Understanding Anal Health

a man with hand on his butt

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 the 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 an 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, before they get worse. 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 inside the warm and cozy walls of your rump:

Anal Itch
Known formerly as anal pruritus, it means the skin around your anus itches. The degree can vary from an occasional itch to severe itching where you scratch your skin until it bleeds. Ow! Think about that the next time you see Homer Simpson scratching his tush.

Causes: According to Gayhealth.com, anal itching can be caused by any number of things: 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. Typically, it will go away with subtle lifestyle changes, but if it persists, schedule a time to talk to your doctor.

A fistula-in-ano is a small, abnormal tube that connects the inside of your rectum with the outside skin, which is not common but can result from physical trauma, infection, genetics, or certain illnesses. It is often infected, causing pus and blood to drain out. The drainage is often minimal and you may only notice a stain in your underwear. Most often you’ll notice a pimple, although sometimes the infection can be accompanied by some pain and swelling. Bursting the pimple can 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. For those of you who are prone to vanity, relax. 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 guys with HIV also have HPV. In fact, HPV is one of the most commonly transmitted sexually transmitted infections (STIs).

Causes: HPV is spread through direct contact with the skin of someone who is infected. This means that HPV can be transmitted even if you don’t have insertive 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 by looking deep into your hole. Treatment for anal warts can range from topical creams to surgery. 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 hurt like crazy. They can even cause anal cancer if left untreated.

No matter how bad it is, or how many times it comes back, remember you’re not alone. HPV is very common and very treatable as long as you stay in touch with your healthcare provider and follow his or her 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 be sure to get treatment.

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

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 crater center will appear; you can usually see a white cheesy 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 all over 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 warm bath soaks; but, 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, for those of you not familiar with anatomy, is that little gland that controls the excretion of urine and semen. You may have also heard of it by its other name: 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, which means they’re 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.

When your doctor puts on that examination glove and tells you to spread ‘em, it is not foreplay; it is for your own good!

Treatment: Treatment for prostate cancer can involve radiation, surgery, or nothing at all, because prostate cancer can develop very slowly. The best way to stay ahead of it, especially if you are over fifty, is to see your doctor and get a physical regularly.

Just when you thought you’d heard enough about the prostate....

In all seriousness, this condition really is a pain in the ass.

Prostatitis is a bacterial infection of your prostate gland. The infection can be either chronic or acute. Chronic prostatitis causes a dull pressure or pain in your rectum or pelvis. It can also cause a burning sensation when you urinate or cum. 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 pee.

Cause: Prostatitis develops when bacteria enter your urethra, the opening to the penis, and pass through to your prostate. A 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, which is 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.

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