Risks during anal sex

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These days there are a number of practices and strategies that can reduce the risk of HIV transmission during anal sex.

 

As you may already know, these strategies won’t necessarily protect you from other STBBIs. Despite the fact that many STBBIs have no symptoms, there are still precautions you can take. For example, before having sex with someone, look at their genitals and the area around their anus and check for redness, ulcers, sores, cankers, warts, or cracks. The odd pimple or ingrown hair is normal, but don’t hesitate to ask questions so you can make informed decisions based on what is really going on.

Getting fucked is about giving yourself over to your urges. The more excited you feel, the stronger the urge. You’ll want it with your whole body and mind. This excitement can help you relax, and allow your anus to relax. Massage, licking, blowing, and rimming can help you to reach this level of arousal. You can also try deep breathing. Being relaxed and having a relaxed anus reduces the risk of pain and lesions. But it’s also important to stop anal penetration if you try these things and it still hurts. There are plenty of other sexual activities to enjoy and experiment with. Some guys try to make penetration easier by using a type of lube that numbs the anal region. This practice isn’t recommended because it can prevent you from responding to the pain signals that your body normally sends out. If you’re in pain, it might be because you aren’t turned on enough, you aren’t relaxed enough, or there’s not enough lubricant. Make sure that you use plenty of lube, and add more as needed!

 

Extremely important if you are living with HIV

The information presented in the following section does not protect you from the risk of criminal prosecution if you do not tell your partner or partners that you are living with HIV. At this point in time, you must have a low viral load (fewer than 1,500 copies / mL of blood) and wear a condom if you do not disclose your status. For more information, visit the Criminalization of HIV Exposure section of the COCQ-SIDA website.

 

Anal douching

Before having anal sex, many people like to clean out their ass using an enema bulb or anal douche. It’s up to you and your partner to decide if this is something that works for you.

Avoid douching with chemical products, which can irritate the lining of the anus and rectum or even remove a layer of protective cells, making it easier to become infected with HIV.

Using lukewarm water (neither too hot nor too cold) is the best option. Avoid too much pressure if you’re using an anal douche. This can be done right before sex, but you can also do it before you meet up with someone which will allow you to take your time. Either way, be sure to pace yourself and respect the limits of your body.

Douching after sex is not advised, since it can actually force fluids deeper into your rectum rather than flushing them out.

Rimming

Because the anus is a highly sensitive area full of nerve endings, many guys like to rim their partner (lick / eat out the anus) or to get rimmed. Others avoid this practice, for various reasons. Again, it’s up to you to decide what you like to do and with whom. If your mouth comes in contact with another person’s anus, the risk of contracting HIV is very low as long as there are no lesions or irritated skin and no blood is exchanged.

However, other STBBIs can be transmitted through rimming. There are a few simple things you can do reduce the risks. First, look over the area you’re about to lick  to make sure there are no sores or small cuts. That said, even if the skin appears to be unbroken and healthy, this does not guarantee the absence of an STBBI. An infection could still be present, and still be transmitted, even if there are no symptoms.

As well, make sure that your mouth is in good health and that there are no sores or ulcers. Avoid brushing or flossing your teeth for an hour before and after you rim someone. You can also use a latex barrier like a condom cut in half lengthwise or a dental dam (a pre-cut latex square). If you prefer a cleaner asshole, ask your partner to wash up before you dive in!

Rimming is high risk for the transmission of hepatitis A. If you haven’t been vaccinated, talk to your doctor. Rimming can also lead to the transmission of certain intestinal bacteria and parasites. If that’s the case, you may end up with symptoms resembling gastroenteritis.

Dipping

Dipping generally refers to the partial insertion of the penis into the anus, although it can also mean complete insertion without a condom for a few seconds, which people sometimes do in order to get really hard. Practices such as these that involve pulling out before ejaculation still carry a risk of HIV transmission, because the virus can be present in the precum of the top or in the anus of the bottom. The risk can be considerably reduced, however, if you use one or more prevention methods such as PrEP or taking viral load into account.

