How to prepare for anal sex: hygiene and douching safely

To prepare for anal sex safely, most of what you need is time, conversation, condoms and lube. Brook, a UK sexual health charity, says safe anal sex requires "preparation, patience and communication". Douching (washing the inside of the anus and rectum with water) is optional: many people do it, but LGBT Foundation says it isn't necessary, and research in men who have sex with men links it with higher odds of HIV and other STIs. This guide covers how to prepare for anal sex, hygiene before and after, and what the evidence says about douching, for anyone of any gender.

How do you prepare for anal sex?

Preparing for anal sex mostly means agreeing it together, having condoms and lube ready, going to the toilet and washing beforehand, and giving yourselves time to relax. These steps come from Brook, LGBT Foundation, the Terrence Higgins Trust and the NHS:

1. Talk and agree first. Anal sex should be discussed and agreed beforehand, even if someone has already agreed to another type of sex, Brook says. Talk about any worries and expectations, and things like speed and depth. Either of you can stop at any point.
2. Have condoms and lube ready. Use a condom on a penis or sex toy, and water-based or silicone-based lube, which are safe with latex condoms (NHS). Anuses don't produce their own lube, so you need enough (LGBT Foundation).
3. Go to the toilet beforehand. Having a poo before anal sex is the easiest way to lower the risk of any accidents, according to Brook.
4. Wash the outside. Brook suggests gently washing the area first with water and a gentle soap. The NHS advises against fragranced shower gels or soaps around the anus.
5. Check your hands. If fingers are involved, make sure there are no cuts on them, keep your nails short and use plenty of lube (Terrence Higgins Trust).
6. Give yourselves time. The muscles around the anus can take some time to relax, and feeling anxious makes that harder (Brook). Start small, go slowly and keep checking in.
7. Be relaxed about a little mess. Brook says there's going to be some poo involved in anal sex and accidents are totally normal.

Do you need to douche before anal sex?

No. Douching is not necessary for anal sex, because there's normally only poo in the rectum when you need to go to the toilet, LGBT Foundation says. Brook says our bodies are very good at keeping poo up high until we need a bowel movement, so the easiest way to cut the risk of accidents is to have a poo before anal sex. Brook adds that deeper penetration carries a greater risk of mess than shallower.

Some people feel more comfortable after douching, especially before rougher sex, LGBT Foundation notes, and Brook says some people want to do it for extra peace of mind. It helps to know the risks first.

Douching options: what Brook and LGBT Foundation say

	What it is.	What the advice says.
Not douching	Having a poo beforehand and washing the outside	Not necessary for anal sex: there's normally only poo in the rectum when you need to go to the toilet (LGBT Foundation)
Small bulb douche	A douche with a small bulb	LGBT Foundation recommends it as easy to use and control; use only water at body temperature
Shower douche	A douche that attaches to a shower	LGBT Foundation doesn't recommend it, as the water temperature and amount are harder to control; Brook says to use one with adjustable pressure
Douche or enema from a pharmacy or supermarket	Normally used to help with constipation	It may contain laxatives, so rinse it out before filling it with water (LGBT Foundation)

Whichever you use, research in men who have sex with men links douching with higher odds of HIV and other STIs, and douching equipment should never be shared.

Is anal douching safe? What the research says

Anal douching can do some harm. Brook explains that it washes away the healthy bacteria and protective mucus in the anus, and if done incorrectly it can damage the delicate lining and leave you more susceptible to infections, including STIs. LGBT Foundation says douching can irritate the lining of the rectum and make it easier to get infections, including HIV.

Research on douching points the same way:

• A 2019 review in the journal Sexually Transmitted Infections pooled 24 studies of 20,398 men who have sex with men. Men who douched had higher odds of having HIV (about 2.8 times) and of having other STIs (about 2.5 times), and these links held in studies that allowed for other factors. The studies show an association; the authors called for longer-term studies to clarify it.
• A US online survey of 4,992 men who have sex with men, published in 2014, found 52% had douched at least once, and water was the most common thing used (65%). The authors say douching with water may be a concern because it may increase HIV and STI infection by damaging the lining.
• In a small 2013 study, nine men each tried three enemas. Only the hyperosmolar one (more concentrated than body fluids) caused the lining of the bowel to slough off; distilled water made the lining more permeable; and the iso-osmolar one, matched to the body's own fluids, was as good as or better than the others on every measure.
• A 2018 review found that up to 88% of men who have receptive anal sex had douched at some point, mostly with water. Little research exists on women, but douching appears less common among them (32% compared with 70% of men).

Most of this research involved men who have sex with men, and the surveys relied on people reporting their own habits.

How can you douche more safely?

If you choose to douche, Brook and LGBT Foundation advise using only water at body temperature, allowing at least an hour before sex, not doing it often and never sharing the equipment. Their advice in more detail:

• Use only water at body temperature. Never use soap or any cleaning products, which irritate the lining of the rectum (LGBT Foundation), and avoid douches with chemicals in them (Brook).
• Douche at least an hour before sex, because it can take some time to get all the water out and you may need the toilet a few times (LGBT Foundation).
• Don't do it often: Brook suggests no more than 2 or 3 times a week.
• Be gentle. Brook suggests relaxing first and putting lube on the tip of a bulb douche before inserting it.
• Clean the douche thoroughly before and after use, and never share it. Shared douches can pass on STIs and infections such as shigella (Brook), and the Terrence Higgins Trust says enema equipment should not be shared because it can carry LGV from one person to another.

What should you do after anal sex?

Afterwards, wash your hands, especially after touching someone's anus or handling used condoms and sex toys (Terrence Higgins Trust). If you're moving on to vaginal sex, Brook says to wash your hands if you've touched the anus and use a new condom, to stop bacteria passing from the anus to the vagina, where they could cause a urinary infection. The Terrence Higgins Trust also lists oral sex after anal sex as a way shigella can pass on.

Brook says you may notice some bleeding or discomfort after anal sex, though not everyone does and not every time. If the bleeding doesn't stop, is a very dark colour, you are in a lot of pain or discomfort, or you are worried, Brook says to seek medical advice.

For a sore or itchy bottom, the NHS suggests washing with water only or unscented soap and patting dry rather than wiping or rubbing. Our guide on how to use a bidet, wipe and wash covers everyday bottom hygiene, and if you like to trim, see how to shave or trim your bum. If rimming is part of things, our guide to rimming covers the infection risks.

What about vaginal douching?

Vaginal douching is a different matter. To ease bacterial vaginosis and stop it coming back, the NHS advises not using vaginal deodorants, washes or douches, and LGBT Foundation says that if you were born with a vagina, douching can be unhealthy. If you have both anal and vaginal sex, use a new condom whenever you move between the two (Terrence Higgins Trust). More on lube types is in our guide to lube for anal sex.

When should you get help?

See a GP if anal pain is severe or doesn't improve after a few days, or if you have blood in your poo or bleeding from your bottom. Ask for an urgent GP appointment or get help from NHS 111 if you have severe anal pain with a high temperature, or you feel hot, cold or shivery. Go to A&E or call 999 if you're bleeding non-stop from your bottom or there's a lot of blood, for example the toilet water turns red or you see large blood clots (NHS).

Diarrhoea, tummy pain, bloating or a fever after sex can be a sign of a sexually transmitted gut infection, such as hepatitis A or shigella. BASHH, the British Association for Sexual Health and HIV, says to go to your local sexual health service if you have symptoms like these. Find a sexual health clinic, and read our anal sex safety guide for what to do about bleeding after sex.