Understanding Anal Health

Anal sex is a very common practice among gay, bisexual, and queer men. Knowing the risks and how to enjoy safer anal sex is vital to a healthy sex life.

The fact is, a lot goes on down there. Many conditions can impact your anal health aside from HIV, gonorrhea, chlamydia, and syphilis. Clinics like Red Door in Minneapolis and Clinic 555 in St. Paul are helpful and gay-friendly. Waiting to see if symptoms disappear may only prolong an unpleasant condition or give you a false sense of confidence that you don’t have a sexually transmitted infection (STI) when, in fact, you do.

Good prevention doesn’t just mean avoiding health problems — it also means dealing with those problems quickly. If your rear end is troubling you, swallow that shyness and make an appointment to see a doctor. Your anus will thank you.

Aside from HIV and STIs, what can disturb an otherwise happy and healthy butt?  Here is a quick roll call of health conditions that can occur.

Anal Itch

Known formerly as anal pruritus, it means the skin around your anus itches. The degree can range from an occasional itch to severe itching that causes you to scratch your skin until it bleeds.

Causes: According to gayhealth.com, anal itching can be caused by any number of things including diet, laundry detergent, soaps, perfume, parasites, or fungi. Certain kinds of latex and lube allergies can cause anal itching, as well.

Treatment: Most often, a change in your daily life—like the kinds of food you eat or the types of household cleaners you use—will help to alleviate symptoms. Anal itch will typically go away with lifestyle changes, but talk with your doctor if it persists.


A fistula-in-ano is a small, abnormal tube that connects the inside of your rectum with the outside skin. This condition is not common but can result from physical trauma, infection, genetics, or certain illnesses, and if infected can cause drainage of pus and blood. The drainage is often minimal, appearing only as a stain in your underwear. Most often this condition is first discovered by noticing a pimple-like bump near your rectum, though the infection may be accompanied by pain and swelling. Bursting the pimple may relieve the condition until it starts over again.

Causes: The fistula is caused by an infection in the glands of your anus, often when a piece of stool gets caught in the glands. If the infection doesn’t go away on its own, it can burrow through the tissues around your anus until it bursts through the outer skin. If the infection is very severe, or if it doesn’t burst through the skin, you can end up with a perirectal abscess, a severe condition requiring medical treatment.

Treatment: In the short term, you can treat the condition by soaking in a warm bath to facilitate drainage. In the long run, surgery is needed to clear out the infection and allow the tissue to heal. Even though surgery may create a sizable wound, it usually heals without scarring.

Genital Warts (HPV)

According Gayhealth.com, over one half of all men who have sex with men have human papillomavirus (or HPV), the virus that causes genital warts. This number is even higher in HIV-positive men: ninety percent of men with HIV also have HPV. In fact, HPV is one of the most commonly transmitted STIs.

Causes: HPV is spread through direct contact with the skin of someone who is infected, which means HPV can be transmitted even if you don’t have penetrative sex. Since the virus can live in the skin on your scrotum, anus, and penis, a condom can’t always protect you from HPV.

Diagnosis and Treatment: Your healthcare provider will be able to tell whether or not you’ve been infected through examination. Treatment for genital warts can range from topical creams to surgery, however, there is no way to kill the HPV virus that causes warts. If you’re carrying it and are prone to outbreaks, treatment is a necessary but temporary solution – you’ll most likely see them again. Untreated warts can grow bigger and bigger until they bleed and cause significant pain, and can even cause anal cancer if left untreated.

No matter how bad it is, or how many times it comes back, remember that you’re not alone. HPV is very common and very treatable as long as you stay in touch with your healthcare provider and follow their treatment advice.


Hemorrhoids are a collection of abnormally dilated veins in the rectum.

Causes: Hemorrhoids aren’t just a “gay” thing – over half of all Americans have them. They’re caused by low-fiber, high-fat diets that produce harder stools, which puts more pressure on your lower rectum. While anal sex doesn’t cause hemorrhoids, hemorrhoids can definitely make for more painful anal sex, so make sure to seek treatment.

Treatment: Over-the-counter treatments combined with appropriate fiber in your diet. Warm baths are useful for loosening up stools, as well.

Molluscum Contagiosum

Molluscum contagiosum is a contagious skin infection caused by a virus.

Causes: When the molluscum virus lands on your skin during sex or even through close non-sexual contact, it begins to reproduce. Within one to three months, a pin-sized pimple with a crater-like center will appear. You can usually see a white, cheesy-looking center under the crater.

The anus is one of the most common points of infection, but these pimples can also be found frequently on the inner thighs, groin, genitals, and lower abdomen. People living with HIV may also be at risk for the infection to spread to greater parts of the body. Sometimes the infection goes away on its own, but while it persists, it can spread to other parts of the body and to other people.

Treatment and Prevention: There is no known medication to treat molluscum. The most common treatments include burning, freezing, or scraping the lesions. The best way to prevent molluscum is to thoroughly examine your partner before having sex.

Perirectal Abscess

A perirectal abscess is a bacterial infection that most often begins in the small glands inside your anus. As the infection grows and spreads to areas around your rectum, the pain gets worse. A cavity filled with pus develops and the skin over it becomes red and swollen. The infection can become so severe that you develop a high fever and other signs of infection.

Causes: Most often this condition is caused by bacteria from a stool getting trapped inside your anal glands, and in rare instances, it can be caused by injuries during sex.

Treatment: If caught early, it can be treated with antibiotics and a warm bath soak. If it grows too large, surgery may be required to remove all of the pus.

Prostate Cancer

Prostate cancer affects one in five men over the age of fifty.

The prostate is the little gland that controls the excretion of urine and semen, as well as being known as the ‘g-spot.’

Diagnosis: There are two ways your doctor can diagnose prostate cancer. The first is a rectal exam where your doctor will feel your prostate for any small, hard nodules or lumps, which are often malignant, therefore cancerous. The second way of diagnosing prostate cancer is with a blood test that measures your level of prostate-specific antigens (PSA), a protein released by cancer cells. Cancer cells produce more PSA than you’d normally find in your blood.

Treatment: Treatment for prostate cancer can involve radiation, surgery, or sometimes, no treatment at all due to the slow rate at which it can develop. The best way to stay ahead of it, especially if you are over fifty, is to see your doctor and get a physical regularly.


Prostatitis is a bacterial infection of your prostate gland. The infection can be either chronic or acute. Chronic prostatitis causes dull pressure or pain in your rectum or pelvis, and can also cause a burning sensation when you urinate or ejaculate. Acute prostatitis is much less subtle: what begins as dull pressure quickly turns into severe pain with chills, high fever, and an enlarged prostate that can prevent you from being able to urinate.

Cause: Prostatitis develops when bacteria enters your urethra (the opening to the penis) and passes through to your prostate. Particular risk occurs when two partners share toys that have been inserted into the urethra. Prostatitis can also develop if you ignore a urinary tract infection, also known as urethritis.

Detection and Prevention: Early detection means you can most likely be treated with a one-month regimen of antibiotics. More advanced prostatitis may require hospitalization and intravenous treatment.