Image of peach and lightning bolts to depict Anodyspareunia - painful anal sex

Painful anal | Don't suffer in silence

Anal play and penetration is becoming increasingly enjoyed by all genders and across all relationship styles. Yet many people engaging in anal sex experience pain on penetration. When this pain causes distress over a period of time, it’s known as Anodyspareunia, the most unacknowledged of all the sexual issues.

A quick Google search on ‘vaginal pain’ will bring about a wealth of diagnoses, resources and treatments offering information on Vaginismus, Vulvodynia and Dyspareunia. A similar search for ‘anal pain’ generates no information on the causes and treatments for Anodyspareunia.

In fact, a formal research study carried out in April 2023, found that pretty much all research into Anodyspareunia focused on cisgender gay men, with limited research targeted at other genders or sexualities, including heterosexual men and lesbian and bisexual women. No research was found on intersex, transgender, and gender nonconforming people. And no research was found that discussed or evaluated treatment. 

Sex education classes rarely mention anal sex, despite its increasing prevalence, and even the NHS doesn’t recognise Anodyspareunia as a condition. But why?

The historical heteronormativity of medicine has tended to focus more on managing conditions that prevent reproduction, rather than pleasure. Pleasure has simply been left off the agenda.

Moreover, there still remains so much stigma regarding anal sex, reinforced by heteronormative societal values and homophobia, despite the increasing, if unspoken, enjoyment of anal play in heterosexual relationships.

So it’s no surprise really that little research funding goes into this treatable yet very distressing condition. And because of stigma, people experiencing Anodyspareunia are far less likely to reach for help, and feelings of anxiety, shame and pain may only make the problem worse.

Lack of information can lead to more unsafe practices of anal sex, and possible causes of pain. And with little awareness that Anodyspareunia is a common and treatable condition, people may presume the problem lies within them, and either endure the pain leading to more entrenched physical and psychological problems, or avoid anal sex and intimacy altogether.

The causes of Anodyspareunia are a complex and multifaceted mix of physical and/or psychosocial factors.

When experiencing anal pain on penetration, we’d advise you to visit your GP to rule out any physical causes, including anal fissures, haemorrhoids, and abscesses. A cream or medication might be all that is needed to fix the problem!

The importance of adequate lubrication and foreplay cannot be underestimated.

Unsafe anal sex continues to be practiced by many due to lack of information. Some people assume the anus naturally lubricates the way the vagina does… it doesn’t!

The use of lots of water-based lubricant is essential for safe anal sex, as is lots of foreplay and a gradual build-up of stimulation and arousal before anal penetration.

The depth and rate of thrusting, the size of the penis, dildo or butt plug, and relaxation/arousal levels, are also key factors in determining whether anal penetration is painful or pleasurable. For these reasons, it’s vital that the receptive partner is in control of being penetrated.

Psychological factors my include fear of pain, possibly stemming from a painful early sexual experience (which is not uncommon given the lack of knowledge around anal sex); a history of sexual trauma; internalised homophobia; fear of illnesses like HIV (despite significant advancements in HIV medications); anxiety around defecation, and body image issues.

Problems may also stem from wider relationship issues. Pain-free anal sex is about communication before, during and after play (unlike what we see in porn); setting boundaries; trust, and allowing the receptive partner to feel in control.

I’m pleased to say that Anodyspareunia is very much treatable.

It may be as simple as using a high-quality lubricant, or engaging in breathing exercises to help you relax. It may be a visit to your GP who to check if the cause is physical and, therefore, treatable. Or you may benefit from Psychosexual Therapy to work through potential trauma, anxiety, shame or relationship and intimacy issues.

Too many people endure painful anal penetration because they believe it’s normal when it isn’t. And while some discomfort may be experienced, when pain is persistent and causes distress, you must look for help and support.

Anodyspareunia is a very real condition, and very much treatable.

We all deserve pleasure, and a fulfilling and enjoyable sex life – including anal play if that floats your boat!

* Tiga-Rose Nercessian, Samantha Banbury & Chris Chandler (2023), A Systematic Review Looking at Anodyspareunia Among Cisgender Men and Women, Journal of Sex & Marital Therapy

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