In remission from Crohn’s — anal sex okay?

Dear Alice,

I have had Crohn's disease for 16 years and am in remission right now. Recently my boyfriend and I have been toying with the idea of anal sex, but I'm concerned about it given my health issues. I have a lot of thickening of the terminal ileum walls and worry that the "trauma" of anal sex could set off a flare up and be painful because of the narrowing. Any thoughts? I'm way too embarrassed to discuss this with my male doctor. Thanks!

-To anal or not to anal

Dear To anal or not to anal,

It’s great that you are exploring additional ways to enjoy sex while simultaneously being conscientious about your health. Many people with Crohn’s in remission worry about the possible causes of “flare ups,” which are still not fully understood. The good news is that it is unlikely that anal sex could cause a flare up because most (not all) areas affected by Crohn’s are higher up in the colon or small intestine and not located right at the anus. Certainly there are cases where fissures, inflammation, irritation, or fistulas (sores in the lining of the colon that may extend to the vagina, skin, or other areas of the colon) can appear near the anus, but this is relatively rare.

You mention wall-thickening and possible narrowing of your ileum. The ileum is much higher up in your bowel, in the small intestine. So while this may affect digestion, stomach cramps, or nausea, it should not be aggravated by anal sex. However, as with any sex, anal sex should not be painful. And since Crohn’s can affect any area of the colon, you are wise to proceed with caution. Use lots of lubrication, go slowly, and if you feel any pain, stop immediately.

You also mention feeling embarrassed talking with your male doctor about anal sex. What do you suppose is causing this embarrassment? Have you had negative experiences with previous health care providers who judged your sexual practices? Or with this provider? While there is no way to predict how any health care provider will respond when you disclose aspects of your sex life, know that anal sex is common and most health care providers (especially gastroenterologists who often treat Crohn’s) have encountered patients who have anal sex. You mention your doctor’s gender as one factor perhaps related to the embarrassment. If you decide that you want to consult a healthcare provider, particularly if you experience pain during or after anal sex, is there any other health care provider you see who is female and you could consult? General practitioners, nurse practitioners, and gynecologists are all providers who would be knowledgeable and could answer questions you may have.

Remember that anal sex experimentation can take many forms ­– using fingers, anal beads, butt plugs, and vibrators designed specifically for anal use may be more pleasurable than penile insertion or may be good ways to work up to penile insertion if that is too painful right away. Lots of lube and condoms are great to use for safer sex with all of these methods.

Good luck and have fun!

Originally published Jul 06, 2015

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