecal matter and cause severe bladder  and urinary tract infections in the female.

So the bottom line is, when it comes to anal intercourse, BE CAREFUL!

Dudley S. Danoff, MD, FACS is the attending urologic surgeon and founder/president of the Cedars-Sinai Medical Center Tower Urology Group in Los Angeles, California. He is the author of Penis Power: The Ultimate Guide To Male Sexual Health (Del Monaco Press, 2011) and Superpotency (Warner Books).