Top / bottom

Top: Active partner, the one who penetrates, who does the fucking

Bottom: Passive partner, the one who is penetrated, who gets fucked

Whether you’re a top, a bottom, or versatile is a question of preference. Choosing sexual positions is also often thought to be an HIV prevention strategy, known as seropositioning. During penetration, the bottom has a higher risk of being infected with HIV than the top. However, the top can still be at risk. It’s important to know that HIV can be found in the anal lining (mucosa) and can therefore be transmitted to the top through the inside of the foreskin and urethra, which are more susceptible to letting the virus through. The bottom can also still be exposed to HIV even if the top doesn’t ejaculate inside him because the virus is present in pre-ejaculatory fluid (precum).

In short, the best way to reduce the risk of transmission for both tops and bottoms is to combine several different prevention strategies such as condoms, PrEP, testing, or negotiated safety. See the Your Hook-up Kit section to learn more.

Fisting and fingering

Fingering involves putting your fingers in someone’s ass, vagina, or frontal hole, whereas fisting involves inserting your entire fist. Both these practices carry a negligible risk of HIV transmission as long as there are no cuts or sores on the hands or anus. However, they can result in damage to anal or vaginal tissue if done incorrectly.

Certain precautions can be taken to make these practices safer. Good communication is critical to ensure that you respect the pace of the person on the receiving end of your fingers or hand. Trim your fingernails to avoid injuring your partner. Wearing a protective glove is also recommended. In a group situation, everyone should stick to the following rule: “When you change holes, change gloves.” Changing gloves is important to avoid passing an infection from one partner to another.

Use plenty of lubricant and reapply more as needed – especially for fisting. People who enjoy fisting often use Crisco because it lasts longer. Other types of oil-based lubricant can also be used. Latex gloves are not compatible with these two types of lube, so opt for polyurethane gloves instead. If that’s not an option, using latex gloves with a water-based lube will do the trick.

It is important to follow another golden rule: “When you change holes, change the container of lube.” Using a shared container of lubricant for multiple partners carries a risk of cross-contamination. If you’re planning to have group sex, ask each person to bring their own lube, or prepare ahead of time to make sure you have as many containers of lube as there are people.

Serosorting

Serosorting consists of choosing sexual partners based on their HIV status. Some guys refuse to have sex with people living with HIV, thinking that this will protect them from infection, but this is not necessarily true. Given that one HIV-positive gay man in five doesn’t know he is living with HIV, only having sex with people who think they are HIV-negative won’t protect you from the virus.

In fact, serosorting is risky and its effectiveness can vary a great deal because it’s not always possible to be sure about your partner’s HIV status – or even your own. This is why some HIV-negative men decide to take PrEP, or to only fuck with HIV-positive men who have an undetectable viral load. It’s up to you to decide what works for you. Combining more than one method helps to increase your protection!

Some HIV-positive men also decide to choose their partners based on their HIV status. Being HIV-positive and only having sex with other HIV-positive guys is a safe practice, except when it comes to other STBBIs!

Taking viral load into consideration

Viral load is a measurement that allows us to quantify the amount of active virus in the blood. Viral load is considered to be undetectable when the level of virus is so low that it’s no longer possible to detect it using conventional tests. In order for viral load to reach undetectable levels, a person living with HIV needs to be on an effective anti-HIV treatment and receive regular follow-up by a physician.

If you fuck or get fucked by a partner with an undetectable viral load, the risk of HIV transmission is greatly reduced for both the top and the bottom, particularly if no other STBBIs are present. If you combine an undetectable viral load with another prevention method such as PrEP, the risk become close to nothing.

To learn more, see the section on Viral load.

Being circumcised

You might have heard that being circumcised can protect you against HIV. Although studies have demonstrated some effectiveness in countries with high rates of HIV, in Canada, circumcision isn’t recommended as a prevention method. Circumcision is a personal choice that should be made for reasons other than HIV prevention.